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:
12498
Service:
DTV
Call Sign:
WGBO-DT
Channel:
35 (UHF)
File Number:
0000028217
FRN:
0001531391
Date Submitted:
05/18/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WGBO LICENSE PARTNERSHIP, G.P.

Doing Business As: WGBO LICENSE PARTNERSHIP, G.P.

Christopher G. Wood

5999 CENTER DRIVE

LOS ANGELES, CA 90045

United States

+1 (310) 348-3600 CWOOD@UNIVISION.NET General Partnership

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

Theodore Stoner

VP Distribution Technology Strategy

Univision Management Company

Theodore Stoner

9405 NW 41st Street

Miami, FL 33178

United States

+1 (513) 608-0308 tstoner@univision.net

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan Place new antenna in open aperture on tower, install new transmission line, replace 2 mask filters, install patch panels to facilitate transmitter cutover to new channel. See attached Implementation Plan for details.

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 Retune Existing
Use Primary (Main)
Ownership Owned
Owner 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 Rohde & Schwarz
Model NV8630
Year 2010
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 24 kW

Primary Transmitter

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Retuning Transmitter Costs

Section Question Response
New IOT Tubes Number of Tubes (including accessories) needed N/A
New Mask Filter
Power 30 kW
Other Power N/A
New Exciter Is a new exciter needed? No

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 No
Size N/A
Length N/A
Other Electrical Service Yes
Description Relocation & install of rigid transmission line and spinner switch connections & testing in transmitter room.
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.

Auxiliary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Retune Existing
Use Auxiliary (Backup)
Ownership Owned
Owner 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 Rohde & Schwarz
Model THU9-12
Year 2013
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 12.5 kW

Auxiliary Transmitter

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Retuning Transmitter Costs

Section Question Response
New IOT Tubes Number of Tubes (including accessories) needed N/A
New Mask Filter
Power 30 kW
Other Power N/A
New Exciter Is a new exciter needed? No

Auxiliary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring Yes
Size 3 inches
Length 100.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 10 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Interior RF Components for the Transmitter

Interior RF Components for the Transmitter

Internal Transmission Line

4 1/16" internal line and installation

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 Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 600.0 kW
Manufacturer
Model ATW25HS4-ESC2-38H
Year 2010

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? 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 Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 550.0 kW
Manufacturer
Model SAA25-ATW_C1-J300-ES6R-35
Year 2019
Justification for New Antenna Existing antenna is single-channel model incapable of use on new 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 6 1/8 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.

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 Corporation
Is antenna shared? Yes
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Slot
Number of Stations Supported 3
Number of Panels/Bays 24
Lower Limit 470.00 MHz
Upper Limit 698.00 MHz
Design power capacity in use 100.0 %
Other Antenna Type N/A
ERP: 330.0 kW
Manufacturer
Model TFU-24WB
Year 2019
Justification for New Antenna For continuity of broadcast while changing main antenna on a shared complex tower.

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 3
Frequencies of channels supported RF channel
Frequency N/A
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 6 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? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Enter a list of RF channel numbers.

RF Channel Number
24
35

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 6 1/8 inches
Other Diameter N/A
Segment Length Other
Other Segment Length 10 feet
Number of parallel runs 1
Length 400 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 Other
Other Segment Length 10 feet
Number of parallel runs 1
Length 400 feet per run
Justification for New Transmission Line Maintain continuity of operation through cutover period and avoid need for tower riggers during the cutover night.

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 Lease New
Type Rigid
Diameter 6 1/8 inches
Segment Length Broadband
Other Segment Length
Number of parallel runs 1
Length 450 feet per run
Justification for New Transmission Line To maintain broadcast continuity during transition on a complex shared 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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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? Located on Building
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users Yes
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1009013
Coordinates (NAD83) Latitude (NAD83) 41° 53' 56.1" N-
Longitude (NAD83) 087° 37' 23.2" W-
Overall Structure Height 1395.00 feet
Support Structure Height 1395.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 592.84 feet
Structure Type BTWR - Building with Tower
Tower Owner American Towers, LLC.
Date Constructed 01/01/1968

