Go to the Federal Communications Commission homepage at www.fcc.gov

FCC Form 399: Reimbursement Request

Approved by OMB 3060-1178
Go to the Federal Communications Commission homepage at www.fcc.gov

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

Facility ID:
591
Service:
DTV
Call Sign:
WAFF
Channel:
15 (UHF)
File Number:
0000024797
FRN:
0018223693
Date Submitted:
04/19/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

GRAY TELEVISION LICENSEE, LLC

Doing Business As: GRAY TELEVISION LICENSEE, LLC

Robert Folliard

4370 PEACHTREE ROAD, NE

ATLANTA, GA 30319

United States

+1 (256) 564-5649 Robert.Folliard@gray.tv Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan Station will install interim antenna and connect to existing tx line Station will install new top mounted antenna and tx line.

Transmitters

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

Auxiliary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Emergency 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 Ranger
Year 2009
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1.1 kW

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model UAXTE-2R37
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.2 kW
Justification for New Transmitter Existing transmitter cannot be re-tuned EOL letter attached

Auxiliary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service Yes
Description Installation of breaker, panel board, and other equipment needed to provide power to transmitter
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Name Description

AuxiliaryTransmitter - De-installation

De-install pre-transition transmitter

Auxiliary Transmitter Installation

Auxiliary Transmitter Installation

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model Ultimate
Year 2003
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power Capacity 2.5 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model ULXTE-60
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 38 kW
Justification for New Transmitter Existing transmitter cannot be re-tuned.

Primary Transmitter

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Other Transmitter Costs

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

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Primary Transmitter- Road Repairs

Road repairs required due to transportation of repack equipment.

Fence to Surround Heat Exchangers

Fence to Surround Heat Exchangers

Primary Transmitter - De-installation

De-install pre-transition transmitter

Primary Transmitter - Video Cables

Primary Transmitter - Video Cables

Primary Transmitter - Other Expenses

Primary Transmitter - Other Expenses

Primary Transmitter - Installation

Primary Transmitter - Installation

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 24.0 kW
Manufacturer
Model TFU-28G
Year 1989

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack 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: 24.5 kW
Manufacturer
Model TFU-16ETT/VP-R
Year 2019
Justification for New Antenna Existing Ch 48 Antenna can not be retuned V-pol premium not reimbursable

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 24.0 kW
Manufacturer
Model TFU-WB8
Year 2019
Justification for New Antenna Side mount Channel 48 antenna needed for transition period to allow for removal of existing top mounted antenna and installation of new.

Interim Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? B
Feed Line Size 4 1/16 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

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 8 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1600 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1600 feet per run
Justification for New Transmission Line Existing Marman clamp transmission line is no longer supported by manufacturer. Existing line now used as interim.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Primary Transmission Line - Other Gases for Welding

Primary Transmission Line - Other Gases for Welding

Primary Transmission Line - RF Switch

Primary Transmission Line - RF Switch

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Rigid
Diameter 4 1/16 inches
Segment Length 20'
Other Segment Length
Number of parallel runs 1
Length 1600 feet per run
Justification for New Transmission Line Initial assumption was the existing line would work post transition, but the existing 8 in line was RCA Caplock which is no longer supported. No additional parts could be ordered to interface with the new post transition channel 15 antenna

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 34° 42' 39.3" N-
Longitude (NAD83) 086° 32' 07.0" W-
Overall Structure Height 1525.90 feet
Support Structure Height 1466.85 feet
Ground Elevation Above Mean Sea Level (AMSL) 1152.22 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner WAFF, LLC
Date Constructed 06/15/1982


Primary Tower

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Tower Modification Costs

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

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower N/A
Helicopter Services Required Are helicopter services required? Yes

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Primary Tower - tree removal

Existing Primary Tower -tree removal

Primary Tower - Structural Engineering Tower Load Study

Existing Primary Tower - Structural Engineering Tower Load Study

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 895
Explanation Pattern analysis Antenna Spec Transmitter Spec Building drawings Installation Supervision Accounting Internal Legal 399 Prep and Reimbursement Project Mgmt
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 No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority 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 No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement No
Address transition timing and coordination issues w/ other stations and wireless providers No
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 3
Justification Required for the installation of various RF parts and to transition station to interim facilities

