TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
WSBT LICENSEE, LLC Doing Business As: WSBT LICENSEE, LLC	Harvey Arnold 10706 Beaver Dam Road Cockeysville, MD 21030 United States	+1 (410) 568-1500	FCCContacts@sbgtv.com	Limited Liability Company

Applicant

Address

Phone

Applicant Type

WSBT LICENSEE, LLC

Doing Business As: WSBT LICENSEE, LLC

Harvey Arnold

10706 Beaver Dam Road

Cockeysville, MD 21030

United States

+1 (410) 568-1500

FCCContacts@sbgtv.com

Limited Liability Company

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
Paul A. Cicelski , Esq . Lerman Senter PLLC	Paul Cicelski 2001 L Street, NW Suite 400 Washington, DC 20036 United States	+1 (202) 416-6756	pcicelski@lermansenter.com

Applicant

Address

Phone

Paul A. Cicelski , Esq .

Lerman Senter PLLC

Paul Cicelski

2001 L Street, NW

Suite 400

Washington, DC 20036

United States

+1 (202) 416-6756

pcicelski@lermansenter.com

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	See Exhibit A.

Transmitters

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

Auxiliary Transmitter

Existing Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Purchase New
	Use	Auxiliary (Backup)
	Description of Use	Backup
	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	CD3100P1UPG2
	Year	2001
	Type	Inductive Output Tube
	IOT Power Type	Single
	Power Capacity	20 kW

Auxiliary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Auxiliary (Backup)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Manufacturer
	Model	THU9evo-20
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	31 kW
	Justification for New Transmitter	Per the manufacturer, the current auxiliary transmitter cannot be retuned and the new channel is higher in ERP than the current channel, which requires more power than the current auxiliary transmitter can provide. See Exhibit C.

Auxiliary 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	Yes
	Size	2 inches
	Length	400.0 feet
	Other Electrical Service	No
	Description	N/A
HVAC Service	Does the replacement transmitter require HVAC Service?	No
	Type	N/A
	Size	N/A
	Other Size	N/A
Transmitter Building Addition/Modification or Leasehold Improvement	Does the Transmitter Building require an addition, modification, other leashold improvement?	No
	Size	N/A
Channel 14 Costs	Is an RF Consulting Engineer needed?	N/A
	Is a channel 14 Mask Filer needed?	N/A
	Is additional field engineering time needed?	N/A
	Number of Days	N/A

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Filter Retune	Filter Retune
Additional parts	Additional parts

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	HD3100P1
	Year	2001
	Type	Inductive Output Tube
	IOT Power Type	Single
	Power Capacity	20 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	THU9evo-20
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	31 kW
	Justification for New Transmitter	Per the manufacturer, the current transmitter cannot be retuned and the new channel is higher in ERP than the current channel, which requires more power than the current transmitter can provide. See Exhibit B.

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	Yes
	Transformer (480V)	Yes
	Power	300 kVA
	Rigid Conduit and Wiring	Yes
	Size	2 inches
	Length	800.0 feet
	Other Electrical Service	Yes
	Description	Installation
HVAC Service	Does the replacement transmitter require HVAC Service?	Yes
	Type	Cooling Only
	Size	Other
	Other Size	6 tons
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
RF Combiner	RF Combiner
Additional parts	Additional parts
Transmitter Building	Transmitter Building
Additional Site Requirement	Additional Site Requirement
Kit Stacking Pumps	Kit Stacking Pumps
Additional Work	Additional Work
Consolidation Service	Consolidation Service

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	Retune Existing
	Antenna Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing antenna shared with another station or stations?	No
	Is the existing antenna directional?	No
	Is antenna in operating condition?	Yes
	Is antenna located on or in close proximity to an antenna farm?	Yes
Existing Antenna Manufacturer and Type	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Broadband Panel
	Number of Stations Supported	1
	Number of Panels	64
	Design power capacity in use	50.0 %
	Lower Limit	518.00 MHz
	Upper Limit	572.00 MHz
	Other Antenna Type	N/A
	ERP:	266.0 kW
	Manufacturer	DIELECTRIC
	Model	TUA-O4-16/64H-1-T-R
	Year	2000

Primary Antenna

Adjustment to Existing Antenna

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

Primary Antenna

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

Primary Antenna

Other Antenna Cost Not Listed

Information not provided.

