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:
72145
Service:
DTV
Call Sign:
WHDH
Channel:
42 (UHF)
File Number:
0000027185
FRN:
0003613825
Date Submitted:
08/22/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WHDH-TV

Doing Business As: WHDH-TV

Paul Magnes

GOVERNMENT CENTER

7 BULFINCH PLACE

BOSTON, MA 02114

United States

+1 (617) 725-0710 pmagnes@whdh.com Trust

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

The Preparer is same as the reimbursement contact.

 

 

 

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 Install interim antenna/transmission line. Broadcast on interim antenna while tower structural work is completed. Install new (upgrade) Solid State Transmitter. Go on air with new Transmitter and main antenna during testing window.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model DCX Paragon
Year 2009
Type Inductive Output Tube
IOT Power Type Three
Power Capacity 75 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model HPTV-PRLX-U33
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 53 kW
Justification for New Transmitter Unlike with WHDH's existing Comark IOT Transmitter, the requested transmitter will permit WHDH to remain on air at full power during the transition

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 Electrician materials and labor to install transmitter Generator Rental for Electrical Installation
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 25 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

QoS ATSC RF Layer Monitoring Receiver

Web Based quality of service monitor

System Design, Site Survey

Transmitter installation site survey

Remote Control Upgrade

Upgrade the current Burk remote control system to allow control of the new Hitachi Comark Parallax transmitter

Antennas

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

Primary Antenna

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Add Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this antenna currently shared with any other stations? No
Is this antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Middle
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model TFU-24GBH-R 06
Year 1998

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? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Top
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: 1000.0 kW
Manufacturer
Model TFU-28JTH/VP-R 06
Year 2017
Justification for New Antenna Current Main antenna cannot be retuned to new frequency

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 8 3/16 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Feed Through Components

6-1/8" 75 OHM elbows, cut lengths, hangers, and transition to 8-3/16" 75 OHM to extend antenna input through support pole into tower top

Bottom Support Pole

Approximate 50' support pole and wedding cake adapter to support main antenna to maintain overall structure height

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? No
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: 1000.0 kW
Manufacturer
Model TFU-16WB
Year 2017
Justification for New Antenna Interim Antenna allows station to broadcast during replacement of Main antenna and during major tower structural modifications

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? 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

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 8 3/16 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1045 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 8 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1085 feet per run
Justification for New Transmission Line Current Transmission line will not work on new Frequency

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 8 3/16 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1045 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 8 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1085 feet per run
Justification for New Transmission Line Current Transmission Line will not work on new frequency

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Transmission Line Ice Shield

Ice Shield to protect transmission from falling ice as line enters building

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 8 3/16 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1045 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 8 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1085 feet per run
Justification for New Transmission Line Current Transmission Line will not work on new Frequency

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Grounding Transmission Lines

Grounding of the 6" and 8" Transmission Lines where they enter the building

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Rigid
Diameter 6 1/8 inches
Segment Length 20'
Other Segment Length
Number of parallel runs 1
Length 910 feet per run
Justification for New Transmission Line To feed Interim Antenna required for transition

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Nitrogen Generator

N2-Gen TL-1050 for Interim and Main Transmission Lines

3' Waveguide

Custom Waveguide to connect Waveguide switch

Motorized Waveguide Switch

Waveguide Switch allows transmitter output to switch between interim and main antenna

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? Terrain Constrained
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1005862
Coordinates (NAD83) Latitude (NAD83) 42° 18' 41.0" N-
Longitude (NAD83) 071° 12' 58.0" W-
Overall Structure Height 1062.30 feet
Support Structure Height 1009.50 feet
Ground Elevation Above Mean Sea Level (AMSL) 108.60 feet
Structure Type other -
Tower Owner WHDH TV
Date Constructed 04/20/1962


Primary Tower

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Tower Modification Costs

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

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 760
Explanation Internal project management. 760 hours anticipated
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 3
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 3
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers No
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