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Filing Fees - STA

Attorney filing fees for WAFF STA

Attorney - Other Matters

Legal Services

Other Expenses

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

Other Expenses

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Other Expenses Not Listed

Name Description

Site Security

Site Security required due to repack construction

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,894,459.16 $494,338.37 N/A $376,543.35 N/A
Total for all systems $3,902,829.34 $2,343,222.79 N/A $2,056,134.82 N/A
Primary Transmitter ULXTE-60 $1,655,233.66 $340,792.51 $267,297.50
Primary Transmitter - Video Cables $310.00 $310.00 Please see WAFF Primary Transmitter Video Cables Budget Justification Letter $310.00 N/A
Primary Transmitter - De-installation $5,000.00 $5,000.00 Please see WAFF THTV Estimate 1017 Removal and De-Installation of Pre Transition Transmitters N/A N/A
Fence to Surround Heat Exchangers $1,881.00 $1,881.00 Athens Fence Proposal dated 11-25-2019 $1,881.00 N/A
Primary Transmitter- Road Repairs $7,895.00 $7,895.00 Please see Cantrell Proposal dated 4-7-2020 $7,895.00 N/A
Other Electrical Service: Installation of breaker, panel board, and other equipment needed to provide power to transmitter $44,125.50 $44,125.50 Please see attached Jesse Stutts Proposal Dated 07.09.2019 and Jesse Stutts Change Order Dated 09.24.2019. This expense is split between the primary and auxiliary transmitters. $44,125.50 N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $5,231.64 GatesAir Quote 82172 $0.00 N/A
Primary Transmitter - Installation $1,350.59 $1,350.59 Please see WAFF - Primary Transmitter Installation - Budget Revision Justification Cover Letter $1,350.59 N/A
Primary Transmitter - Other Expenses $4,522.09 $4,522.09 Please see WAFF-110-1st Primary Transmitter - Other Expenses V1 $4,522.04 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A $0.00 N/A
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW $1,473,000.00 $192,027.21 Please see WAFF Main TX Proposal $165,063.89 N/A
UHF - Air Cooled Solid State Transmitter 3.4 kW $42,149.48 $42,149.48 ***System Notice: Estimate adjusted and locked because line has been superseded.***Quote attached Headroom analysis attached Existing transmitter can not be retuned. Manufacturer letter attached $42,149.48 N/A
Auxiliary Transmitter UAXTE-2R37 $239,225.50 $153,545.86 $109,245.85
AuxiliaryTransmitter - De-installation $5,000.00 $5,000.00 Please see WAFF THTV Estimate 1017 Removal and De-Installation of Pre Transition Transmitters N/A N/A
Auxiliary Transmitter Installation $350.00 $350.00 Please see WAFF Auxiliary Transmitter - Install Revision Justification Cover Letter $350.00 N/A
Other Electrical Service: Installation of breaker, panel board, and other equipment needed to provide power to transmitter $44,125.50 $44,125.50 Please see attached Jesse Stutts Proposal Dated 07.09.2019 and Jesse Stutts Change Order Dated 09.24.2019. This expense is split between the primary and auxiliary transmitters $44,125.50 N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $24,300.00 N/A $0.00 N/A
Switchgear - industrial 800 amp $38,200.00 $15,000.00 N/A $0.00 N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $64,770.36 see Estimated Cost Justification WAFF-150-1st Auxiliary Transmitter - UHF Air-Cooled Solid State, 1-2.5 kW v0 $64,770.35 N/A

Components

Actual Information Description File Name
Primary Transmitter - Video Cables

Component Description:
Beldon - 1505A - Violet - Per Foot
Amount:
$310.00
Primary Transmitter - De-installation Information not provided.
Fence to Surround Heat Exchangers

Component Description:
Install 35' - 2' galvanized 9 ga chain-link fence
Amount:
$1,881.00
Primary Transmitter- Road Repairs

Component Description:
Mobilize equipment and manpower.
Amount:
$7,895.00
Other Electrical Service: Installation of breaker, panel board, and other equipment needed to provide power to transmitter