Auxiliary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Retune Existing
	Antenna Use	Auxiliary (Backup)
	Description of Use	Backup
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing antenna shared with another station or stations?	No
	Is the existing antenna directional?	No
	Is antenna in operating condition?	Yes
	Is antenna located on or in close proximity to an antenna farm?	Yes
Existing Antenna Manufacturer and Type	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Broadband Panel
	Number of Stations Supported	1
	Number of Panels	32
	Design power capacity in use	50.0 %
	Lower Limit	518.00 MHz
	Upper Limit	572.00 MHz
	Other Antenna Type	N/A
	ERP:	261.0 kW
	Manufacturer	DIELECTRIC
	Model	TUA-04-8-1
	Year	2005

Auxiliary Antenna

Adjustment to Existing Antenna

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

Auxiliary Antenna

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

Auxiliary Antenna

Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

Existing Transmission Line

Section	Question	Response
Existing Transmission Line Description	Type of change	Utilize Existing
	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	Dielectric
	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	1114 feet per run

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Auxiliary Transmission Line

Existing Transmission Line

Section	Question	Response
Existing Transmission Line Description	Type of change	Utilize Existing
	Use	Auxiliary (Backup)
	Description of Use	Backup Line
	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	Dielectric
	Type	Rigid
	Diameter	6 1/8 inches
	Other Diameter	N/A
	Segment Length	19 1/2 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	830 feet per run

Auxiliary Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

Section	Question	Response
Tower Equipment or Rigging Costs Changes	Do you have tower equipment or rigging costs changes?	No

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	400
	Explanation	Outside consulting engineering, legal work, and accounting services, as well as project management for regional and comprehensive repack execution.
Outside RF consulting Engineering Services	Perform engineering study for new channel assignment and antenna development	Yes
	Prepare engineering section of Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	Yes
	For Main Facility	Yes
	Prepare engineering section of Form FCC License to Cover Application	Yes
	For Auxiliary Facility	Yes
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	Yes
	Quantity	2
	Do you have Distributed Transmission System engineering services?	N/A
	Critical Facility	N/A
	Terrain-Shielded Facility	N/A
Attorney and Other Outside Consulting Services	Prepare and file Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	Yes
	For Main Facility	Yes
	Prepare and file Form FCC License to Cover Application	Yes
	For Auxiliary Facility	Yes
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	Yes
	Quantity	2
	NEPA Section 106 environmental review	No
	Environmental Assessment	No
	ASR Modification	Yes
	FAA Consultation (including preparation of FAA Form 7460)	Yes
	Negotiation of Lease and other Matter for Shared Locations	Yes
	Prepare or Review FCC Form 399 for Reimbursement	Yes
	Address transition timing and coordination issues w/ other stations and wireless providers	Yes
RF Field Engineering Services	Comprehensive coverage verification via field study	Yes
	RF exposure measurements	No
	Additional Field Engineering Service	No
	Number of Days	N/A
	Justification	N/A

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Name	Description
Sinclair Internal Costs	Internal Employee Time Costs

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)?	Yes
	Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs?	Yes
	Does this relocation require Equipment Storage?	Yes
	Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change?	Yes
	Does this relocation require MVPD Notification of a Channel Change?	Yes

Other Expenses

Other Expenses Not Listed

Information not provided.