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 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? No
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,985,220.00 $1,906,820.00 N/A $1,907,015.41 N/A
Total for all systems $5,804,590.25 $4,175,932.75 N/A $3,641,604.47 N/A
Primary Transmitter HPTV-PRLX-U33 $1,985,220.00 $1,906,820.00 $1,907,015.41
Remote Control Upgrade $0.00 $0.00 N/A N/A N/A
System Design, Site Survey $15,300.00 $15,300.00 N/A $15,300.00 N/A
QoS ATSC RF Layer Monitoring Receiver $0.00 $0.00 N/A N/A N/A
25 Ton system $91,500.00 $61,100.00 N/A $60,970.41 N/A
Other Electrical Service: Electrician materials and labor to install transmitter Generator Rental for Electrical Installation $90,420.00 $90,420.00 N/A $90,745.00 The need for a Generator Rental to complete the work pushed the sub total higher than the estimated cost
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW $1,788,000.00 $1,740,000.00 N/A $1,740,000.00 N/A

Components

Actual Information Description File Name
Remote Control Upgrade Information not provided.
System Design, Site Survey

Component Description:
System Design Site Survey Down Payment
Amount:
$2,000.00

Component Description:
System Design, Site Survey final balance
Amount:
$13,300.00
QoS ATSC RF Layer Monitoring Receiver Information not provided.
25 Ton system

Component Description:
Supply and Install 25 ton HVAC System. Proposal, Invoice and W-9
Amount:
$60,970.41
Other Electrical Service: Electrician materials and labor to install transmitter Generator Rental for Electrical Installation

Component Description:
Electrical work for Transmitter Installation
Amount:
$63,820.00

Component Description:
Progress Payment Electrical Install
Amount:
$25,000.00

Component Description:
Generator and electrical distribution rental for Electrical Installation. Proposal, invoice and W-9
Amount:
$1,925.00
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW

Component Description:
Primary Transmitter 50% deposit due with order
Amount:
$870,000.00

Component Description:
Primary Transmitter 45% due 7 days prior to shipment
Amount:
$783,000.00

Component Description:
Transmitter 5 percent due upon proof of performance
Amount:
$87,000.00

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 $645,270.00 $569,190.00 N/A $537,510.00 N/A
Total for all systems $5,804,590.25 $4,175,932.75 N/A $3,641,604.47 N/A
Interim Antenna TFU-16WB $152,300.00 $133,641.00 $133,641.00
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $10,312.00 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $10,312.00 N/A
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,700.00 $8,209.00 N/A $8,209.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,400.00 N/A
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, horizontally polarized $108,720.00 $108,720.00 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $108,720.00 N/A
Primary Antenna TFU-28JTH/VP-R 06 $492,970.00 $435,549.00 $403,869.00
Bottom Support Pole $156,960.00 $156,960.00 N/A $156,960.00 N/A
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed) $15,250.00 $14,488.00 N/A $14,488.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,400.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $233,171.00 N/A $201,491.00 N/A
Feed Through Components $24,530.00 $24,530.00 T $24,530.00 N/A

Components

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

Component Description:
Antenna Mounting Brackets for Tapered Tower
Amount:
$4,640.40

Component Description:
Side Mount Brackets balance due
Amount:
$1,031.20

Component Description:
Antenna Mounting Brackets For Tapered Tower
Amount:
$4,640.40
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Elbow Complex balance due
Amount:
$820.90

Component Description:
Transition WR1500 X 8-75 CH35
Amount:
$1,714.05

Component Description:
Transition WR1500 X 6-50 UHF System Use Per Rev-E
Amount:
$990.00

Component Description:
Transition WR1500 X 6-50 UHF System Use Per Rev-E 013A77140
Amount:
$990.00

Component Description:
Trans WR1500 X 6-50 CH35
Amount:
$990.00

Component Description:
Transition WR1500 X 8-75 CH35
Amount:
$1,714.05

Component Description:
TRANS WR1500 X 6-50 CH35
Amount:
$990.00
Sweep test of existing antenna

Component Description:
Interim Antenna Sweep Test balance due
Amount:
$640.00

Component Description:
Repack Sweep
Amount:
$2,880.00

Component Description:
Repack Sweep
Amount:
$2,880.00
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, horizontally polarized