Component Description:
Scope of PO- Partial Billing #2
Amount:
$12,400.00

Component Description:
Final Billing
Amount:
$12,404.50

Component Description:
Scope of PO
Amount:
$12,400.00

Component Description:
Change Order Scope of Work
Amount:
$6,921.00
Transformer 3 phase/480v - 300 KVA Information not provided.
Primary Transmitter - Installation

Component Description:
Labor Hours- Project Manager and Material
Amount:
$1,350.59
Primary Transmitter - Other Expenses

Component Description:
PLT8H-L0 PANDUIT CORP
Amount:
$337.83

Component Description:
Freight
Amount:
$1,583.06

Component Description:
Freight
Amount:
$2,353.14

Component Description:
AC Current Sensor
Amount:
$248.01
Switchgear - industrial 800 amp

Component Description:
Invoice moved to correct budget category
Amount:
N/A
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW

Component Description:
A. Mask Filter and RF Accessories
Amount:
$80,764.95

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

Component Description:
"ULXTE-60-WB Channel Change per Quote Q-82172"
Amount:
$84,298.94
UHF - Air Cooled Solid State Transmitter 3.4 kW

Component Description:
Transmitter, Mask Filter Saystem, RF Accessories, Electrical, Installation & Proof
Amount:
$25,289.69

Component Description:
UAXTE-6-E
Amount:
$16,859.79
AuxiliaryTransmitter - De-installation Information not provided.
Auxiliary Transmitter Installation

Component Description:
Adam J. installed square to round
Amount:
$350.00
Other Electrical Service: Installation of breaker, panel board, and other equipment needed to provide power to transmitter

Component Description:
WAFF-150-1st Auxiliary Transmitter - Other Electrical Service
Amount:
$6,921.00

Component Description:
WAFF-150-1st Auxiliary Transmitter - Other Electrical Service
Amount:
$12,400.00

Component Description:
WAFF-150-1st Auxiliary Transmitter - Other Electrical Service
Amount:
$12,404.50

Component Description:
WAFF-150-1st Auxiliary Transmitter - Other Electrical Service
Amount:
$12,400.00
Transformer 3 phase/480v - 150 KVA Information not provided.
Switchgear - industrial 800 amp Information not provided.
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
UAXTE-2-E
Amount:
$5,261.08

Component Description:
"Transmitter Mask Filter Saystem"
Amount:
$27,547.51

Component Description:
ULXTE-2R37 Transmitter
Amount:
$7,350.87

Component Description:
Transmitter, Mask Filter Saystem, Electrical, Installation & Proof
Amount:
$7,891.62

Component Description:
Transmitter
Amount:
$16,719.27

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $368,090.00 $237,030.50 N/A $226,745.48 N/A
Total for all systems $3,902,829.34 $2,343,222.79 N/A $2,056,134.82 N/A
Interim Antenna TFU-WB8 $71,860.00 $69,835.00 $60,580.00
UHF - High Power, Side Mount, basic slot antenna, 24 kW input, directional,, horizontally polarized $54,180.00 $54,180.00 Quote attached $52,791.75 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,400.00 N/A
Elbow complex, broadband, at antenna input, per 4 1/16. feedline (if needed) $10,950.00 $9,255.00 Please see Dielectric order confirmation 131001 $1,388.25 N/A
Primary Antenna TFU-16ETT/VP-R $296,230.00 $167,195.50 $166,165.48
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $160,795.50 Quote attached E-pol premium not included in cost $160,795.49 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $5,369.99 N/A

Components

Actual Information Description File Name
UHF - High Power, Side Mount, basic slot antenna, 24 kW input, directional,, horizontally polarized

Component Description:
Other Elbow complex
Amount:
$6,738.75

Component Description:
ANTENNA
Amount:
$27,090.00

Component Description:
Antenna
Amount:
$13,545.00

Component Description:
Interim Antenna
Amount:
$5,418.00
Sweep test of existing antenna

Component Description:
WAFF-280-Interim Antenna - Sweep test
Amount:
$960.00

Component Description:
WAFF-280-Interim Antenna - Sweep test
Amount:
$1,600.00

Component Description:
WAFF-280-Interim Antenna - Sweep test
Amount:
$3,200.00

Component Description:
Interim Antenna Sweep
Amount:
$640.00
Elbow complex, broadband, at antenna input, per 4 1/16. feedline (if needed)

