TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
TRUSTEES OF INDIANA UNIVERSITY Doing Business As: TRUSTEES OF INDIANA UNIVERSITY	Deborah A. Lemon, Secretary of the Board of Trustees FRANKLIN HALL 200 601 E. KIRKWOOD AVE. BLOOMINGTON, IN 47405 United States	+1 (812) 856-3731	DALEMON@IU.EDU	Private Not-for-Profit Educational Institution

Applicant

Address

Phone

Applicant Type

TRUSTEES OF INDIANA UNIVERSITY

Doing Business As: TRUSTEES OF INDIANA UNIVERSITY

Deborah A. Lemon, Secretary of the Board of Trustees

FRANKLIN HALL 200

601 E. KIRKWOOD AVE.

BLOOMINGTON, IN 47405

United States

+1 (812) 856-3731

DALEMON@IU.EDU

Private Not-for-Profit Educational Institution

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant	Address	Phone	Email
[Confidential]

Preparer Contact Information

Preparer Contact Name and Information

Applicant	Address	Phone	Email
George C. Hopstetter Director Operation and Engineering Indiana University	George C. Hopstetter WTIU, Indiana University 1229 E. 7th Street Bloomington, IN 47405 United States	+1 (812) 855-3177	GHOPSTET@INDIANA.EDU

Applicant

Address

Phone

George C. Hopstetter

Director Operation and Engineering

Indiana University

George C. Hopstetter

WTIU, Indiana University

1229 E. 7th Street

Bloomington, IN 47405

United States

+1 (812) 855-3177

GHOPSTET@INDIANA.EDU

Broadcaster Information and Transition Plan

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	WTIU will need to replace the current transmitter, exciter with backup, mask filter, combiner, dehydrator and top mount antenna to re-locate to digital Ch. 33. Current transmission line was sweep to verify acceptable RF/VSWR to operate on Ch.33.

Transmitters

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

Primary Transmitter

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	Diamond DHD45P2
	Year	2003
	Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power Capacity	10.5 kW

Primary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Primary (Main)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Manufacturer
	Model	ULXTE-72
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	47.2 kW
	Justification for New Transmitter	Existing transmitter can not be re-channeled to meet the new FCC Ch. assignment. WTIU is upgrading to maximize TPO for Ch. 33 from a Like-for-like Transmitter ULXTE-30 to -72, see attached "Indiana_Univ_JW30004503V.1_WTIU_TV_TV_(002)"

Primary Transmitter

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	New electrical breaker panel is required to facilitate Ch. 33 transmitter and supporting equipment. See attached Quote "20170384-BL800A Sare Rd Transmitter-New Transmitter"
HVAC Service	Does the replacement transmitter require HVAC Service?	Yes
	Type	Cooling Only
	Size	5 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

Other Transmitter Cost Not Listed

Name	Description
Transmitter unloading	Unload transmitter from semi, Transmitter, heat-exchangers, associated gear.
Core Concret wall	Hire Professional Concrete coring provider to core 1- 10" hole and 8-3" diameter holes in 8"concrete wall for TX coolant lines and transmission line
Electrical Cable trays	Required Electrical cabling trays to install Gates Air ULXTE-72 liquid cooled transmitter
Coolant water for Liquid cooled transmitter	Distilled water for Liquid cooled transmitter purchased local

Antennas

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

Primary Antenna

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?	No
Existing Antenna Manufacturer and Type	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Broadband Panel
	Number of Stations Supported	1
	Number of Panels	32
	Design power capacity in use	35.0 %
	Lower Limit	470.00 MHz
	Upper Limit	806.00 MHz
	Other Antenna Type	N/A
	ERP:	224.0 kW
	Manufacturer
	Model	TUA-SP4A-8/32H-1-TR
	Year	2002

Primary Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Primary (Main)
	Description of Use	N/A
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	Yes
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Types	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Not in Stack
	Polarization	Elliptical
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels/Bays	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Design power capacity in use	N/A
	Other Antenna Type	N/A
	ERP:	797.0 kW
	Manufacturer
	Model	ATW18H3-ETTX-33H
	Year	2019
	Justification for New Antenna	Current broadband antenna is not efficient single channel operations and limited capabilities. Antenna sweep indicated that power divider had a high than desired reflection on assigned channel.Initial Report when installed had a higher than desired VSWR

Primary Antenna

Other Antenna Costs

Section	Question	Response
Combiner for Shared Antenna	Do you need a Combiner for a Shared Antenna?
	Type
	Number of channels supported	N/A
	Frequencies of channels supported	N/A
	Frequency	N/A
	Do you need a combiner output splitter/switcher for dual feed lines?	N/A
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	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?
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

Other Antenna Cost Not Listed

Name	Description
Main Antenna Sweep Test	TV Sweep test of New MAIN Ch. 33 antenna.