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
73226 WLS-TV DTV
67073 WOJO FM
19525 WKQX FM
72115 WGN-TV DTV
66649 WBEZ FM
28620 WUSN FM
6377 WTMX FM
35092 WOCK-CD DTV
70042 WLIT-FM FM
6588 WVAZ FM
73233 WCKL-FM FM
16853 WXRT FM
47905 WMAQ-TV DTV
49552 WDRV FM
12279 WYCC DTV
53971 WEBG FM
10059 WSHE-FM FM
60539 WXFT-DT DTV

Other Types of Users

Users
WRME-LP
WCHU-LD
W2268AY
W216CL
W280EM

Primary Tower

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Tower Modification Costs

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

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Ground and Building Permit Drawing Package

For construction and maintenance needs

Construction project management

Tower Modification reinforcements and facilities

Tower Permit Drawing Package

For permitting needs

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 414
Explanation Univision stations are only staffed for daily station operations and minor equipment changes, major projects are contracted out externally. The large volume of work associated with repack schedule requires using external project management 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 Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority 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 Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority No
Quantity N/A
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 No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Transmission Line Design

Design assistance with transmission line in complex shared tower

RF System Test

RF testing of new broadband combiner

Site Coordination Meeting

Multiple construction meetings for all stake holders in complex shared tower site

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning No
Non-zoning permits Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application Yes
FCC Special Temporary Authority Application No
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
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? No

Other Expenses

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Other Expenses Not Listed

Name Description

Evaluation of temporary antenna

Evaluation of temporary antenna use under STA

Local Non-zoning BP

Building Permit Fee (Chicago)

Security for lift

JHC engineering/security personnel for smoke shaft equipment lift

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 $560,998.59 $370,143.59 N/A $323,257.13 N/A
Total for all systems $1,953,356.36 $1,360,334.79 N/A $1,052,206.76 N/A
Primary Transmitter NV8630 $150,280.00 $140,815.00 $121,413.07
Other Electrical Service: Relocation & install of rigid transmission line and spinner switch connections & testing in transmitter room. $12,480.00 $12,480.00 Please see WGBO-DT Krueger Broadcast Services Inc. estimate 1040 $12,480.00 N/A
30 kW mask filter $32,600.00 $33,785.00 Estimated Cost Justification WGBO-DT-110-1st Primary Transmitter - Retune Existing Transmitter, 30 kW Mask Filter V0 $33,785.00 N/A
UHF and VHF - minor banding issues $105,200.00 $94,550.00 Please see WGBO-DT Myat quote 90004833 $75,148.07 N/A
Auxiliary Transmitter THU9-12 $410,718.59 $229,328.59 $201,844.06
Interior RF Components for the Transmitter $1,920.00 $1,920.00 Please see WGBO-DT Alive Telecom proposal dated 10-3-2019 $1,920.00 N/A
3" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $4,410.00 N/A $3,307.50 N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $10,500.00 N/A $7,875.00 N/A
Switchgear - industrial 800 amp $38,200.00 $10,890.00 N/A $8,167.50 N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $4,110.00 N/A $3,082.50 N/A
30 kW mask filter $32,600.00 $23,900.00 N/A $17,847.69 N/A
UHF and VHF - minor banding issues $105,200.00 $25,000.00 N/A $20,139.06 N/A
Internal Transmission Line $137,498.59 $137,498.59 see Estimated Cost Justification WGBO-DT-150-1st Auxiliary Transmitter - Internal Transmission Line v0 $131,179.81 N/A
10 Ton system $38,900.00 $11,100.00 N/A $8,325.00 N/A

Components

Actual Information Description File Name
Other Electrical Service: Relocation & install of rigid transmission line and spinner switch connections & testing in transmitter room.