Component Description:
WAFF-280-Interim Antenna - Elbow Complex
Amount:
$1,388.25
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
UHF - HIGH POWER TOP MOUNT
Amount:
$80,397.75

Component Description:
UHF - High Power Top Mount (200 - EA 1,000 KW)
Amount:
$24,119.33

Component Description:
UHF- HIGH POWER TOP MOUNT
Amount:
$40,198.86

Component Description:
UHF High Power Top Mount (200-1000kW)
Amount:
$16,079.55
Sweep test of existing antenna

Component Description:
WAFF - 210 - Primary Antenna - Sweep Test
Amount:
$3,129.99

Component Description:
Primary Antenna Sweep
Amount:
$640.00

Component Description:
WAFF - 210 - Primary Antenna - Sweep Test
Amount:
$1,600.00

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $792,365.61 $473,919.37 N/A $458,347.87 N/A
Total for all systems $3,902,829.34 $2,343,222.79 N/A $2,056,134.82 N/A
Interim Transmission Line $227,200.00 $23,480.75 $23,480.75
Rigid Transmission Line - copper, 4 1/16" $227,200.00 $23,480.75 Please see Estimated Cost Justification WAFF-380-Interim Transmission Line - Rigid, Copper, 4 1 16 v0 $23,480.75 N/A
Primary Transmission Line $565,165.61 $450,438.62 $434,867.12
Rigid Transmission Line - copper, 6 1/8" $323,200.00 $315,074.25 Please see WAFF-310-Primary Transmission Line - Rigid, Copper, 6 1_8_ Superseded Category Budget Increase Justification Cover Letter v1 $299,502.75 N/A
Primary Transmission Line - RF Switch $14,399.00 $14,399.00 Please see Dielectric quote 1931361 $14,399.00 N/A
Primary Transmission Line - Other Gases for Welding $366.61 $366.61 Please see COMB WAFF Airgas USA LLC 9099117700 Budget Revision Justification Letter $366.61 N/A
Rigid Transmission Line - copper, 4 1/16" $227,200.00 $120,598.76 ***System Notice: Estimate adjusted and locked because line has been superseded.***Quote attached (see interim antenna quote) This is main line replacement even though it is shown inside the interim quote $120,598.76 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 4 1/16"

Component Description:
REDUCER 6-50 EIA X 4-50 EIA CU "QS
Amount:
$1,776.50

Component Description:
AL Sales Tax- Invoice 726009
Amount:
$142.12

Component Description:
WAFF-380-Interim Transmission Line - Rigid, Copper, 4 1/16"
Amount:
$21,562.13
Rigid Transmission Line - copper, 6 1/8"

Component Description:
Rigid Transmission Line - Copper
Amount:
$241,947.32

Component Description:
AL Sales Tax Invoice 723003
Amount:
$22,185.39

Component Description:
RIGID TRANSMISSION LINE
Amount:
$35,370.04

Component Description:
Elbow Complex, SIngle Channel, At Antenna Input
Amount:
$6,132.99
Primary Transmission Line - RF Switch

Component Description:
Dielectric
Amount:
$14,399.00
Primary Transmission Line - Other Gases for Welding

Component Description:
Oxygen Industrial
Amount:
$366.61
Rigid Transmission Line - copper, 4 1/16"

Component Description:
WAFF-310-Primary Transmission Line - Rigid, Copper, 4 1/16"
Amount:
$35,470.22

Component Description:
WAFF-310-Primary Transmission Line - Rigid, Copper, 4 1-16"
Amount:
$70,940.45