Interim Antenna

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	Elliptical
	Type	Broadband Panel
	Number of Stations Supported	1
	Number of Panels/Bays	16
	Lower Limit	470.00 MHz
	Upper Limit	698.00 MHz
	Design power capacity in use	95.0 %
	Other Antenna Type	N/A
	ERP:	132.43 kW
	Manufacturer
	Model	i230ECW-16-14/33
	Year	2019
	Justification for New Antenna	Interim antenna, side mount broadband operation on Ch. 14 during transition of primary top mount antenna to single CH. 33. Dielectric/ERI does not rent or lease interim antennas or transmission line.

Interim Antenna

Other Antenna Costs

Section	Question	Response
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	Yes
	Broadband or Single Channel?	S
	Feed Line Size	6 1/8 inches
Side Mount Brackets	Do you require the separate purchase of side mount brackets for an antenna?	No
Pattern Scatter Analysis	Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna?	No
Sweep Test	Do you require the sweep testing of transmission line and antenna?	Yes

Interim Antenna

Other Antenna Cost Not Listed

Name	Description
Interim Antenna and line Sweep test	Interim antenna and 5-inch transmission line TV sweep test

Transmission Line

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

Auxiliary Transmission Line

Add Transmission Line

Section	Question	Response
Existing Transmission Line Description	Type of change	Purchase New
	Use	Auxiliary (Backup)
	Description of Use	Interim Transmission line currently exist
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is this transmission currently shared with any other stations?	No
	Is Transmission Line in operating condition?	No
Existing Transmission Line Manufacturer and Type	Manufacturer
	Type	Flexible Air
	Diameter	5 inches
	Other Diameter	N/A
	Segment Length	N/A
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	530 feet per run

Auxiliary Transmission Line

New Transmission Line

Section	Question	Response
New Transmission Line Costs	Use	Auxiliary (Backup)
	Description of Use	Pre/Post-transition 5" transmission Line
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Type	Flexible Air
	Diameter	5 inches
	Other Diameter	N/A
	Segment Length	N/A
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	530 feet per run
	Justification for New Transmission Line	Flex 5 inch Andrew HJ9-50 for interim side mount antenna feed. To service while primary top mount antenna is removed and replace by new single Ch. 33 antenna.

Auxiliary Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Primary Transmission Line

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?	No
Existing Transmission Line Manufacturer and Type	Manufacturer
	Type	Rigid
	Diameter	6 1/8 inches
	Other Diameter	N/A
	Segment Length	19 3/4 inches
	Other Segment Length	N/A
	Number of parallel runs	0
	Length	710 feet per run

Primary Transmission Line

New Transmission Line

Section	Question	Response
New Transmission Line Costs	Use	Primary (Main)
	Description of Use	N/A
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Type	Rigid
	Diameter	6 1/8 inches
	Other Diameter	N/A
	Segment Length	19 3/4 inches
	Other Segment Length	N/A
	Number of parallel runs	0
	Length	710 feet per run
	Justification for New Transmission Line	"Main" Dielectric 6 1/8" Dielectric DigiTLine transmission line fialed 2- months after transitioning over from UHF Ch. 14 to UHF Ch. 33 repack. Current 18-year old line is now non-operational and need replaced as soon as possible. Main antenna off air

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Primary Transmission Line

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	Broadband
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	650 feet per run

Primary Transmission Line

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	Broadband
	Other Segment Length	N/A
	Number of parallel runs	0
	Length	0 feet per run
	Justification for New Transmission Line	Primary 6 1/8 DigiLine transmission line does not need to be changed out. Disregard this entery

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Name	Description
Interim Aux	New 5 inch flexible transmission line is for the Interim AUX antenna not the Primary Main

Tower Equipment And Rigging Costs

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

Primary Tower

Add Tower

Section	Question	Response
Existing Tower Description	Type of change	Modify Existing
	Tower Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Is this tower consider Complex?	No
	Is this tower currently shared with any other stations?	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
Existing Tower Structure Registration	ASR Number	1234684
Coordinates (NAD83)	Latitude (NAD83)	39° 08' 31.0" N-
	Longitude (NAD83)	086° 29' 42.9" W-
	Overall Structure Height	645.99 feet
	Support Structure Height	610.23 feet
	Ground Elevation Above Mean Sea Level (AMSL)	806.09 feet
	Structure Type	GTOWER - Guyed Structure Used for Communication Purposes
	Tower Owner	Trustees of Indiana University
	Date Constructed	12/28/2015

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
68269	WFIU	FM

Other Types of Users

Users
Sprint
New Cingular
T-Mobile
Verizon

Primary Tower

Tower Modification Costs

Section	Question	Response
Engineering Study	Please what type of engineering study is required, if any:	No study needed
Tower Reinforcements	Please select whether tower reinforcements are needed:	Minor Reinforcements needed