Component Description:
Additional transmitter room work
Amount:
$12,480.00
30 kW mask filter

Component Description:
K. Lahm - Main mask filter installation planning
Amount:
$875.00

Component Description:
REDUCER 6-50 X 3-50 W/CONN "QS
Amount:
$32,910.00
UHF and VHF - minor banding issues

Component Description:
Invoice moved to correct budget category per NMI message
Amount:
N/A

Component Description:
30kW FILTER SY 4 1-16in PORTS
Amount:
$75,148.07
Interior RF Components for the Transmitter

Component Description:
Tuner Attachment
Amount:
$1,920.00
3" Rigid Conduit and Wiring (Cost per foot)

Component Description:
WGBO-DT-150-1st Auxiliary Transmitter - Rigid Conduit and Wiring (3)
Amount:
$2,205.00

Component Description:
WGBO-DT-150-1st Auxiliary Transmitter - Rigid Conduit and Wiring (3)
Amount:
$1,102.50
Transformer 3 phase/480v - 300 KVA

Component Description:
WGBO-DT-150-1st Auxiliary Transmitter - Transformer (480V) (300KVA)
Amount:
$5,250.00

Component Description:
WGBO-DT-150-1st Auxiliary Transmitter - Transformer (480V) (300KVA)
Amount:
$2,625.00
Switchgear - industrial 800 amp

Component Description:
WGBO-DT-150-1st Auxiliary Transmitter - Switchgear (industrial 800 amp)
Amount:
$5,445.00

Component Description:
WGBO-DT-150-1st Auxiliary Transmitter - Switchgear (industrial 800 amp
Amount:
$2,722.50
Service entrance 3 phase/800 amp/208 volt

Component Description:
CAPITAL CONTRIBUTION
Amount:
$2,055.00

Component Description:
CAPITAL CONTRIBUTION
Amount:
$1,027.50
30 kW mask filter

Component Description:
25KW AIR COOLED LOAD
Amount:
$17,847.69
UHF and VHF - minor banding issues

Component Description:
Connection kit liquid cooling
Amount:
$3,639.06

Component Description:
Engineering Services
Amount:
$16,500.00
Internal Transmission Line

Component Description:
Install customer provided 4-1/8" rigid coax from WGBO 93rd floor transmitter room to 97th floor UHF combiner spline input module.
Amount:
$42,000.00

Component Description:
Invoice for 25% draw on project at half way completion point.
Amount:
$21,000.00

Component Description:
FINE MATCHER
Amount:
$1,500.53

Component Description:
Final payment 25% of project cost
Amount:
$21,000.00

Component Description:
MACXLINE 4 1/16" 50 OHM CUSTOM SECTION
Amount:
$697.09

Component Description:
4-1/16" to 3-1/8" FLANGED STEP REDUCER
Amount:
$1,651.82

Component Description:
ELBOW 4-1/16" 50 OHM EQUAL 90 DEGR FLNG
Amount:
$8,948.31

Component Description:
ELBOW 4-1/16" 50 OHM EQUAL 90 DEGR FLNG
Amount:
$10,882.82

Component Description:
4-1/16" VARIABLE FLANGED BOTH ENDS
Amount:
$23,499.24
10 Ton system

Component Description:
WGBO-DT-150-1st Auxiliary Transmitter - HVAC Services
Amount:
$5,550.00

Component Description:
WGBO-DT-150-1st Auxiliary Transmitter - HVAC Services
Amount:
$2,775.00

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $428,401.77 $358,813.34 N/A $297,417.93 N/A
Total for all systems $1,953,356.36 $1,360,334.79 N/A $1,052,206.76 N/A
Interim Antenna TFU-24WB $179,680.00 $110,714.57 $85,065.18
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $6,600.00 N/A $4,950.00 N/A
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,700.00 $3,900.00 N/A $2,925.00 N/A
New combiner, cost per channel (without antenna) $84,200.00 $39,000.00 N/A $30,200.62 N/A
Sweep test of existing antenna $6,730.00 $9,314.57 see Estimated Cost Justification WGBO-DT-280-Interim Antenna - Sweep Test v0 $8,064.56 N/A
UHF - High Power, Side Mount, basic slot antenna, 24 bay,, 330 kW input, directional,, horizontally polarized $51,900.00 $51,900.00 WGBO's share of 3 multi-channel antenna $38,925.00 N/A
Primary Antenna SAA25-ATW_C1-J300-ES6R-35 $248,721.77 $248,098.77 $212,352.75
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 Per RFS quote 20077929 $3,000.00 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $24,117.00 RFS quote plus 10.25% sales/use tax $21,373.48 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $11,700.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,000.00 Per RFS quote 20077929 $5,400.00 N/A
UHF - High Power, Side Mount, basic slot antenna, 550 kW input, directional,, elliptically or circularly polarized $201,281.77 $201,281.77 see Estimated Cost Justification WGBO-DT-210-Primary Antenna - UHF High Power Side Mount, Directional, E-POL v0 $182,579.27 N/A