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	$2,581,807.97	$2,313,582.06	N/A	$2,018,738.26	N/A
Total for all systems	$2,908,467.52	$2,606,222.28	N/A	$2,108,091.42	N/A
Primary Transmitter THU9evo-20	$1,588,634.15	$1,537,134.15		$1,252,317.35
RF Combiner	$205,960.02	$205,960.02	N/A	$205,960.02	N/A
Consolidation Service	$20,129.93	$20,129.93	N/A	$20,129.93	N/A
Additional Work	$26,000.00	$26,000.00	N/A	$26,000.00	N/A
Kit Stacking Pumps	$2,855.83	$2,855.83	N/A	$2,855.83	N/A
Additional Site Requirement	$63,508.00	$63,508.00	N/A	$63,508.00	N/A
Transmitter Building	$84,664.00	$84,664.00	See quotes.	$84,664.00	N/A
Additional parts	$30,657.38	$30,657.38	N/A	$30,657.38	N/A
Other -- HVAC Service Type: C Size:6 (Other)	$35,684.60	$35,684.60	N/A	$35,684.60	N/A
Other Electrical Service: Installation	$76,374.39	$76,374.39	N/A	$28,624.39	N/A
2" Rigid Conduit and Wiring (Cost per foot)	$20,800.00	$20,000.00	N/A	N/A	N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	$947,000.00	$900,000.00	N/A	$749,083.20	N/A
Switchgear - industrial 800 amp	$38,200.00	$36,300.00	N/A	$5,150.00	N/A
Transformer 3 phase/480v - 300 KVA	$36,800.00	$35,000.00	N/A	N/A	N/A
Auxiliary Transmitter THU9evo-20	$993,173.82	$776,447.91		$766,420.91
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	$947,000.00	$730,674.09	N/A	$730,647.09	N/A
Filter Retune	$7,960.24	$7,960.24	N/A	$7,960.24	N/A
2" Rigid Conduit and Wiring (Cost per foot)	$10,400.00	$10,000.00	N/A	N/A	N/A
Additional parts	$27,813.58	$27,813.58	N/A	$27,813.58	N/A

Components

Actual Information Description	File Name
RF Combiner	Component Description: Combiner cost. #9500114431 Amount: $1,990.20 Component Description: Transmitter related cost. #9500114427 Amount: $119,947.00 Component Description: Transmitter related cost. #9500114446 Amount: $51,627.50 Component Description: Transmitter related cost. #9500114429 Amount: $32,395.32
Consolidation Service	Component Description: Transmitter related cost. #9500117120 Amount: $20,129.93
Additional Work	Component Description: Transmitter related cost. #2020-01 Amount: $16,000.00 Component Description: Transmitter related cost. #2020-2 Amount: $10,000.00
Kit Stacking Pumps	Component Description: Transmitter related cost. #9500124276 Amount: $2,855.83
Additional Site Requirement	Component Description: Transmitter related cost. #9500121808 Amount: $63,508.00
Transmitter Building	Component Description: Transmitter related cost. #2020-6 Amount: $6,067.00 Component Description: Transmitter building cost. #2046 Amount: $6,600.00 Component Description: Transmitter building cost. #2012 Amount: $36,000.00 Component Description: Transmitter related cost. #2259 Amount: $35,997.00
Additional parts	Component Description: Transmitter related cost. #9500114428 Amount: $14,946.83 Component Description: Transmitter related cost. #20190517 Amount: $15,710.55
Other -- HVAC Service Type: C Size:6 (Other)	Component Description: HVAC system cost. #310216050 Amount: $11,534.60 Component Description: Transmitter related cost. #66952 Amount: $24,150.00
Other Electrical Service: Installation	Component Description: Transmitter related cost. #2012 Amount: $36,000.00 Component Description: Oxygen and acetylene for transmitter installation. #92224142 Amount: $204.39 Component Description: Transmitter related cost. #2046 Amount: $6,600.00 Component Description: Transmitter electrical installation. #50314 Amount: $28,420.00 Component Description: Transmitter related cost. #50278 Amount: $5,150.00
2" Rigid Conduit and Wiring (Cost per foot)	Information not provided.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	Component Description: Transmitter cost, 25% down. #9500093182 Amount: $188,093.30 Component Description: Transmitter related cost 75%. #9500108624 Amount: $560,989.90
Switchgear - industrial 800 amp	Component Description: Switchgear cost. #50278 Amount: $5,150.00
Transformer 3 phase/480v - 300 KVA	Information not provided.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	Component Description: 75% final transmitter payment. #9500135763 Amount: $554,041.47 Component Description: Transmitter related cost 25%. #9500101345 Amount: $176,605.62
Filter Retune	Component Description: Transmitter related cost. #002605 Amount: $7,960.24
2" Rigid Conduit and Wiring (Cost per foot)	Information not provided.
Additional parts	Component Description: Transmitter related cost. #9500114508 Amount: $27,813.58