Primary Tower

Tower Rigging Costs

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

Primary Tower

Other Tower Expenses Not Listed

Name	Description
MAIn Transmission Line installation	Main 6 1/8" Dielectric DigiTLine failed 2-months after transition date from Ch. 14 to Ch. 33.
Antenna replacement	Costs to remove existing top mounted antenna and install new Ch. 33 top mount antenna
Interim Antenna installation	Cost to install Aux antenna and 500ft of 4" transmission line for Ch. 14 while Primary antenna is removed and replaced.
Lower Guy support upgrade	Lower Guy supports upgraded to handle the added "AUX" Interim antenna loading on tower

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	No
	Number of Hours	N/A
	Explanation	N/A
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	1
	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	1
	NEPA Section 106 environmental review	No
	Environmental Assessment	No
	ASR Modification	Yes
	FAA Consultation (including preparation of FAA Form 7460)	Yes
	Negotiation of Lease and other Matter for Shared Locations	No
	Prepare or Review FCC Form 399 for Reimbursement	Yes
	Address transition timing and coordination issues w/ other stations and wireless providers	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

Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

Section	Question	Response
AM Pattern Disturbance	Is an Impact Study needed?	No
AM Pattern Disturbance	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	No
	BLM or NFS Coordination	No
	FCC Construction Permit Minor Change	No
	FCC License to Cover Application	Yes
	FCC Special Temporary Authority Application	Yes
Other Miscellaneous Expenses	Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)?	No
	Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs?	Yes
	Does this relocation require Equipment Storage?	No
	Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change?	Yes
	Does this relocation require MVPD Notification of a Channel Change?	Yes

Other Expenses

Other Expenses Not Listed

Name	Description
Endeavor Communications	New Ch. 33 receive element for provided PR-450 receive antenna feed local cable system programming. Change Ch. 14 element to CH. 33 element on Receive tower

Cost Information

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	$1,651,904.20	$843,356.62	N/A	$735,947.84	N/A
Total for all systems	$3,006,624.20	$1,913,426.62	N/A	$1,207,373.67	N/A
Primary Transmitter ULXTE-72	$1,651,904.20	$843,356.62		$735,947.84
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW	$1,473,000.00	$650,351.92	Requesting reimbursement for Like-for-like transmitter Gates Air ULXTE-30 Only. WTIU will be responsible for the Maximization cost to upgrade to a Gates Air ULXTE-72.	$642,651.92	N/A
Coolant water for Liquid cooled transmitter	$330.00	$330.00	Transmitter manufacture requires that all distilled water to be purchased local to the transmitter site for water cooled transmitters.	$329.18	N/A
Electrical Cable trays	$2,250.00	$2,250.00	Gates Air required electrical cable trays to be installed with Gates Air ULXTE-72 transmitter	$2,250.00	Gates Air required electrical cable trays/elbows to be installed with Gates Air ULXTE-72 transmitter
Transmitter unloading	$466.00	$466.00	Cost to rent a Telehandler (Forklift) to unload transmitter from semi to ground. Gates air required on-site unloading semi.	$466.00	N/A
Other Electrical Service: New electrical breaker panel is required to facilitate Ch. 33 transmitter and supporting equipment. See attached Quote "20170384-BL800A Sare Rd Transmitter-New Transmitter"	$155,178.20	$155,178.20	Electrical contractor bid and university Physical plant charges for Transfer switch, electrical distribution panel for new transmitter. See Attachment: "20170384-BL800A Sare Rd Transmitter-new Transmitter"	$89,821.27	N/A
5 Ton system	$20,250.00	$34,350.50	Upload Technical operating data showing the room heat dissipation of the Gate Air transmitter. New transmitter is to be installed in a separate room with limited HVAC service. See 20170384_CO Proposal #03_HVAC.rev.1	$0.00	N/A
Core Concret wall	$430.00	$430.00	Core concrete waal for 8-3" TX coolant hoses and 1-10" transmission line trough 8" concrete wall for installation of Gate Air transmitter.	$429.47	N/A