Components

Actual Information Description File Name
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
WGBO-DT-280-Interim Antenna - Side Mount Brackets, High Power
Amount:
$3,300.00

Component Description:
WGBO-DT-280-Interim Antenna - Side Mount Brackets, High Power
Amount:
$1,650.00
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
WGBO-DT-280-Interim Antenna - Elbow Complex
Amount:
$1,950.00

Component Description:
WGBO-DT-280-Interim Antenna - Elbow Complex
Amount:
$975.00
New combiner, cost per channel (without antenna)

Component Description:
IL Sales Tax - Invoice 626028
Amount:
$73.19

Component Description:
Other Flange Field
Amount:
$877.43

Component Description:
WGBO-DT-290-Interim Antenna - Combiner Systems
Amount:
$9,750.00

Component Description:
WGBO-DT-290-Interim Antenna - Combiner Systems
Amount:
$19,500.00
Sweep test of existing antenna

Component Description:
WGBO-DT-280-Interim Antenna - Sweep Test
Amount:
$2,500.00

Component Description:
WGBO transmitter
Amount:
$4,314.56

Component Description:
WGBO-DT-280-Interim Antenna - Sweep Test
Amount:
$1,250.00
UHF - High Power, Side Mount, basic slot antenna, 24 bay,, 330 kW input, directional,, horizontally polarized

Component Description:
WGBO-DT-280-Interim Antenna - UHF - High Power, Side Mount, broadband, 24 bay
Amount:
$12,975.00

Component Description:
WGBO-DT-280-Interim Antenna - UHF - High Power, Side Mount, broadband, 24 bay
Amount:
$25,950.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)

Component Description:
WGBO-DT-210-Primary Antenna - Pattern Scatter Analysis
Amount:
$1,500.00

Component Description:
WGBO-DT-210-Primary Antenna - Pattern Scatter Analysis
Amount:
$1,500.00
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
WGBO-DT-210-Primary Antenna - Side Mount Brackets, High Power
Amount:
$6,562.50

Component Description:
WGBO-DT-210-Primary Antenna - Side Mount Brackets, High Power
Amount:
$6,562.50

Component Description:
WGBO-DT-210-Primary Antenna - Side Mount Brackets, High Power
Amount:
$8,248.48
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) Information not provided.
Sweep test of existing antenna

Component Description:
WGBO-DT-210-Primary Antenna - Sweep Test
Amount:
$1,800.00

Component Description:
WGBO-DT-210-Primary Antenna - Sweep Test
Amount:
$1,800.00

Component Description:
WGBO-DT-210-Primary Antenna - Sweep Test
Amount:
$1,800.00
UHF - High Power, Side Mount, basic slot antenna, 550 kW input, directional,, elliptically or circularly polarized

Component Description:
SAA25-ATW_C1-J3--ES6R-35 bay, side mounted
Amount:
$57,503.71

Component Description:
SAA25-ATW_C1-J3--ES6R-35 bay, side mounted, elliptically polarized RFStar slotted array antenna
Amount:
$56,107.50

Component Description:
SAA25-ATW_C1-J3--ES6R-35 bay, side mounted, elliptically polarized RFStar slotted array antenna
Amount:
$68,968.06