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	$13,460.00	$12,800.00	N/A	$5,000.00	N/A
Total for all systems	$2,908,467.52	$2,606,222.28	N/A	$2,108,091.42	N/A
Primary Antenna TUA-O4-16/64H-1-T-R	$6,730.00	$6,400.00		$5,000.00
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$5,000.00	N/A
Auxiliary Antenna TUA-04-8-1	$6,730.00	$6,400.00		$0.00
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Sweep test of existing antenna	Component Description: Antenna system checkout. #1422 Amount: $5,000.00
Sweep test of existing antenna	Information not provided.

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	$0.00	$0.00	N/A	$0.00	N/A
Total for all systems	$2,908,467.52	$2,606,222.28	N/A	$2,108,091.42	N/A
Primary Transmission Line	$0.00	$0.00		$0.00
Auxiliary Transmission Line	$0.00	$0.00		$0.00

Components

Information not provided.

Cost Information

Tower Equipment and Rigging Costs

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	$200,607.35	$167,813.02	N/A	$47,339.52	N/A
Total for all systems	$2,908,467.52	$2,606,222.28	N/A	$2,108,091.42	N/A
Outside Professional Services	$200,607.35	$167,813.02		$47,339.52
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	$1,057.50	N/A
Project management of the transition	$63,200.00	$60,000.00	N/A	$39,906.01	N/A
Sinclair Internal Costs	$452.35	$452.35	N/A	$452.35	.
Comprehensive coverage verification via field study, if needed	$84,200.00	$80,000.00	N/A	N/A	N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	$2,105.00	$2,000.00	N/A	N/A	N/A
ASR modification (prepare FCC Form 854)	$2,105.00	$2,000.00	N/A	N/A	N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization	$7,360.00	$0.00	N/A	N/A	N/A
Attorney Fees - Negotiation of lease and other matters for shared locations	$4,210.00	$0.00	N/A	N/A	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$0.00	N/A	N/A	N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application	$4,210.00	$0.00	N/A	N/A	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$221.92	N/A	$221.92	N/A
Prepare request for Special Temporary Authorization	$4,100.00	$3,000.00	N/A	N/A	N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application	$1,580.00	$1,500.00	N/A	N/A	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,638.75	See Carl T Jones invoice	$1,638.75	N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application	$2,105.00	$2,000.00	N/A	N/A	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$1,500.00	N/A
Address transition timing and coordination issues w/ other stations and wireless	$2,630.00	$2,500.00	N/A	N/A	N/A
Prepare and or review reimbursement form	$2,630.00	$2,500.00	N/A	$2,562.99	#461746, #460524 and #453947 should be removed.