Components

Actual Information Description	File Name
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW	Component Description: Gates Air Installation & Proof "Like-for-Like" equivalent cost Amount: $31,616.00 Component Description: Shipment due payment for transmitter ship to site for installation of Like-for-like reimburse expense of transmitter. Amount: $396,818.61 Component Description: Gates Air requires purchasing distilled water locally for the install of their transmitter, had to go to 2 location to gain enough water. Amount: N/A Component Description: Telehandler (Forklift) rental to unload Transmitter components from semi. Amount: N/A Component Description: Cable tray to support coolant hoses from transmitter over head. Amount: N/A Component Description: 30% down payment for the Like-for-like ULXTE-30 transmitter. WTIU will be responsible for the Maximization ULXTE-72 Down PMT $251,696.83 difference. See Invoice Attachment: "Indiana Univ JW30004503V.1 WTIU-TV-TV (002)" Amount: $214,217.31 Component Description: Gates Air requires customer to provide distilled water for water cooled transmitter to be purchased locally. Amount: N/A Component Description: Gates Air requires client to core/drill all holes in customers wall for coolant lines and transmission line. Amount: N/A Component Description: Gates Air Install & Proof "Like-for-Like" equivalent cost. Amount: $31,616.00
Coolant water for Liquid cooled transmitter	Component Description: Distilled water for transmitter coolant, 228 1-gallon containers Amount: $215.26 Component Description: Distilled water for Transmitter coolant purchased local, 128 1-gallon containers. Amount: $113.92
Electrical Cable trays	Component Description: Gates Air required electrical cable trays to be installed with Gates Air ULXTE-72 transmitter Amount: $2,250.00
Transmitter unloading	Component Description: Telehandler, (Forklift) to unload transmitter from semi Amount: $466.00
Other Electrical Service: New electrical breaker panel is required to facilitate Ch. 33 transmitter and supporting equipment. See attached Quote "20170384-BL800A Sare Rd Transmitter-New Transmitter"	Component Description: 1st payment for completed-to-date based on invoice date electrical work completed for electrical installation of Ch. 33 transmitter. Amount: $19,475.00 Component Description: 2nd Payment-to-date of completion for electrical installation for repack transmitter WTIU Ch. 33 Amount: $44,673.66 Component Description: 5th Payment-to-date for electrical installation for WTIU Ch. 33 transmitter repack. Amount: $15,017.30 Component Description: 4th Payment-to-date for Electrical installation of WTIU Ch. 33 transmitter repack. Amount: $10,655.31 Component Description: 3rd Payment-to-date for electrical installation of WTIU Ch. 33 repack installation. Amount: $49,109.78
5 Ton system	Component Description: Payment for purchase and installation of 5-ton HVAC unit to support WTIU Gates Air Transmitter CH. 33 installation. Amount: $30,018.38
Core Concret wall	Component Description: Gates Air requires client to core/drill all holes in clients walls for coolant and transmission through lines. Amount: $429.47 Component Description: Core 1-10" hole for transmission line through wall and 8-3" holes for transmitter coolant hoses through 8" concrete wall. Quote attached. Amount: $429.47

Cost Information

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	$443,160.00	$417,709.00	N/A	$124,053.65	N/A
Total for all systems	$3,006,624.20	$1,913,426.62	N/A	$1,207,373.67	N/A
Interim Antenna i230ECW-16-14/33	$128,380.00	$182,231.00		$56,951.44
UHF - Lower Power Side Mount, One Station antenna . medium power (50-200 kW), elliptically or circularly polarized	$103,100.00	$170,813.00	Change in interim antenna, ERI does not rent or lease interim antenna. Requires purchase of new interim antenna. Includes side mounts $9,800 increasing the cost of the interim antenna system	$53,256.32	Cost of ERI Interim side mounted antenna i230ECW-16-14/33, new design and currently the one the manufacture now offers as a interim antenna.
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	$12,300.00	$5,168.00	6 1/8" 90 degree miter elbow and hardware,	$1,672.48	Item requesting addition information is lock and can not access to modify submission, Total for Interim Elbow complex will be $5,168.00
Interim Antenna and line Sweep test	$6,250.00	$6,250.00	Interim Antenna and 5-inch TV sweep test	$2,022.64	N/A
Sweep test of existing antenna	$6,730.00	$0.00	N/A	$0.00	N/A
Primary Antenna ATW18H3-ETTX-33H	$314,780.00	$235,478.00		$67,102.21
Main Antenna Sweep Test	$6,250.00	$6,250.00	Main Antenna TV Sweep test after installation	$2,022.64	N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	$12,300.00	$18,016.00	Replace failed 6 1/8" Dielectric line with ERI MACXLine, will need to replace existing elbow complex with ERI to match inner conductors	$2,088.01	N/A
Sweep test of existing antenna	$6,730.00	$12,500.00	Re-sweep replacement 6 1/8" transmission line after failed line has been replace to fine match tune to antenna. (See attachment	$3,700.00	N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	$289,500.00	$198,712.00	ERI Cost is Hpol - Vpol cost of $15,500.00, See ERI quote: "ERI-Main_AUX_antenna_quote.pdf"	$59,291.56	N/A