Component Description:
Interim Antenna balance due
Amount:
$10,872.00

Component Description:
UHF Broadband Sidemount Aux/Interim TFU 16WB
Amount:
$48,924.00

Component Description:
Interim Antenna- UHF Broadband Side Mount
Amount:
$48,924.00
Bottom Support Pole

Component Description:
Bottom Support Pole balance due
Amount:
$15,696.00

Component Description:
Bottom Support Pole
Amount:
$70,632.00

Component Description:
Bottom Support Pole
Amount:
$70,632.00
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed)

Component Description:
Balance payment Elbow Complex
Amount:
$1,448.80

Component Description:
Elbow Complex-Single Channel
Amount:
$6,519.60

Component Description:
Elbow Complex Single Channel At Antenna Input for 8-3/16" 75 Ohm
Amount:
$6,519.60
Sweep test of existing antenna

Component Description:
Sweep Test balance due
Amount:
$640.00

Component Description:
Repack Sweep
Amount:
$2,880.00

Component Description:
Repack Sweep
Amount:
$2,880.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Main Antenna balance due
Amount:
$20,003.70

Component Description:
UHF High Power Top Mount Antenna
Amount:
$90,016.65

Component Description:
UHF High Power Top Mount TFU-28JTH/VP-R 06
Amount:
$90,016.65

Component Description:
L-864 Red Beacon
Amount:
$1,454.00
Feed Through Components

Component Description:
Feed through components balance payment
Amount:
$2,453.00

Component Description:
Feed Through Components
Amount:
$11,038.50

Component Description:
Feed Through Components
Amount:
$11,038.50

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 $1,356,955.25 $882,095.75 N/A $479,874.70 N/A
Total for all systems $5,804,590.25 $4,175,932.75 N/A $3,641,604.47 N/A
Interim Transmission Line $216,671.25 $207,678.75 $203,553.75
Motorized Waveguide Switch $13,778.00 $13,778.00 N/A $13,778.00 N/A
3' Waveguide $800.00 $800.00 N/A $800.00 N/A
Nitrogen Generator $18,273.25 $18,273.25 N/A $18,273.25 N/A
Rigid Transmission Line - copper, 6 1/8" $183,820.00 $174,827.50 N/A $170,702.50 N/A
Primary Transmission Line $376,495.00 $280,000.00 $265,521.95
Rigid Transmission Line - copper, 8 3/16" $376,495.00 $280,000.00 N/A $265,521.95 Additional Cut Line Sections and Additional Elbows were required to complete the work. The original quotation missed these items.
Primary Transmission Line $383,618.00 $14,246.00 $7,123.00
Transmission Line Ice Shield $7,123.00 $7,123.00 N/A $7,123.00 N/A
Rigid Transmission Line - copper, 8 3/16" $376,495.00 $7,123.00 N/A N/A N/A
Primary Transmission Line $380,171.00 $380,171.00 $3,676.00
Rigid Transmission Line - copper, 8 3/16" $376,495.00 $376,495.00 N/A N/A N/A
Grounding Transmission Lines $3,676.00 $3,676.00 N/A $3,676.00 N/A

Components

Actual Information Description File Name
Motorized Waveguide Switch

Component Description:
Switch WR1150 H Plane 115 VAC 60000
Amount:
$6,200.10

Component Description:
Switch WR1150 H Plane 115 VAC 60000
Amount:
$6,200.10

Component Description:
Wave Guide Switch balance payment
Amount:
$1,377.80
3' Waveguide

Component Description:
Wave Guide Kit balance payment
Amount:
$80.00

Component Description:
W/G Kit WR1500 RF System Use for inside Building Non Pressurized Painted Black
Amount:
$360.00

Component Description:
W/G Kit WR1500 RF System Use for inside Building Non Pressurized Painted Black
Amount:
$360.00
Nitrogen Generator

Component Description:
Portable Nitrogen Purity Sensor for N2-Gen Nitrogen Generator
Amount:
$228.60