Components

Actual Information Description	File Name
Perform engineering study for new channel assignment and antenna development	Component Description: Consulting engineering cost. #878-82-0004 Amount: $285.00 Component Description: Consulting engineering cost. Amount: $1,057.50
Project management of the transition	Component Description: $26,919.78 credit to be split across 93 Sinclair stations reimbursed $999.20 for Invoice 461759 (correct reimbursement amount is $709.74). #CM-11-21-2019-461759 Amount: ($289.46) Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #465001 Amount: $596.30 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #476367 Amount: $364.80 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #479285 Amount: $372.60 Component Description: Legal Service Cost. #478317 Amount: $45.00 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1167 Amount: $313.41 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472985 Amount: $282.68 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #478288 Amount: $194.86 Component Description: Legal services cost. #484788 Amount: $57.50 Component Description: Portion of general repack matter invoice attributable to this station - divided by 54 stations. #236 Amount: $1,117.50 Component Description: Legal services cost. #479338 Amount: $57.50 Component Description: Portion of general repack matter invoice attributable to this station - divided by 38 stations. #170 Amount: $1,374.71 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #477820 Amount: $320.19 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #464321 Amount: $683.07 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #463026 Amount: $801.57 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1045 Amount: $185.10 Component Description: Portion of general repack matter invoice attributable to this station - divided by 99 stations. #468718 Amount: $349.51 Component Description: Legal services cost. #460883 Amount: $615.00 Component Description: Portion of general repack matter invoice attributable to this station - divided by 31 stations. #189 Amount: $1,968.06 Component Description: Legal services cost. #477359 Amount: $352.50 Component Description: Portion of general repack matter invoice attributable to this station - divided by 38 stations. #481976 Amount: $965.23 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #477305 Amount: $393.53 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #480175 Amount: $377.96 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #476885 Amount: $403.34 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #132 Amount: $589.44 Component Description: Portion of general repack matter invoice attributable to this station - divided by 31 stations. #482707 Amount: $1,071.61 Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. #453972 Amount: $716.28 Component Description: Portion of general repack matter invoice attributable to this station - divided by 99 stations. #1086 Amount: $275.35 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1079 Amount: $177.14 Component Description: Legal services cost. #465242 Amount: $177.50 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #471524 Amount: $322.83 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1093 Amount: $265.72 Component Description: Legal services cost. #469642 Amount: $418.75 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1143 Amount: $436.90 Component Description: Legal services cost. #472217 Amount: $301.25 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1145 Amount: $369.98 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1105 Amount: $216.88 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #470923 Amount: $406.65 Component Description: Legal services cost. #470338 Amount: $62.50 Component Description: Legal services cost. #477874 Amount: $1,965.10 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472173 Amount: $311.78 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1156 Amount: $399.52 Component Description: Legal services cost. #474460 Amount: $57.50 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1130 Amount: $281.49 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #474405 Amount: $490.56 Component Description: Legal services cost. #478827 Amount: $45.00 Component Description: Portion of general repack matter invoice attributable to this station - divided by 99 stations. Amount: $377.14 Component Description: Legal services cost. #471585 Amount: $57.50 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472583 Amount: $279.89 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #479829 Amount: $458.99 Component Description: Consulting engineering costs. #878-82-0004 Amount: $285.00 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1072 Amount: $237.64 Component Description: $26,919.78 credit to be split across 93 Sinclair stations reimbursed $999.20 for Invoice 461759 (correct reimbursement amount is $709.74). #CM-11-21-2019-461759 Amount: ($289.46) Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #474809 Amount: $395.77 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #465173 Amount: $654.26 Component Description: Legal services cost. #472640 Amount: $163.75 Component Description: Legal services cost. #460524 Amount: $435.20 Component Description: Legal services cost. #453947 Amount: $172.50 Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. #450412 Amount: $999.04 Component Description: Legal services cost. #464414 Amount: $120.00 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #467861 Amount: $470.30 Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289 Amount: $91.50 Component Description: Legal services cost. #464756 Amount: $57.50 Component Description: Engineering evaluation cost. #878-82-0004 Amount: $285.00 Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. Amount: $731.71 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1090 Amount: $176.70 Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. #1010 Amount: $86.88 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759 Amount: $29.98 Component Description: Legal services cost. #467445 Amount: $365.00 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #466690 Amount: $446.87 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #470237 Amount: $436.37 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #478780 Amount: $271.41 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1111 Amount: $159.58 Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. #457331 Amount: $836.44 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #107 Amount: $602.28 Component Description: Legal services cost. #476941 Amount: $166.25 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1063 