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 $185,200.00 $124,945.00 N/A $25,243.99 N/A
Total for all systems $1,953,356.36 $1,360,334.79 N/A $1,052,206.76 N/A
Interim Transmission Line $104,400.00 $26,325.00 $23,368.99
Rigid Transmission Line - copper, 6 1/8" broadband $104,400.00 $26,325.00 N/A $23,368.99 N/A
Primary Transmission Line $80,800.00 $98,620.00 $1,875.00
Rigid Transmission Line - copper, 6 1/8" $80,800.00 $98,620.00 Components per attached ERI quote, plus 10.25% sales/use tax and estimated freight $1,875.00 N/A

Components

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

Component Description:
WGBO-DT-310-InterimTransmission Line - 6 1/8" Rigid Copper
Amount:
$6,581.25

Component Description:
WGBO-DT-310-InterimTransmission Line - 6 1/8" Rigid Copper
Amount:
$13,162.50

Component Description:
Temp transmission line
Amount:
$3,625.24
Rigid Transmission Line - copper, 6 1/8"

Component Description:
Invoice moved to correct budget category
Amount:
N/A

Component Description:
WGBO-DT-310-Primary Transmission Line - 6 1/8" Rigid Copper
Amount:
$1,875.00

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 $619,900.00 $272,880.00 N/A $236,102.00 N/A
Total for all systems $1,953,356.36 $1,360,334.79 N/A $1,052,206.76 N/A
Primary Tower BTWR $619,900.00 $272,880.00 $236,102.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $200,000.00 N/A $179,942.00 N/A
Tower Permit Drawing Package $4,700.00 $4,700.00 N/A $3,525.00 N/A
Minor tower reinforcement/modifications $158,000.00 $27,900.00 N/A $20,925.00 N/A
Construction project management $18,900.00 $18,900.00 N/A $14,175.00 N/A
Ground and Building Permit Drawing Package $4,700.00 $4,700.00 N/A $3,525.00 N/A
Structural engineering tower load study for well documented tower $12,600.00 $16,680.00 Justification per Customer Project Cost Estimation $14,010.00 N/A

Components

Actual Information Description File Name
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
Receive RF system equipment at Hancock loading dock and install as required in 93rd floor transmitter room to effect sequence of changeover from CH38 to CH35.
Amount:
$123,000.00

Component Description:
Additional costs based on new rigging
Amount:
$21,692.00

Component Description:
Receive shipment at Hancock
Amount:
$1,500.00

Component Description:
WGBO-DT-410-Existing Primary Tower - Complex Tower - Tower Rigging and Equipment
Amount:
$11,250.00

Component Description:
WGBO-DT-410-Existing Primary Tower - Complex Tower - Tower Rigging and Equipment
Amount:
$22,500.00
Tower Permit Drawing Package

Component Description:
WGBO-DT-410-Existing Primary Tower - Complex Tower - Tower Permit Drawing Package
Amount:
$1,175.00

Component Description:
WGBO-DT-410-Existing Primary Tower - Complex Tower - Tower Permit Drawing Package
Amount:
$2,350.00
Minor tower reinforcement/modifications

Component Description:
WGBO-DT-410-Existing Primary Tower - Complex Tower - Minor tower reinforcement/modifications
Amount:
$6,975.00

Component Description:
WGBO-DT-410-Existing Primary Tower - Complex Tower - Minor tower reinforcement/modifications
Amount:
$13,950.00
Construction project management

Component Description:
WGBO-DT-410-Existing Primary Tower - Complex Tower - Construction project management
Amount:
$9,450.00

Component Description:
WGBO-DT-410-Existing Primary Tower - Complex Tower - Construction project management
Amount:
$4,725.00
Ground and Building Permit Drawing Package

Component Description:
WGBO-DT-410-Existing Primary Tower - Complex Tower - Ground & Building A&E Permit Drawing Package
Amount:
$2,350.00

Component Description:
WGBO-DT-410-Existing Primary Tower - Complex Tower - Ground & Building A&E Permit Drawing Package
Amount:
$1,175.00
Structural engineering tower load study for well documented tower

Component Description:
WGBO-DT-410-Existing Primary Tower - Complex Tower - Structural engineering tower load study
Amount:
$8,340.00