Component Description:
Failure Alarm for N2-Gen Nitrogen Generator
Amount:
$67.05

Component Description:
Nitrogen Generator N2-Gen TL-1050.110V, 15A
Amount:
$4,905.00

Component Description:
Installation Plumbing Kit for N2-Gen Nitrogen Generator
Amount:
$67.05

Component Description:
Annual Filter Replacement Kit for N2-Gen Nitrogen Generator
Amount:
$42.19

Component Description:
Nitrogen Purity Sensor Sampling Kit for N2-Gen Nitrogen Generator
Amount:
$88.20

Component Description:
Failure Alarm for N2-Gen Nitrogen Generator
Amount:
$67.05

Component Description:
Nitrogen Generator N2-Gen TL-1050. 110V, 15A
Amount:
$4,905.00

Component Description:
Dew Point Alarm W/touch screen PLC Upgrade for N2-Gen Nitrogen Generator
Amount:
$2,459.25

Component Description:
Annual Filter Replacement Kit for N2-Gen Nitrogen Generator
Amount:
$42.19

Component Description:
Nitrogen Purity Sensor Sampling Kit for N2-Gen Nitrogen Generator
Amount:
$88.20

Component Description:
Installation Plumbing Kit for N2-Gen Nitrogen Generator
Amount:
$67.05

Component Description:
Nitrogen Generator balance due
Amount:
$1,827.31

Component Description:
Dew Point Alarm W/touch screen PLC Upgrade for N2-Gen Nitrogen Generator
Amount:
$2,459.25

Component Description:
Portable Nitrogen Purity Sensor for N2-Gen Nitrogen Generator
Amount:
$228.60

Component Description:
Regulator Kit W/low pressure alarm for N2-Gen Nitrogen Generator
Amount:
$365.63

Component Description:
Regulator Kit W/low pressure alarm for N2-Gen Nitrogen Generator
Amount:
$365.63
Rigid Transmission Line - copper, 6 1/8"

Component Description:
3 Cut Line sections balance payment
Amount:
$6,187.50

Component Description:
T/L 6-50 EIA Length 15' To 20' Fixed FLG 1End/Swivel FLG 1 End
Amount:
$5,568.75

Component Description:
Ice Bridge covering Main and Aux Transmission Lines
Amount:
N/A

Component Description:
Rigid Transmission Line-Copper 6-1/8" 50 OHM EIA- 800FT (830' V and 80' H)
Amount:
$72,147.37

Component Description:
1 Cut Line Section balance payment
Amount:
$2,062.50

Component Description:
T/L 6-50 EIA Length 15' To 20' Fixed FLG 1 End/Swivel FLG 1 End
Amount:
$5,568.75

Component Description:
6" 50/ 6" 75 Transformer for Aux Transmission line
Amount:
$2,125.00

Component Description:
Interim TX Line balance due
Amount:
$4,895.26

Component Description:
Rigid Transmission Line-Copper 6-1/8" 50 OHM EIA - 800FT (830' V and 80' H)
Amount:
$72,147.37
Rigid Transmission Line - copper, 8 3/16"

Component Description:
Primary Transmission Line balance due
Amount:
$2,008.50

Component Description:
1 Cut Line Section balance payment
Amount:
$2,656.00

Component Description:
Main Transmission Line due at shipping
Amount:
$6,334.62

Component Description:
Dielectric 8" Tunable Elbows
Amount:
$10,000.00

Component Description:
End Cap Assembly 7 3/16 EIA and Air Valve 1/8 MPT X FPT BRS
Amount:
$1,640.50

Component Description:
T/L 8-75 EIA Length 15' to 20' Fixed FLG 1 End/ Swivel FLG 1 End
Amount:
$2,656.00

Component Description:
Elbow 8-75 EIA DIGIT 12 X 24 quantity 2
Amount:
$8,160.00

Component Description:
1 Cut Line Section balance payment
Amount:
$2,656.00

Component Description:
Rigid Transmission Line Cut Lengths per change order
Amount:
$7,450.25