Amount: $262.29 Component Description: Legal services cost #467934 Amount: $62.50 Component Description: Legal Service Cost. #474874 Amount: $355.00 Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. Amount: $912.82 Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. #1012 Amount: $20.64 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1114 Amount: $242.25 Component Description: Legal services cost. #481937 Amount: $45.00 Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. Amount: $20.91 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1058 Amount: $187.24 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1099 Amount: $266.93 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #118 Amount: $468.97 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1098 Amount: $238.07 Component Description: Legal services cost. #482728 Amount: $183.75 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #475744 Amount: $305.99 Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. Amount: $107.53 Component Description: Legal services cost. #476430 Amount: $96.25 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1117 Amount: $282.68 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1151 Amount: $388.07 Component Description: Legal services cost. #461746 Amount: $86.70 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1090 Amount: $176.70 Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. Amount: $1,954.93 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1141 Amount: $406.17 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #473506 Amount: $421.40 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1039 Amount: $30.47 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #467378 Amount: $576.96 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1161 Amount: $267.48 Component Description: Legal services cost. #467934 Amount: $62.50 Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. Amount: $32.35 Component Description: Legal services cost. #480212 Amount: $310.00 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1133 Amount: $307.72 Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. #453686 Amount: $943.95 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1123 Amount: $342.14 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #467861 Amount: $470.30 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #463567 Amount: $566.48 Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. #457851 Amount: $818.59 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #473885 Amount: $318.62 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1055 Amount: $243.38 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1078 Amount: $215.68 Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. Amount: $43.72 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. #475283 Amount: $384.08 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1051 Amount: $105.97 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1069 Amount: $246.68
Sinclair Internal Costs	Component Description: Portion of general repack matter invoice attributable to this station - divided by 31 stations. Amount: $4.10 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. Amount: $5.37 Component Description: Portion of general repack matter invoice attributable to this station - divided by 54 stations. Amount: $23.95 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. Amount: $26.93 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. Amount: $33.53 Component Description: Portion of general repack matter invoice attributable to this station - divided by 54 stations. Amount: $8.64 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. Amount: $11.39 Component Description: Portion of general repack matter invoice attributable to this station - divided by 38 stations. Amount: $60.06 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. Amount: $23.96 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. Amount: $8.66 Component Description: Portion of general repack matter internal time card attributable to this station - divided by 100. Amount: $66.55 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. Amount: $16.53 Component Description: Portion of general repack matter invoice attributable to this station - divided by 31 stations. Amount: $52.76 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. Amount: $7.86 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. Amount: $1.69 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. Amount: $17.02 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. Amount: $9.47 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. Amount: $6.09 Component Description: Portion of general repack matter invoice attributable to this station - divided by 38 stations. Amount: $8.19 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. Amount: $7.96 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. Amount: $15.08 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. Amount: $11.03 Component Description: Portion of general repack matter invoice attributable to this station - divided by 100 stations. Amount: $25.53
Comprehensive coverage verification via field study, if needed	Information not provided.
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	Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations	Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Information not provided.
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application	Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289 Amount: $122.00 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759 Amount: $99.92
Prepare request for Special Temporary Authorization	Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application	Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Component Description: Outside professional Service Cost. #878-82-0005 Amount: $1,638.75
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application	Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: Consulting engineering cost. Amount: $1,500.00
Address transition timing and coordination issues w/ other stations and wireless	Information not provided.
Prepare and or review reimbursement form	Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. Amount: $152.01 Component Description: Legal services cost. #461746 Amount: $86.70 Component Description: Legal services Amount: $230.20 Component Description: Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759 Amount: $869.30 Component Description: Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289 Amount: $1,311.48 Component Description: Legal services cost. Amount: $172.50 Component Description: Legal services cost. #460524 Amount: $435.20