Component Description:
Primary Transmission Line
Amount:
$14,188.09

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $483,459.00 $729,044.93 N/A $716,185.93 N/A
Total for all systems $3,902,829.34 $2,343,222.79 N/A $2,056,134.82 N/A
Primary Tower TOWER $483,459.00 $729,044.93 $716,185.93
Minor tower reinforcement/modifications $158,000.00 $196,305.93 Estimated Cost Justification WAFF-410-Existing Primary Tower - Minor Tower Reinforcement Modifications V0 $196,305.93 N/A
Tower Helicopter Lift $70,300.00 $70,300.00 Please see Estimated Cost Justification WAFF-410-Existing Primary Tower - Tower Helicopter Lift v0 $66,800.00 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $10,500.00 Please see the attached Tower King II, Inc. invoice #3179 and FDH Velocitel Invoices 134562 and 127306 $10,500.00 N/A
Tall Tower (greater than 500') $210,500.00 $433,580.00 see Estimated Cost Justification WAFF-410-Existing Primary Tower - Tower Rigging, Tall Tower v0 $433,580.00 N/A
Primary Tower - Structural Engineering Tower Load Study $14,859.00 $14,859.00 Please see Stainless proposals P20_2819_001 and P17_281910_001 $5,500.00 N/A
Primary Tower - tree removal $3,500.00 $3,500.00 Please see Tree Pro Inc estimate dated 2.7.2020 $3,500.00 N/A

Components

Actual Information Description File Name
Minor tower reinforcement/modifications

Component Description:
Engineering Services Down PMT 50%
Amount:
$40,203.00

Component Description:
engineering - material only
Amount:
$4,679.50

Component Description:
engineering - material only
Amount:
$4,679.50

Component Description:
F1905336
Amount:
$1,852.43

Component Description:
TOWER SERVICE
Amount:
$104,688.50

Component Description:
Engineering Services Final
Amount:
$40,203.00
Tower Helicopter Lift

Component Description:
WAFF-410-Existing Primary Tower - Tower Helicopter Lift
Amount:
$32,859.15

Component Description:
License Fee
Amount:
$1,000.00

Component Description:
WAFF-410-Existing Primary Tower - Tower Helicopter Lift
Amount:
$19,764.51

Component Description:
WAFF-410-Existing Primary Tower - Tower Helicopter Lift
Amount:
$13,176.34

Component Description:
Invoice moved to correct budget category.
Amount:
N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Engineering Study
Amount:
$2,500.00

Component Description:
Tower Service - Mapping of WAFF for Repack
Amount:
$5,500.00

Component Description:
Engineering Study
Amount:
$2,500.00
Tall Tower (greater than 500')

Component Description:
Acceptance of Contract Down Payment
Amount:
$130,235.49

Component Description:
Tower Service
Amount:
$86,823.66

Component Description:
Progress payment billing for the WAFF-TV Project in Huntsville AL.
Amount:
$216,520.85
Primary Tower - Structural Engineering Tower Load Study

Component Description:
Broadcast Analysis Down PMT 50%
Amount:
$2,750.00

Component Description:
Broadcast Analysis Final PMT 50%
Amount:
$2,750.00
Primary Tower - tree removal

Component Description:
Tree Removal
Amount:
$3,500.00

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $277,928.84 $330,962.89 N/A $239,039.02 N/A
Total for all systems $3,902,829.34 $2,343,222.79 N/A $2,056,134.82 N/A
Outside Professional Services $277,928.84 $330,962.89 $239,039.02
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $747.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $0.00 N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A $900.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $329.16 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $2,000.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $26,848.98 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $26,848.98 Please see submitted invoices.
Project management of the transition $141,410.00 $180,495.07 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $180,495.07 N/A
Additional Field Engineering Service, 3 Days $25,181.89 $25,181.89 Please see WAFF Field Engineering Services Budget Revision Justification Letter. The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time $25,181.89 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A $0.00 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A $850.00 N/A
Filing Fees - STA $600.00 $600.00 Please see WAFF STA Filing Fees Revision Justification Cover Letter $600.00 N/A
Attorney - Other Matters $1,086.95 $1,086.95 Covington 60801187 $1,086.92 N/A

Components

Actual Information Description File Name
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
WAFF-550-Attorney - License to Cover Application (Main)
Amount:
$747.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization

Component Description:
Consulting Engineer
Amount:
$900.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
WAFF-530-RF Eng - License to Cover Application (Main)
Amount:
$179.16

Component Description:
Consulting Engineer - J. Davis - Hourly
Amount:
$150.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
FCC Form 2100 Construction Permit Application
Amount:
$2,000.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Repack Engineering
Amount:
$4,467.44