Component Description:
1 Cut Line Section balance payment
Amount:
$2,656.00

Component Description:
Ice Bridge over the Main and Aux Transmission Lines
Amount:
N/A

Component Description:
Rigid Transmission Line- Copper 8-3/16" 75 OHM EIA- 1020 FT (940' V and 80' H)
Amount:
$104,871.24

Component Description:
Transmission Line 8-75 EIA Length 15' to 20' Fixed FLG 1 END/ Swivel FLG 1 END
Amount:
$4,780.80

Component Description:
Rigid Transmission Line- Copper 8-3/16" 75 OHM EIA- 1020 FT (940' V and 80' H)
Amount:
$104,871.24

Component Description:
Transmission Line 8-75 EIA Length 15' to 20' Fixed FLG 1 END/ Swivel FLG 1 END
Amount:
$4,780.80
Transmission Line Ice Shield

Component Description:
Ice Shield to protect primary transmission line as it enters the building
Amount:
$7,123.00
Rigid Transmission Line - copper, 8 3/16" Information not provided.
Rigid Transmission Line - copper, 8 3/16" Information not provided.
Grounding Transmission Lines

Component Description:
Grounding the 6" and 8" Transmission Lines where they enter the building
Amount:
$3,676.00

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 $1,485,600.00 $613,072.00 N/A $603,543.42 N/A
Total for all systems $5,804,590.25 $4,175,932.75 N/A $3,641,604.47 N/A
Primary Tower other $1,485,600.00 $613,072.00 $603,543.42
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $460,000.00 The requirement of a helicopter lift increased complex tower costs. Internal labor costs were also added to this category increasing the amount above the predetermined cost estimate $458,471.42 N/A
Serious tower reinforcement/modifications $1,052,000.00 $140,572.00 Tower requires minor modifications, not serious modifications $132,572.00 N/A
Structural engineering tower load study for well documented tower $12,600.00 $12,500.00 Complex self supporting tower. Structural analysis came in higher than $12,000.00 $12,500.00 N/A

Components

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

Component Description:
Internal Hours for Complex Tower
Amount:
$33,113.99

Component Description:
Internal project hours for Complex Tower
Amount:
$18,435.93

Component Description:
Final Balance TV Antenna Change/ Transmission Line Removal
Amount:
$288,843.50

Component Description:
Down Payment and Mobilization for WHDH TV Antenna and Line Rigging
Amount:
$115,350.00

Component Description:
Police Details for Helicopter Lift of Main Antenna
Amount:
$2,244.00

Component Description:
Police detail for Helicopter Lift of Main Antenna
Amount:
$484.00
Serious tower reinforcement/modifications

Component Description:
Tower Structural Reinforcement materials. Updated invoice with corrected call sign and proposal attached
Amount:
$31,286.00

Component Description:
Structural Materials for Tower reinforcement
Amount:
$31,286.00

Component Description:
WHDH TV Structural Modification Labor Cost
Amount:
$70,000.00
Structural engineering tower load study for well documented tower

Component Description:
Structural engineering tower load study for well documented tower down payment
Amount:
$5,250.00

Component Description:
Structural engineering tower load study for well documented tower progress payment
Amount:
$5,250.00

Component Description:
Structural engineering tower load study for well documented tower final payment
Amount:
$2,000.00