Component Description:
WGBO-DT-410-Existing Primary Tower - Structural Engineering Load Study
Amount:
$1,500.00

Component Description:
WGBO-DT-410-Existing Primary Tower - Complex Tower - Structural engineering tower load study
Amount:
$4,170.00

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $113,327.00 $191,583.86 N/A $139,465.21 N/A
Total for all systems $1,953,356.36 $1,360,334.79 N/A $1,052,206.76 N/A
Outside Professional Services $113,327.00 $191,583.86 $139,465.21
Perform engineering study for new channel assignment and antenna development $7,360.00 $11,346.36 Please see Estimated Cost Justification WGBO-DT-590-Outside Professional Services - Perform Engineering Study v1 $10,970.36 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $1,000.00 N/A $195.75 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
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $562.50 Please see Prepare engineering section of FCC Form 2100 Aux Construction Permit Application Revision Justification Cover Letter $562.50 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $1,750.00 N/A
RF System Test $7,500.00 $7,500.00 N/A $5,625.00 N/A
Transmission Line Design $6,750.00 $6,750.00 Please see Estimated Cost Justification WGBO-DT-590-Outside Professional Service - Transmission Line Design v0 $5,875.00 N/A
Project management of the transition $65,412.00 $147,675.00 Univision stations are only staffed for daily station operations and minor equipment changes, major projects are contracted out externally. The large volume of work associated with repack schedule requires using external project management resources. $110,736.60 N/A
Site Coordination Meeting $5,000.00 $5,000.00 N/A $3,750.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $2,500.00 N/A N/A N/A

Components

Actual Information Description File Name
Perform engineering study for new channel assignment and antenna development

Component Description:
K. Lahm - Temporary RF subsystem planning - 5/14&16/2019
Amount:
$250.00

Component Description:
WGBO-DT-590-Outside Professional Service - Perform engineering study
Amount:
$1,250.00

Component Description:
K. Lahm - TPO update & temp/aux transmission line plan
Amount:
$187.50

Component Description:
K. Lahm - Residence to/from WGBO transmitter
Amount:
$4,845.36

Component Description:
Engineer Review
Amount:
$687.50

Component Description:
WGBO-DT-590-Outside Professional Service - Perform engineering study
Amount:
$1,125.00

Component Description:
WGBO-DT-590-Outside Professional Service - Perform engineering study
Amount:
$2,500.00

Component Description:
WGBO-DT-590-Outside Professional Service - Perform engineering study
Amount:
$125.00
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
Legal Services
Amount:
$195.75
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application

Component Description:
Permit App
Amount:
$562.50
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Preparation of the engineering portion of FCC Form 2100.
Amount:
$1,750.00

Component Description:
Invoice moved to correct budget category
Amount:
N/A
RF System Test

Component Description:
WGBO-DT-590-Outside Professional Service - RF System Test
Amount:
$3,750.00

Component Description:
WGBO-DT-590-Outside Professional Service - RF System Test
Amount:
$1,875.00
Transmission Line Design

Component Description:
Main transmission line planning
Amount:
$2,250.00

Component Description:
WGBO-DT-590-Outside Professional Service - Transmission Line Design
Amount:
$1,125.00

Component Description:
K. Lahm - Main transmission line planning
Amount:
$250.00

Component Description:
WGBO-DT-590-Outside Professional Service - Transmission Line Design
Amount:
$2,250.00
Project management of the transition

Component Description:
Project Management Services
Amount:
$241.50

Component Description:
Project management Services
Amount:
$463.45

Component Description:
Project Management Services
Amount:
$987.66

Component Description:
Project Management
Amount:
$8,137.95

Component Description:
Project Management Services
Amount:
$438.10

Component Description:
Project Management
Amount:
$4,167.90

Component Description:
Project management Services
Amount:
$201.25

Component Description:
Project Management Services
Amount:
$114.00

Component Description:
Project management Services
Amount:
$386.25

Component Description:
Project management Services
Amount:
$627.50

Component Description:
Project management Services
Amount:
$338.00

Component Description:
Project Management Services
Amount:
$105.00

Component Description:
Project Management
Amount:
$4,505.30

Component Description:
Project Management
Amount:
$2,970.00

Component Description:
American Tower project calls & consultations
Amount:
$150.00