Components

Actual Information Description	File Name
UHF - Lower Power Side Mount, One Station antenna . medium power (50-200 kW), elliptically or circularly polarized	Component Description: 2nd payment for shipping material for interim antenna. Amount: $103,001.70 Component Description: ERI 1/3rd down payment for Interim Antenna and mounting system. Amount: $53,256.32 Component Description: Interim Antenna and mounting, 2nd payment due at hardware shipment. Amount: $111,306.68 Component Description: Down payment of Interim Antenna "AUX" cost. Amount: $67,811.30 Component Description: Interim antenna 2nd payment due for reimbursement. Amount: $111,306.68 Component Description: Down Payment for Interim antenna: See attached invoice and Note of breakdown of payment. Amount: $53,256.32 Component Description: Down Payment for Interim antenna: See attached invoice and Note of breakdown of payment. Also see attached (ERI Letter - WTIU) for additional information Amount: $53,256.32
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	Component Description: ERI 1/3 down payment of Interim Elbow Complex transmission system Amount: $1,672.48 Component Description: 2nd payment upon shipping material for interim antenna elbow complex Amount: $3,305.76 Component Description: Interim TV transmission line elbow complex breakout, down payment Amount: $1,672.48 Component Description: Interim Transmission TV line break out of Elbow complex, 2nd Payment due Hardware shipment. Amount: $3,495.52 Component Description: Revised Invoiced Down Payment for ERI RF system for interim antenna elbow complex: See attached invoice with notes. Amount: $1,672.48 Component Description: Interim Antenna Elbow Complex 2nd payment. Quote Line item # 26 ERI Proposal 20190323-51. Amount: $3,495.52 Component Description: down payment of Interim antenna "AUX" elbow complex cost. Amount: $1,862.24
Interim Antenna and line Sweep test	Component Description: ERI 1/3rd down payment for Interim Antenna and 5in transmission system Sweep Test. Amount: $2,022.64 Component Description: Interim Antenna & Transmission TV Line Sweep, 2nd payment due Amount: $4,227.36 Component Description: Interim Antenna and transmission line TV sweep test 2nd payment due reimbursement. Amount: $4,227.36 Component Description: Interim Antenna and 5-in transmission line TV Sweep down payment. Amount: $2,022.64 Component Description: Interim Antenna & Transmission TV Line sweep , down payment Amount: $2,022.64
Sweep test of existing antenna	Component Description: No existing interim "AUX" antenna exist to sweep test. Amount: N/A
Main Antenna Sweep Test	Component Description: ERI 1/3rd down payment for MAIN WTIU Antenna TV sweep test Amount: $2,022.64 Component Description: MAIN Antenna Sweep test Ch. 33, 2nd payment due Amount: $4,227.36 Component Description: MAIN Antenna TV Sweep test down payment due. Amount: $2,022.64 Component Description: MAIN Antenna TV Sweep 2nd payment due reimbursement. Amount: $4,227.36 Component Description: Main Antenna TV sweep test Ch. 33, down payment Amount: $2,022.64
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	Component Description: 2nd payment for shipping material for MAIN antenna elbow complex Amount: $4,127.09 Component Description: ERI 1/3rd down payment for MAIN TV transmission system Elbow Complex. Amount: $2,088.01 Component Description: Main Antenna Ch.33 Transmission TV Line elbow Complex, 2nd payment due at hardware shipment. Amount: $4,363.99 Component Description: Main Antenna Ch. 33 Transmission TV line Elbow complex breakout, Down payment Amount: $2,088.01 Component Description: Down payment for Main antenna elbow Complex: See attached invoice and note for details. Amount: $2,088.01 Component Description: MAIN Antenna Elbow complex 2nd payment due for reimbursement. Amount: $4,363.99 Component Description: Down payment of Elbow complex for Main antenna system. Amount: $2,324.91
Sweep test of existing antenna	Component Description: System Sweep of existing 6.125" line and antenna operating on Ch.14 to determine use on Ch.33. 50% down with order and 50% due NET-30. See attachment: Note-ERI invoice PO 1998688 WTIU Line Sweep Amount: $1,850.00 Component Description: 50% down payment, Remaining 50% payment was prior entry only showed total marked out and $1850 remaining. Amount: $1,850.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	Component Description: WTIU MAIN Antenna, Ch. 33, 2nd payment due at hardware shipment. Amount: $123,920.44 Component Description: 2nd payment upon shipping material for MAIN antenna Amount: $121,188.01 Component Description: ERI 1/3 down payment for MAIN antenna and mounting hardware Amount: $59,291.56 Component Description: WTIU Main antenna Ch. 33, down payment. Amount: $59,291.56 Component Description: Requesting Down payment for Main Antenna less V-pol cost. See note attached to invoice. Amount: $59,291.56 Component Description: MAIN Antenna 2nd payment due for reimbursement. Amount: $123,920.44 Component Description: Down payment of ERI ATW18H3-16-14/33 "MAIN" antenna top mount Ch. 33 Amount: $68,273.99