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	$112,592.20	$112,027.20	N/A	$37,013.64	N/A
Total for all systems	$2,908,467.52	$2,606,222.28	N/A	$2,108,091.42	N/A
Other Expenses	$112,592.20	$112,027.20		$37,013.64
MVPD Notification of Channel Change	$5,000.00	$5,000.00	See Exhibit J.	N/A	N/A
Develop and air announcement of upcoming channel change	$28,050.00	$28,050.00	See Response to August 14 Inquiry.	N/A	N/A
Equipment Delivery and Handling Charges	$10,000.00	$10,000.00	See Exhibit J.	$4,037.44	Praxair Distribution invoice #92224142 can be deleted.
Disposal Costs (for equipment and other waste, net of any salvage value)	$28,566.00	$28,566.00	See Response to August 14 Inquiry.	$1,130.00	N/A
DTV Medical Facility Notification	$11,550.00	$11,000.00	N/A	$2,950.00	N/A
FCC Filing Fees - Form 2100 license to cover application	$335.00	$325.00	N/A	N/A	N/A
FCC Filing Fees - Special Temporary Authorization request	$195.00	$190.00	N/A	N/A	N/A
Equipment Storage	$28,896.20	$28,896.20	See Exhibit J.	$28,896.20	N/A

Components

Actual Information Description	File Name
MVPD Notification of Channel Change	Information not provided.
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Delivery and Handling Charges	Component Description: Equipment delivery and handling cost. #174384326-002 Amount: $140.00 Component Description: Equipment Delivery and Handling Costs. #174384326-001 Amount: $3,897.44 Component Description: Equipment delivery and handling costs. #92224142 Amount: N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	Component Description: Waste disposal cost. #2330735 Amount: $1,130.00
DTV Medical Facility Notification	Component Description: Medical notification cost. #1309 Amount: $2,950.00
FCC Filing Fees - Form 2100 license to cover application	Information not provided.
FCC Filing Fees - Special Temporary Authorization request	Information not provided.
Equipment Storage	Component Description: Storage related cost. #15270395 Amount: $255.40 Component Description: Equipment storage cost. #16127762 Amount: $255.40 Component Description: Equipment storage cost. #14395658 Amount: $255.40 Component Description: Equipment storage cost. #14106956 Amount: $255.40 Component Description: Equipment storage cost. #14688752 Amount: $255.40 Component Description: Storage cost. #16416878 Amount: $255.40 Component Description: Equipment storage cost. #15556388 Amount: $255.40 Component Description: Storage cost. #16815362 Amount: $162.38 Component Description: Equipment storage cost. #15838016 Amount: $255.40 Component Description: Equipment storage cost. #13815581 Amount: $255.40 Component Description: Equipment Storage related cost. #12924896 Amount: $510.80 Component Description: Storage cost. #17106863 Amount: $162.38 Component Description: Aux consolidation storage equipment. #9500134179 Amount: $20,129.92 Component Description: Equipment Storage related cost. #13120322 Amount: $538.60 Component Description: Equipment storage cost. #14982116 Amount: $255.40 Component Description: Storage cost. #16710224 Amount: $255.40 Component Description: Equipment storage related cost. #13519553 Amount: $276.80 Component Description: Storage cost. #17004803 Amount: $255.40 Component Description: Equipment Storage related cost. #13220294 Amount: $510.80 Component Description: Equipment storage cost. #12629156 Amount: $510.80 Component Description: Equipment storage cost. #12056016 Amount: $2,518.12 Component Description: Equipment storage cost. #12339941 Amount: $510.80

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$2,908,467.52	$2,606,222.28	$2,108,091.42

Reimbursement Status

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

Certification

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.	Lucy Rutishauser CFO 05/06/2021

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.

Lucy Rutishauser

CFO

05/06/2021

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.	Lucy Rutishauser CFO 05/06/2021

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.

Lucy Rutishauser

CFO

05/06/2021

(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

Auxiliary Transmitter

Existing Transmitter Information

Auxiliary Transmitter

New Transmitter Costs

Auxiliary Transmitter

Other Transmitter Costs

Auxiliary Transmitter

Other Transmitter Cost Not Listed

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

Adjustment to Existing Antenna

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Auxiliary Antenna

Existing Antenna Information

Auxiliary Antenna

Adjustment to Existing Antenna

Auxiliary Antenna

Other Antenna Costs

Auxiliary Antenna

Other Antenna Cost Not Listed

Transmission Line

Primary Transmission Line

Existing Transmission Line

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Auxiliary Transmission Line

Existing Transmission Line

Auxiliary Transmission Line

Other Transmission Line Expenses Not Listed

Tower Equipment And Rigging Costs

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

Cost Information

Outside Professional Services

Components