Component Description:
Project Management
Amount:
$2,703.35

Component Description:
Project management Services
Amount:
$372.50

Component Description:
Project Management Services
Amount:
$905.06

Component Description:
Project management Services
Amount:
$405.00

Component Description:
Project Management
Amount:
$5,308.10

Component Description:
Project Management
Amount:
$8,478.70

Component Description:
Project Management Services
Amount:
$1,142.24

Component Description:
Review directional coupler
Amount:
$75.00

Component Description:
Project Management Services
Amount:
$130.50

Component Description:
Invoice revisions to meet FCC submittal requirements
Amount:
$52.50

Component Description:
Project Management Services
Amount:
$236.25

Component Description:
Project management Services
Amount:
$434.85

Component Description:
Project Management Services
Amount:
$217.50

Component Description:
Project Management Services
Amount:
$590.00

Component Description:
Project Management Services
Amount:
$521.25

Component Description:
Project management Services
Amount:
$375.00

Component Description:
Project management services
Amount:
$1,560.00

Component Description:
WGBO-DT-510-Project Management
Amount:
$2,370.00

Component Description:
Project Management Services
Amount:
$240.00

Component Description:
Project management Services
Amount:
$462.50

Component Description:
Project management services
Amount:
$75.00

Component Description:
Project management Services
Amount:
$675.00

Component Description:
Project Management
Amount:
$3,438.80

Component Description:
Project management Services
Amount:
$51.35

Component Description:
WGBO-DT-510-Project Management
Amount:
$4,740.00

Component Description:
Project Management
Amount:
$2,765.75

Component Description:
Project Management Services
Amount:
$415.50

Component Description:
Project Management Services
Amount:
$466.50

Component Description:
Project Management Services
Amount:
$384.00

Component Description:
Project management Services
Amount:
$493.75

Component Description:
Project management services
Amount:
$121.50

Component Description:
Project Management Services
Amount:
$694.50

Component Description:
Project management Services
Amount:
$372.50

Component Description:
Cost Reconciliation
Amount:
$2,853.95

Component Description:
Project Management
Amount:
$33.00

Component Description:
Project management Services
Amount:
$866.25

Component Description:
Project Management Services
Amount:
$310.50

Component Description:
Project management Services
Amount:
$413.75

Component Description:
Project Management
Amount:
$4,378.40

Component Description:
Project management services
Amount:
$423.00

Component Description:
Project Management Services
Amount:
$781.50

Component Description:
Project Management
Amount:
$4,704.55

Component Description:
Project Management
Amount:
$1,237.30

Component Description:
Project Management Services
Amount:
$206.25

Component Description:
Project Management Services
Amount:
$737.50

Component Description:
Project management Services
Amount:
$272.35

Component Description:
Project Management
Amount:
$1,829.40

Component Description:
Project Management
Amount:
$1,483.60

Component Description:
Project Management
Amount:
$2,356.85

Component Description:
Project Management
Amount:
$3,525.90

Component Description:
Project management Services
Amount:
$291.25

Component Description:
Project management services
Amount:
$49.50

Component Description:
Project Management Services
Amount:
$1,653.00

Component Description:
Project Management
Amount:
$2,004.45

Component Description:
Project management services
Amount:
$163.50

Component Description:
Project management services
Amount:
$127.50

Component Description:
Project Management
Amount:
$317.20

Component Description:
Project Management
Amount:
$8,038.05

Component Description:
Project management Services
Amount:
$801.25

Component Description:
Project management Services
Amount:
$234.65

Component Description:
Project management Services
Amount:
$463.75

Component Description:
Project Management
Amount:
$2,070.75

Component Description:
Project management Services
Amount:
$269.75

Component Description:
Project Management Services
Amount:
$687.70

Component Description:
Project Management
Amount:
$2,712.50

Component Description:
Project management Services
Amount:
$401.05

Component Description:
K. Lahm - Antenna specification check & project
Amount:
$187.50