Cost Information

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	$55,650.00	$166,786.00	N/A	$19,515.75	N/A
Total for all systems	$3,006,624.20	$1,913,426.62	N/A	$1,207,373.67	N/A
Primary Transmission Line	$0.00	$106,482.00		$0.00
Rigid Transmission Line - copper, 6 1/8"	$0.00	$106,482.00	Main transmission line failure 2-months after repack from UHF Ch. 14 to UHF Ch. 33. Main Dielectric 6 1/8" line inner connections failed. Report attached. (WTIU Failed Transmission line Quote)	$0.00	N/A
Primary Transmission Line	$0.00	$0.00		$0.00
Auxiliary Transmission Line	$55,650.00	$60,304.00		$19,515.75
Flexible Air Transmission Line - dielectric, 5"	$55,650.00	$60,304.00	New 5" coax line to feed interim antenna wideband. Pre & Post transition Ch. 14 Pre channel operation, CH. 33 Post Channel operation as an "AUX" antenna. Included hoist grips, hangers, gas stop, through-wall seal, ground kits and 6 1/8" connectors.	$19,515.75	N/A

Components

Actual Information Description	File Name
Rigid Transmission Line - copper, 6 1/8"	Information not provided.
Flexible Air Transmission Line - dielectric, 5"	Component Description: 2nd payment for shipping material for AUX Interim antenna 5in feed line Amount: $44,834.60 Component Description: ERI 1/3rd down payment for Interim 5in Flex Coax Transmission Line and hardware. Amount: $19,515.75 Component Description: Interim Antenna 5" flex transmission TV-line, 2nd payment due at hardware Shipment. Amount: $40,788.25 Component Description: 5" Interim coax line feed for Interim antenna, 1/3rd down payment request at this time. Amount: $19,515.75 Component Description: Interim Antenna 5-inch Transmission line 2nd payment due for reimbursement. Amount: $40,788.25 Component Description: Interim antenna 5" transmission flex TV-line, down payment Amount: $19,515.75

Actual Information Description

File Name

Rigid Transmission Line - copper, 6 1/8"

Information not provided.

Flexible Air Transmission Line - dielectric, 5"

Component Description:: 2nd payment for shipping material for AUX Interim antenna 5in feed line
Amount:: $44,834.60

Component Description:: ERI 1/3rd down payment for Interim 5in Flex Coax Transmission Line and hardware.
Amount:: $19,515.75

Component Description:: Interim Antenna 5" flex transmission TV-line, 2nd payment due at hardware Shipment.
Amount:: $40,788.25

Component Description:: 5" Interim coax line feed for Interim antenna, 1/3rd down payment request at this time.
Amount:: $19,515.75

Component Description:: Interim Antenna 5-inch Transmission line 2nd payment due for reimbursement.
Amount:: $40,788.25

Component Description:: Interim antenna 5" transmission flex TV-line, down payment
Amount:: $19,515.75

Cost Information

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	$783,336.00	$414,836.00	N/A	$290,057.00	N/A
Total for all systems	$3,006,624.20	$1,913,426.62	N/A	$1,207,373.67	N/A
Primary Tower GTOWER	$783,336.00	$414,836.00		$290,057.00
Antenna replacement	$95,251.00	$95,251.00	Cost to remove existing top mounted Ch. 14 antenna replace with Ch. 33 top mounted antenna (TFU-18GTH/VP-R 6S250), hook to existing 6 1/8" line. install and wire top AOL beacon. Installation cost increased since original quotes	$95,251.00	N/A
Interim Antenna installation	$134,914.00	$134,914.00	Interim aux antenna (i230ECW-16-14/33) installation with 530-ft 5" flexible transmission line. Aux antenna needed to maintain air operations while top antenna is being replaced. Note: Installation cost tripled since original quote.	$134,914.00	N/A
Minor tower reinforcement/modifications	$158,000.00	$0.00	N/A	N/A	N/A
Tall Tower (greater than 500')	$210,500.00	$0.00	No new tower needed.	N/A	N/A
Lower Guy support upgrade	$63,332.00	$63,332.00	Structural Analysis shows lower guy over stressed with "AUX" Interim antenna added to tower, manufacture recommends lower guy supports be upgraded to elevate over stress points on the lower guy.	$59,892.00	N/A
MAIn Transmission Line installation	$121,339.00	$121,339.00	Installation cost to remove and replace existing failed 6 1/8" DigiTLine transmission line with ERI 6 1/8" MACXLine' Transmission line failure after transition to Ch. 33.	N/A	N/A