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 $272,765.00 $148,795.00 N/A $66,878.75 N/A
Total for all systems $5,804,590.25 $4,175,932.75 N/A $3,641,604.47 N/A
Outside Professional Services $272,765.00 $148,795.00 $66,878.75
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A $25,619.50 N/A
RF Exposure Measurements $21,050.00 $20,000.00 N/A $2,574.00 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $11,040.00 $11,040.00 N/A $7,986.50 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $5,255.00 Predetermined Cost were not enough to cover the Main License Application and Filing. Holland and Knights hours required $6,200.00 for this application and filing.
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $8,400.00 Preparation Fees were double due to Aux Antenna being licensed for both pre transition and post transition channel $5,872.50 Note- New attachment includes cover letter identifying the difference between the requested amount and the invoice as requested by the reviewer
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $1,950.00 N/A
Prepare request for Special Temporary Authorization $6,150.00 $4,605.00 N/A $3,217.50 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $8,000.00 Aux Antenna is used for both Pre Transition and Post Transition Channels and required double filings making the amount go over the predetermined costs $7,961.25 I mistakenly assigned the wrong invoice to the aux construction permit component (029-03-0010)- that invoice should have been assigned here. it too was over the estimated costs- $1,860 vs. the estimate of $1,500. CTJC invoice is higher than the estimate
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $0.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $1,620.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $3,000.00 N/A $2,962.50 N/A
Prepare and or review reimbursement form $2,630.00 $0.00 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 $1,860.00 N/A
Project management of the transition $120,080.00 $0.00 N/A $0.00 N/A

Components

Actual Information Description File Name
Comprehensive coverage verification via field study, if needed

Component Description:
Coverage Verification Measurement Study down payment
Amount:
$25,619.50
RF Exposure Measurements

Component Description:
Tower Climber support for Broadcast Signal Labs RF Measurements
Amount:
$1,989.00

Component Description:
RF Exposure Measurements
Amount:
$585.00
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
File request for Special Temporary Authority
Amount:
$598.50

Component Description:
WHDH STA application
Amount:
$180.00

Component Description:
Prepare and File request for Special Temporary Authorization
Amount:
$598.50

Component Description:
Special Temporary Authorization Filing
Amount:
$1,624.50

Component Description:
STA Preparation and Filing
Amount:
$2,365.00

Component Description:
Attorney Fees- Prepare and File request for Special Temporary Authority
Amount:
$4,445.50

Component Description:
Prepare and File request for Special Temporary Authorization
Amount:
$3,448.00

Component Description:
Prepare and File request for Special Temporary Authorization
Amount:
$397.50
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Attorney Fees Main License Application and Filing
Amount:
$5,255.00

Component Description:
Main License application.
Amount:
$855.00
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application

Component Description:
Prepare and File request for Special Temporary Authority
Amount:
N/A

Component Description:
Interim facility construction permit
Amount:
$70.00

Component Description:
Prepare and File Form 2100 Construction Permit or License Application
Amount:
$764.50

Component Description:
Matter 320205.00208 draft and file aux antenna construction permit
Amount:
$2,502.50

Component Description:
FCC filing fee, Aux construction permit. Reimbursable costs 5/3/18
Amount:
$1,070.00

Component Description:
Prepare and File request for Special Temporary Authority
Amount:
N/A

Component Description:
prepare and File Form 2100 Aux Antenna
Amount:
$238.50

Component Description:
Construction Permit filing for Interim facility
Amount:
$1,297.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Attorney Fees- Prepare and file FCC form 2100 (main) Construction Permit
Amount:
$1,950.00
Prepare request for Special Temporary Authorization

Component Description:
Preparation of a Request for Special Temporary Authority to use pre transition channel 42 on Aux Antenna
Amount:
$570.00

Component Description:
Preparation of engineering in support of a Request for STA and waiver request to transition in Phase 7 instead of Phase 8
Amount:
$2,100.00

Component Description:
Additional Engineering information for FCC in support of STA request
Amount:
$547.50
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application

Component Description:
Application for License to cover the outstanding construction permit for the auxiliary facility
Amount:
$5,343.75

Component Description:
Consulting Engineer prepare prepare and submit application for aux antenna construction permit
Amount:
$2,617.50
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Preparation of the engineering section, Schedule A, of FCC Form 2100 Construction Permit Application
Amount:
$1,620.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Performance of engineering studies for the new channel assignment and antenna development
Amount:
$2,962.50
Prepare and or review reimbursement form Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application

Component Description:
Preparation of FCC Form 2100 Interim antenna construction permit
Amount:
$1,860.00
Project management of the transition

Component Description:
Internal project management hours Transmitter install and Antenna, Transmission Line Rigging
Amount:
N/A