Component Description:
WAFF-530-RF Eng - Engineering Study for New Channel Assignment
Amount:
$100.00

Component Description:
WAFF-530-RF Eng - Engineering Study for New Channel Assignment:
Amount:
$3,475.99

Component Description:
Review Dielectric's gain-loss summary sheets for planned antenna/line configuration
Amount:
$775.00

Component Description:
Consulting Engineer
Amount:
$450.00

Component Description:
WAFF-530-RF Eng - Engineering Study for New Channel Assignment
Amount:
$762.50

Component Description:
Engineering study work for new channel assignment and antenna development.
Amount:
$125.00

Component Description:
WAFF-530-RF Eng - Engineering Study for New Channel Assignment
Amount:
$541.66

Component Description:
WAFF-530-RF Eng - Engineering Study for New Channel Assignment
Amount:
$15,001.39

Component Description:
Engineering study work for new channel assignment and antenna development; Preparation of the engineering portion of FCC Form 2100
Amount:
$1,000.00

Component Description:
Initial steps toward review of planned antenna/line configuration for repac CH-15
Amount:
$150.00
Project management of the transition

Component Description:
Project Management
Amount:
$12,627.85

Component Description:
Project Management
Amount:
$3,897.65

Component Description:
Project Management
Amount:
$3,577.85

Component Description:
Project Management
Amount:
$2,156.70

Component Description:
Project Management
Amount:
$6,192.25

Component Description:
Project Management
Amount:
$6,337.00

Component Description:
Project management
Amount:
$8,210.10

Component Description:
Project Management
Amount:
$2,305.25

Component Description:
Project management
Amount:
$8,432.95

Component Description:
Project Management
Amount:
$2,216.20

Component Description:
Project Management
Amount:
$148.86

Component Description:
Project Management
Amount:
$2,572.55

Component Description:
Project Management
Amount:
$43.12

Component Description:
Project Management
Amount:
$1,398.84

Component Description:
Project Management
Amount:
$3,121.90

Component Description:
Project Management
Amount:
$2,565.85

Component Description:
Project Management
Amount:
$3,296.95

Component Description:
Project Management
Amount:
$11,715.05

Component Description:
Project Management
Amount:
$3,057.30

Component Description:
Project Management
Amount:
$4,402.00

Component Description:
Project Management
Amount:
$6,032.05

Component Description:
Project Management
Amount:
$77.00

Component Description:
Off-Duty Officers
Amount:
$360.00

Component Description:
Off-Duty Officers
Amount:
$540.00

Component Description:
Off-Duty Officers
Amount:
$360.00

Component Description:
Project management
Amount:
$10,291.80

Component Description:
Project Management
Amount:
$48.76

Component Description:
System floor plan design, Project Management
Amount:
$1,768.44

Component Description:
Off-Duty Officers
Amount:
$720.00

Component Description:
Project Management
Amount:
$9,267.45

Component Description:
Project Management
Amount:
$3,356.20

Component Description:
Project Management
Amount:
$8,710.15

Component Description:
Project Management
Amount:
$6,985.90

Component Description:
Project Management
Amount:
$736.63

Component Description:
Project Management
Amount:
$3,697.50

Component Description:
Off-Duty Officers
Amount:
$180.00

Component Description:
Project Management
Amount:
$3,356.20

Component Description:
Project Management
Amount:
$2,343.15

Component Description:
Project Management
Amount:
$174.53

Component Description:
Project Management
Amount:
$2,156.70

Component Description:
Project Management
Amount:
$56.46

Component Description:
Off-Duty Officers
Amount:
$360.00

Component Description:
Project Management
Amount:
$272.05

Component Description:
Off-Duty Officers
Amount:
$360.00

Component Description:
Off-Duty Officers
Amount:
$630.00

Component Description:
Project Management
Amount:
$17,133.15

Component Description:
Project Management
Amount:
$2,357.20

Component Description:
Off-Duty Officers
Amount:
$360.00

Component Description:
WAFF-510-Project Management
Amount:
$41.07

Component Description:
Project management
Amount:
$5,143.65

Component Description:
Off-Duty Officers
Amount:
$720.00

Component Description:
Project Management
Amount:
$4,555.90

Component Description:
Project Management
Amount:
$77.00

Component Description:
Off-Duty Officers
Amount:
$360.00

Component Description:
Project Management
Amount:
$318.26

Component Description:
Project Management
Amount:
$8,774.55
Additional Field Engineering Service, 3 Days