Components

Actual Information Description	File Name
Antenna replacement	Component Description: Remaining installation cost of WTIU "Main" antenna reimbursement. Amount: $61,841.72 Component Description: ERI 1/3rd down payment for Main TV Antenna Installation and Site survey. Amount: $33,409.28 Component Description: MAIN Antenna installation Ch. 33, down payment Amount: $33,409.28 Component Description: .334 down deposit with order and 50% of $6500 applied for Layout Site survey for installation of Antennas. Amount: $33,409.28 Component Description: Invoiced down payment for Main antenna replacement installation. See attached invoice with notes. Amount: $33,409.28
Interim Antenna installation	Component Description: Remaining installation cost of WTIU "interim" antenna and 5" transmission line. Amount: $85,385.62 Component Description: ERI 1/3rd down payment for Interim Antenna and 5in Coax Installation Amount: $49,528.38 Component Description: Invoiced down payment for Interim antenna installation/5-in Transmission Line installation, See attached invoice with notes. Amount: $49,528.38 Component Description: .333 down and includes 50% layout site survey cost of $6,500, .333 of $3250 applied. Amount: $49,528.38 Component Description: Interim Antenna and 5" transmission line installation, down payment. Amount: $49,528.38
Minor tower reinforcement/modifications	Information not provided.
Tall Tower (greater than 500')	Information not provided.
Lower Guy support upgrade	Component Description: 50% shipping material and 70% mobilization to site. Amount: $37,262.40 Component Description: Uploaded note with ERI invoice 2342077: "Note_ERI Invoice 20190522-630 Rev A_Guy Material Down Payment" with terms of payments. Amount: $11,655.00 Component Description: Remaining 50% of Guy material shipped payment. Amount: $10,974.60
MAIn Transmission Line installation	Information not provided.

Cost Information

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	$40,185.00	$38,665.00	N/A	$18,715.00	N/A
Total for all systems	$3,006,624.20	$1,913,426.62	N/A	$1,207,373.67	N/A
Outside Professional Services	$40,185.00	$38,665.00		$18,715.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$5,120.00	N/A	$5,200.00	3-hours (approximately $1,392.85) listed as 7/12/17 applied to cost related to the FCC computer website slow or non-responsive for hours on July12, 2017. Conferences with FCC and client to determine filing option in the last hours before deadline.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application	$1,580.00	$1,535.00	N/A	$675.00	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,535.00	N/A	$675.00	N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application	$2,105.00	$2,050.00	N/A	$1,650.00	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,070.00	N/A	$3,370.00	Construction Permit Modification, comprehensive technical study for proposing minor change in Main directional antenna.
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,170.00	N/A	$3,900.00	N/A
Prepare and or review reimbursement form	$2,630.00	$2,560.00	N/A	$900.00	Lohnes and Culver is the Engineering firm that review Form 399 for the technical engineering. Fletcher, Heald and Hildreth, P.L.C. was for Legal review of the application and Form 399 and submittal.
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	$2,105.00	$2,050.00	N/A	N/A	N/A
ASR modification (prepare FCC Form 854)	$2,105.00	$2,050.00	N/A	N/A	N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization	$3,680.00	$3,585.00	N/A	$975.00	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,305.00	N/A	$0.00	N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application	$4,210.00	$4,100.00	N/A	$0.00	N/A
Prepare request for Special Temporary Authorization	$2,050.00	$1,535.00	N/A	$1,370.00	N/A

Components

Actual Information Description	File Name
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: Legal Services modification of application, draft Construction Permit and Legal Certification. Review Form 399, file attached. Amount: $5,200.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application	Component Description: Auxiliary Antenna License App., Prepare license application to cover construction Permit No. 0000086567 Amount: $675.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Component Description: Main Antenna License Application to Cover Permit No. 0000081146 Amount: $675.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application	Component Description: Auxiliary Antenna Construction Permit App., Perform Studies to determine parameters for operation on the reassignment Channel Amount: $1,650.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: Prepare engineering section of FCC Form 2100 for filing Construction Permit filling in the 90-day filing window. Amount: $1,970.00 Component Description: Construction Permit Modification, comprehensive technical exhibit for proposing minor change in Main directional antenna. Amount: $1,400.00 Component Description: Cost of preparing engineering section of FCC Form 2100 and prepare comprehensive technical exhibits attachment for filing in the initial 90-day window. FCC Construction Permit ApplicationApplication Amount: $1,970.00
Perform engineering study for new channel assignment and antenna development	Component Description: New Channel and Antenna Development, RF studies Post-Auction Plan for transitioning to new channel Amount: $3,900.00 Component Description: Cost to conduct technical studies for new UHF channel and replacement directional antenna. Amount: $3,900.00
Prepare and or review reimbursement form	Component Description: Reimbursement Form check for accuracy and completeness, technical specifications and engineering. Amount: $900.00 Component Description: Cost of Review and edit FCC Form 399 Application, Amount: $900.00 Component Description: Legal Services modification of application, draft Construction Permit and Legal Certification. Review Form 399, file Application as listed Amount: N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	Information not provided.
ASR modification (prepare FCC Form 854)	Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization	Component Description: Modification applications and interim special Temporary Authority (STA) for WTIU Amount: $975.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Component Description: Revise and finalize FCC application for license for MAIN antenna. 1.5hr highlighted time Amount: $750.00
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application	Component Description: Highlighted- legal time for revise and finalize CP application for license for Main antenna. Amount: $2,350.00 Component Description: Finalize and file auxiliary antenna license application with FCC. Legal (Highlighted time) Amount: $1,100.00
Prepare request for Special Temporary Authorization	Component Description: Using an interim antenna on the pre-repack channel and prepare a request for STA to operate. Amount: $1,370.00