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 $58,780.00 $55,960.00 N/A $46,782.19 N/A
Total for all systems $5,804,590.25 $4,175,932.75 N/A $3,641,604.47 N/A
Other Expenses $58,780.00 $55,960.00 $46,782.19
MVPD Notification of Channel Change $1,700.00 $1,700.00 N/A $1,641.50 N/A
Equipment Storage $15,000.00 $15,000.00 Equipment Storage Required for Main and Aux Antenna and Line systems required more than the predetermined cost estimate $12,372.25 N/A
Equipment Delivery and Handling Charges $20,000.00 $20,000.00 Delivery and Handling Charges is more than the predetermined estimate due to delivery of 2 systems, Main and Aux Antenna and transmission lines. $15,299.64 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $10,000.00 $10,000.00 N/A $8,402.80 N/A
Non-zoning permits $0.00 $0.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $670.00 Channel Share required 2 License filing fees $670.00 FCC fee for license to cover application was higher than predetermined cost estimate.
DTV Medical Facility Notification $11,550.00 $8,400.00 N/A $8,396.00 N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change

Component Description:
Notification of Cable and Satellite MVPD Providers of new RF Channel and Transport Stream Parameters on Repack Channel
Amount:
$1,641.50
Equipment Storage

Component Description:
Interim equipment Storage balance due
Amount:
$932.64

Component Description:
On site storage container rental
Amount:
$131.38

Component Description:
Storage of Main Antenna/Support Pole/Transmission Line
Amount:
$9,500.00

Component Description:
Storage Unit Leasing Antenna and Transmission Line Install
Amount:
$1,145.87

Component Description:
Storage Charge Aux Antenna and Transmission Line
Amount:
$662.36
Equipment Delivery and Handling Charges

Component Description:
Freight (original)
Amount:
($2,700.00)

Component Description:
Actual Freight (main quote)
Amount:
$1,200.89

Component Description:
Freight and Shipping Main Transmission Line
Amount:
$288.10

Component Description:
Shipping of Antenna Beacon
Amount:
$35.39

Component Description:
Shipping charge for Invoice 616017 XFRM 6-50 / 6-75
Amount:
$134.33

Component Description:
Freight and Shipping Main Antenna and Transmission Line
Amount:
$501.15

Component Description:
Freight and Shipping Aux Antenna and Transmission Line
Amount:
$852.86

Component Description:
Freight and Shipping Aux Antenna and Transmission Line
Amount:
$597.33

Component Description:
Freight and Shipping Main Antenna and Transmission Line
Amount:
$589.96

Component Description:
Freight, Shipping, and Handling Main Antenna and Transmission Line
Amount:
$2,700.00

Component Description:
Interim Antenna and Transmission line Shipping and Handling to Site
Amount:
$1,350.00

Component Description:
Freight Charges
Amount:
$460.00

Component Description:
Freight and Shipping Main Antenna and Transmission Line
Amount:
$5,239.63

Component Description:
Interim Antenna and Transmission line Shipping and Handling to Site
Amount:
$1,350.00

Component Description:
Freight, Shipping, and Handling Main Antenna and Transmission Line
Amount:
$2,700.00
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Dumpster Fees removal of construction debris
Amount:
$78.00

Component Description:
Roll off dumpster for construction waste
Amount:
$644.80

Component Description:
Removal and disposal of Pre Transition CIF and Switch
Amount:
$7,680.00
Non-zoning permits Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application

Component Description:
License fee to Cover Application
Amount:
$670.00

Component Description:
License fee to cover application
Amount:
$670.00
DTV Medical Facility Notification

Component Description:
Notification of Medical Facilities Transmitter Medical Facility Notification
Amount:
$8,396.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $5,804,590.25 $4,175,932.75 $3,641,604.47

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. Yes
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.

James Edmund Shultis

Director of Engineering


08/22/2020

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.

James Edmund Shultis

Director of Engineering


08/22/2020

Certification

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Section Question Response
Submission of Final Allocation or Accounting Information 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 and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

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

  3. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.

  4. 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.

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

  6. 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.

James Edmund Shultis

Director of Engineering


08/22/2020

Attachments

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