Component Description:
Travel
Amount:
$17,581.85

Component Description:
WAFF-530-RF Eng - Additional Field Engineering Service
Amount:
$7,600.04
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Total Professional Services
Amount:
$850.00
Filing Fees - STA

Component Description:
For Professional Services Rendered
Amount:
$200.00

Component Description:
WAFF-550-Attorney - Filing Fees - STA
Amount:
$400.00
Attorney - Other Matters

Component Description:
Professional legal services
Amount:
$1,086.92

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $86,526.73 $77,926.73 N/A $39,273.17 N/A
Total for all systems $3,902,829.34 $2,343,222.79 N/A $2,056,134.82 N/A
Other Expenses $86,526.73 $77,926.73 $39,273.17
Site Security $17,190.00 $17,190.00 see Estimated Cost Justification WAFF-610-Site Security v2 $17,190.00 N/A
Equipment Delivery and Handling Charges $20,050.25 $20,050.25 See Estimated Cost Justification WAFF-610-Equipment Delivery and Handling v2 $12,301.69 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $1,933.18 $1,933.18 Please see Estimated Cost Justification WAFF-610-Disposal v0 $1,933.18 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 Please see WAFF Filing Fee - License to Cover Budget Justification Cover Letter $335.00 N/A
DTV Medical Facility Notification $11,550.00 $2,950.00 Group quote attached $2,950.00 N/A
MVPD Notification of Channel Change $2,118.30 $2,118.30 Estimated Cost Justification WAFF-610-MVPD Notifications v0 $2,118.30 N/A
Develop and air announcement of upcoming channel change $2,850.00 $2,850.00 estimate for on air rescan announcement production. Quote attached $0.00 N/A
Equipment Storage $30,500.00 $30,500.00 Estimate for Dielectric on site antenna storage Dielectric letter attached $2,445.00 N/A