Cost Information

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	$32,389.00	$32,074.00	N/A	$19,084.43	N/A
Total for all systems	$3,006,624.20	$1,913,426.62	N/A	$1,207,373.67	N/A
Other Expenses	$32,389.00	$32,074.00		$19,084.43
Endeavor Communications	$3,985.00	$3,985.00	Uploaded quote for tower crew to change out PR-450 element for Cloverdale (Endeavor Communications) cable headend to receive new Ch. 33. Cost of tower service	N/A	N/A
MVPD Notification of Channel Change	$2,974.00	$2,974.00	Estimate uploaded <EST-001591 MVDP Notification.pdf>	$2,974.00	N/A
Develop and air announcement of upcoming channel change	$2,500.00	$2,500.00	N/A	N/A	N/A
Equipment Delivery and Handling Charges	$10,850.00	$10,850.00	Gates Air transmitter freight charge increase, Quote #Q-86957 for $10,141.33 from vendor for freight is attached	$10,824.43	Gates Air actual Freight cost increase, Quote #Q-86957 for $10,141.33 from vendor, attached .
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	$325.00	N/A	N/A	N/A
DTV Medical Facility Notification	$11,550.00	$11,250.00	N/A	$5,286.00	N/A

Components

Actual Information Description	File Name
Endeavor Communications	Information not provided.
MVPD Notification of Channel Change	Component Description: Attached Invoice: INV-002206_DTV Notification_MVDP.pdf Amount: $2,974.00
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Delivery and Handling Charges	Component Description: Gates Air Freight cost increased from original quote of $5,100.00. New freight cost and Quote # Q-86957 for $10,141.33 attached Amount: $10,141.33 Component Description: Freight cost on Guy material delivered from ERI. Amount: $683.10
FCC Filing Fees - Special Temporary Authorization request	Information not provided.
FCC Filing Fees - Form 2100 license to cover application	Information not provided.
DTV Medical Facility Notification	Component Description: Invoice attached: INV-002205_DTV Notification_Medical.pdf Amount: $5,286.00

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$3,006,624.20	$1,913,426.62	$1,207,373.67

Reimbursement Status

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

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.
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. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. 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). 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. 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. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. 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.	George C Hopstetter Director, Operations & Engineering 01/22/2021

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.

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.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
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).
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.
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.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
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.

George C Hopstetter

Director, Operations & Engineering

01/22/2021

Certification

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).

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 certifies that the statements in this form and attached documentation are true, complete, and correct.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
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) .
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.
The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
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.

George C. Hopstetter

Director, Operations and Engineering

01/22/2021

Certification

Section

Question

Response

Submission of Final Allocation or Accounting Information Statements

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.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
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.
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.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
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.

Deborah A Lemon

Secretary of the board of trustees

01/22/2021

(REFERENCE COPY - Not for submission) FCC Form 399: Reimbursement Request

Applicant Information

Applicant Name, Type, and Contact Information

Reimbursement Contact Information

Reimbursement Contact Name and Information

Preparer Contact Information

Preparer Contact Name and Information

Broadcaster Information and Transition Plan

Transmitters

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Antennas

Primary Antenna

Existing Antenna Information

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Interim Antenna

New Antenna Costs

Interim Antenna

Other Antenna Costs

Interim Antenna

Other Antenna Cost Not Listed

Transmission Line

Auxiliary Transmission Line

Add Transmission Line

Auxiliary Transmission Line

New Transmission Line

Auxiliary Transmission Line

Other Transmission Line Expenses Not Listed

Primary Transmission Line

Add Transmission Line

Primary Transmission Line

New Transmission Line

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Primary Transmission Line

Existing Transmission Line

Primary Transmission Line

New Transmission Line

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Tower Equipment And Rigging Costs

Primary Tower

Add Tower

FM, AM or TV radio broadcasters. Facility ID's, Call Signs and Services of other broadcast stations with whom the tower is shared

Other Types of Users

Primary Tower

Tower Modification Costs

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Components

Cost Information

Tower Equipment and Rigging Costs

Components