Component Description:
Place of the Sun, LLC
Amount:
$238.55

Component Description:
Project Management Services
Amount:
$428.34

Component Description:
Project management Services
Amount:
$243.75

Component Description:
Project management Services
Amount:
$542.75
Site Coordination Meeting

Component Description:
WGBO-DT-590-Outside Professional Service - Site Coordination Meeting
Amount:
$2,500.00

Component Description:
WGBO-DT-590-Outside Professional Service - Site Coordination Meeting
Amount:
$1,250.00
Prepare and or review reimbursement form Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit 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 $45,529.00 $41,969.00 N/A $30,720.50 N/A
Total for all systems $1,953,356.36 $1,360,334.79 N/A $1,052,206.76 N/A
Other Expenses $45,529.00 $41,969.00 $30,720.50
Equipment Delivery and Handling Charges $18,000.00 $18,000.00 N/A $13,500.00 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $600.00 $600.00 N/A $450.00 N/A
Non-zoning permits $4,344.00 $4,344.00 Justifying Invoice & Quote - WGBO-DT AMERICAN TOWER 460214351 $3,258.00 N/A
Security for lift $7,500.00 $7,500.00 N/A $5,625.00 N/A
Local Non-zoning BP $750.00 $750.00 N/A $562.50 N/A
Evaluation of temporary antenna $950.00 $950.00 see Estimated Cost Justification WGBO-DT-610-Other Expenses-Antenna Evaluation v0 $950.00 N/A
Equipment Storage $1,500.00 $1,500.00 N/A $1,125.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $8,000.00 N/A $5,250.00 N/A

Components

Actual Information Description File Name
Equipment Delivery and Handling Charges

Component Description:
WGBO-DT-610-Other Expenses - Equipment Delivery and Handling Charges
Amount:
$9,000.00

Component Description:
WGBO-DT-610-Other Expenses - Equipment Delivery and Handling Charges
Amount:
$4,500.00
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
WGBO-DT-610-Other Expenses - Equipment Disposal Costs
Amount:
$150.00

Component Description:
WGBO-DT-610-Other Expenses - Equipment Disposal Costs
Amount:
$300.00
Non-zoning permits

Component Description:
WGBO-DT-610-Other Expenses - Non-zoning Permit Expenses
Amount:
$2,172.00

Component Description:
WGBO-DT-610-Other Expenses - Non-zoning Permit Expenses
Amount:
$1,086.00
Security for lift

Component Description:
WGBO-DT-610-Other Expenses - Security for lift
Amount:
$1,875.00

Component Description:
WGBO-DT-610-Other Expenses - Security for lift
Amount:
$3,750.00
Local Non-zoning BP

Component Description:
WGBO-DT-610-Other Expenses - Local Non-zoning BP
Amount:
$187.50

Component Description:
WGBO-DT-610-Other Expenses - Local Non-zoning BP
Amount:
$375.00
Evaluation of temporary antenna

Component Description:
WGBO-DT-610-Other Expenses - Antenna evaluation
Amount:
$375.00

Component Description:
discussion of ATC aperture plans & schedule evaluation of temporary antenna use under STA
Amount:
$575.00
Equipment Storage

Component Description:
WGBO-DT-610-Other Expenses - Equipment Storage Expenses
Amount:
$750.00

Component Description:
WGBO-DT-610-Other Expenses - Equipment Storage Expenses
Amount:
$375.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.
DTV Medical Facility Notification

Component Description:
Medical Notification
Amount:
$5,250.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,953,356.36 $1,360,334.79 $1,052,206.76

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. No
Construction of final facilities or all necessary modifications are complete. No
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator. No

Certification

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Section Question Response
Submission of Estimated Expenses Statements

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

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

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

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

  4. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).

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

  6. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.

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

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

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

JOSE E FRANCHI , FRANCHI .

VP FINANCE


05/18/2020

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.

JOSE E FRANCHI , FRANCHI .

VP FINANCE


05/18/2020

Attachments

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