Components

Actual Information Description File Name
Site Security

Component Description:
Joshua Smith
Amount:
$360.00

Component Description:
Eric Watkins
Amount:
$360.00

Component Description:
Angela Nance-Woods
Amount:
$720.00

Component Description:
Jefford Wright
Amount:
$180.00

Component Description:
Joseph Deboer
Amount:
$360.00

Component Description:
Joseph Deboer
Amount:
$360.00

Component Description:
Gerald Johnson
Amount:
$720.00

Component Description:
Timothy Richards
Amount:
$360.00

Component Description:
Donald Long
Amount:
$360.00

Component Description:
Kevin Lambert
Amount:
$360.00

Component Description:
Joseph Deboer
Amount:
$630.00

Component Description:
Donald Long
Amount:
$180.00

Component Description:
Kevin Lambert
Amount:
$360.00

Component Description:
Joshua Smith
Amount:
$360.00

Component Description:
Gerald Johnson
Amount:
$360.00

Component Description:
Angela Nance-Woods
Amount:
$360.00

Component Description:
Joseph Deboer
Amount:
$360.00

Component Description:
Dequan Hyter
Amount:
$360.00

Component Description:
Off-Duty Officers
Amount:
$360.00

Component Description:
Joshua Smith
Amount:
$360.00

Component Description:
Joshua Smith
Amount:
$360.00

Component Description:
Stephen Gibbs
Amount:
$360.00

Component Description:
Dequan Hyter
Amount:
$360.00

Component Description:
Invoice to be resubmitted.
Amount:
N/A

Component Description:
Joseph Deboer
Amount:
$360.00

Component Description:
Timothy Richards
Amount:
$360.00

Component Description:
Invoice to be resubmitted.
Amount:
N/A

Component Description:
Invoice to be resubmitted.
Amount:
N/A

Component Description:
Robert Glaser
Amount:
$360.00

Component Description:
Jefford Wright
Amount:
$180.00

Component Description:
Dequan Hyter
Amount:
$360.00

Component Description:
Gerald Johnson
Amount:
$360.00

Component Description:
Timothy Richards
Amount:
$720.00

Component Description:
Joshua Smith
Amount:
$360.00

Component Description:
Donald Long
Amount:
$180.00

Component Description:
Invoice to be resubmitted.
Amount:
N/A

Component Description:
Joshua Smith
Amount:
$360.00

Component Description:
Donald Long
Amount:
$360.00

Component Description:
Dequan Hyter
Amount:
$360.00

Component Description:
Invoice to be resubmitted.
Amount:
N/A

Component Description:
Donald Long
Amount:
$720.00

Component Description:
Eric Watkins
Amount:
$360.00

Component Description:
Gerald Johnson
Amount:
$720.00

Component Description:
Stephen Gibbs
Amount:
$360.00

Component Description:
Donald Long
Amount:
$360.00

Component Description:
Timothy Richards
Amount:
$720.00

Component Description:
Invoice to be resubmitted.
Amount:
N/A

Component Description:
Timothy Richards
Amount:
$720.00

Component Description:
Gerald Johnson
Amount:
$540.00

Component Description:
Gerald Johnson
Amount:
$720.00

Component Description:
Gerald Johnson
Amount:
$720.00

Component Description:
Invoice to be resubmitted.
Amount:
N/A

Component Description:
Matthew Edger
Amount:
$180.00

Component Description:
Timothy Richards
Amount:
$360.00

Component Description:
Invoice to be resubmitted.
Amount:
N/A

Component Description:
Donald Long
Amount:
$360.00

Component Description:
Donald Long
Amount:
$360.00

Component Description:
Invoice to be resubmitted.
Amount:
N/A

Component Description:
Invoice to be resubmitted.
Amount:
N/A

Component Description:
Eric Watkins
Amount:
$720.00

Component Description:
Invoice to be resubmitted.
Amount:
N/A

Component Description:
Eric Watkins
Amount:
$360.00

Component Description:
Gerald Johnson
Amount:
$360.00

Component Description:
Joseph Deboer
Amount:
$360.00

Component Description:
Timothy Richards
Amount:
$360.00

Component Description:
Invoice to be resubmitted.
Amount:
N/A

Component Description:
Gerald Johnson
Amount:
$360.00

Component Description:
Dequan Hyter
Amount:
$360.00

Component Description:
Invoice to be resubmitted.
Amount:
N/A

Component Description:
Angela Nance-Woods
Amount:
$720.00
Equipment Delivery and Handling Charges

Component Description:
WAFF-610-Equipment Delivery and Handling
Amount:
$6,728.63

Component Description:
WAFF-610-Equipment Delivery and Handling
Amount:
$2,378.57

Component Description:
Freight and shipping
Amount:
$186.81

Component Description:
FREIGHT AND SHIPPING
Amount:
$434.25

Component Description:
FREIGHT AND SHIPPING
Amount:
$4,952.00
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Delivery 20 yd open top
Amount:
$257.18

Component Description:
20 Yd flat rolloff
Amount:
$488.91

Component Description:
20 Yd flat rolloff
Amount:
$1,187.09
FCC Filing Fees - Form 2100 license to cover application

Component Description:
For Professional Services Rendered
Amount:
$335.00
DTV Medical Facility Notification

Component Description:
Medical Notification
Amount:
$2,950.00
MVPD Notification of Channel Change

Component Description:
Prepare WAFF MVPD Repack Notices
Amount:
$2,118.30
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage

Component Description:
WAFF-610-Equipment Storage
Amount:
$2,445.00

Component Description:
WAFF-610-Equipment Storage
Amount:
$1,800.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,902,829.34 $2,343,222.79 $2,056,134.82

Reimbursement Status

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

Certification

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Section Question Response
Submission of Estimated Expenses Statements

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

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

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

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

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

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

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

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

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

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

Robert Folliard , III .

Assistant Secretary


04/19/2021

Certification

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Section Question Response
Submission of Actual Cost Documentation Statements

WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733).

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

  2. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct.

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

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

  5. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) .

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

  7. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.

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

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

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

Robert Folliard , III .

Assistant Secretary


04/19/2021

Attachments

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