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:
30577
Service:
DTV
Call Sign:
WUTF-TV
Channel:
19 (UHF)
File Number:
0000028350
FRN:
0001529627
Date Submitted:
06/21/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

ENTRAVISION HOLDINGS, LLC

Mark Boelke

Suite 6000 West

2425 Olympic Boulevard

Santa Monica, CA 90404

United States

+1 (310) 447-3896 mboelke@entravision.com 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

Samuel Hariton

Widelity

4031 University Dr

Suite 100

Fairfax, VA 22030

United States

+1 (339) 222-8107 sam.hariton@widelity.com

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 The plan is for WUNI to replace the existing Channel 29 system with a new Channel 19 antenna, new 8-3/16" line, and a new transmitter.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model DHD60P2
Year 2005
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power Capacity 60 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-120
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 75.1 kW
Justification for New Transmitter The existing transmitter is not capable of being retuned per the manufacturer and will need to be replaced.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring Yes
Size 2 inches
Length 250.0 feet
Other Electrical Service Yes
Description The new main transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, WUNI estimated the electrical work cost.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 20 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 1500.0 square feet
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

4 Inch Rigid Conduit and Wiring - Cost per foot

New conduit and wiring required for new WUTF power service needed for repack per ATC - approximately 45 feet.

Transmitter - Other Expenses

Transmitter - Other Expenses

New Electrical Sub-panels

New Sub Panel an Installation for WUTF Power per WUTF 282685 Needham Heights Cost Estimates 5-30-2018

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 Lease 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: 270.0 kW
Manufacturer
Model ATW25H27-HTO
Year 2005

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 Lease New
Is this a request for upgraded equipment? Yes
Ownership Leased
Owner ATC
Is antenna shared? Yes
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 5
Number of Panels/Bays 14
Lower Limit 470.00 MHz
Upper Limit 700.00 MHz
Design power capacity in use 91.0 %
Other Antenna Type N/A
ERP: 970.0 kW
Manufacturer
Model PEP70E
Year 2019
Justification for New Antenna New antenna necessary to accommodate repack channels on shared tower at Needham Heights ATC site.

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? Yes
Type New
Number of channels supported 5
Frequencies of channels supported Upper and lower frequency
Frequency 503.0 MHz - 515.0 MHz
Do you need a combiner output splitter/switcher for dual feed lines? No
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Broadband
Feed Line Size 8 3/16 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna?
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 Lease New
Ownership Leased
Owner ATC
Is antenna shared? Yes
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Slot
Number of Stations Supported 3
Number of Panels/Bays 24
Lower Limit 470.00 MHz
Upper Limit 700.00 MHz
Design power capacity in use 92.0 %
Other Antenna Type N/A
ERP: 75.0 kW
Manufacturer
Model TFU-24WB-1-R C170
Year 2018
Justification for New Antenna Interim side mounted antenna needed at new shared tower location while new primary antenna and line work is completed.

Interim Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? Yes
Type Additional Module
Number of channels supported 2
Frequencies of channels supported Upper and lower frequency
Frequency 503.0 MHz - 515.0 MHz
Do you need a combiner output splitter/switcher for dual feed lines? No
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? B
Feed Line Size 8 3/16 inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for an antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Interim Antenna

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Other Antenna Cost Not Listed

Name Description

Ice Shield

Ice Shield

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 Lease 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 Other
Other Segment Length 19.8 feet
Number of parallel runs 1
Length 1560 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 Lease New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 8 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 2
Length 1500 feet per run
Justification for New Transmission Line WUTF will be making use of a refurbished existing transmission line leased from ATC for its new primary transmission line at new tower location.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Primary Transmission Line - Additional Pieces

Primary Transmission Line - Additional Pieces

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Lease New
Type Rigid
Diameter 8 3/16 inches
Segment Length 20'
Other Segment Length
Number of parallel runs 1
Length 1330 feet per run
Justification for New Transmission Line WUTF will be making use of a refurbished existing transmission line leased from ATC for its interim transmission line at the new tower location.

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Interim Transmission Line - Additional Pieces

Interim Transmission Line - Additional Pieces

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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Add Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1003433
Coordinates (NAD83) Latitude (NAD83) 42° 18' 37.0" N-
Longitude (NAD83) 071° 14' 12.0" W-
Overall Structure Height 1296.24 feet
Support Structure Height 1192.24 feet
Ground Elevation Above Mean Sea Level (AMSL) 152.89 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner American Towers LLC
Date Constructed 01/01/1957

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

Facility ID Call Sign Service
6463 WFXT DTV
65684 WCVB-TV DTV
51864 WNEU DTV
72098 WGBX-TV DTV
73982 WSBK-TV DTV
25456 WBZ-TV DTV

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? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Tower Permit Drawing Package - Cost Per Customer

Necessary for WUTF to move to shared ATC Antenna. Please see ATC Boston Repack Market Plan_WUTF_15May2018 for full details on the Needham Heights plan.

Construction Project Management - Tower Modification Reinforcements and Facilities

Necessary for WUTF to move to shared ATC Antenna. Please see ATC Boston Repack Market Plan_WUTF_15May2018 for full details on the Needham Heights plan.

Structural Engineering Tower Load Study

Necessary to assess repack plan on shared antenna owned by ATC. Please see ATC Boston Repack Market Plan_WUTF_15May2018 for full details on the Needham Heights plan.

Ground and Building A and E Permit Drawing Package - Cost Per Customer

Necessary for WUTF to move to shared ATC Antenna. Please see ATC Boston Repack Market Plan_WUTF_15May2018 for full details on the Needham Heights plan.

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Construct New
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1024374
Coordinates (NAD83) Latitude (NAD83) 42° 20' 09.0" N-
Longitude (NAD83) 071° 42' 55.0" W-
Overall Structure Height 1350.05 feet
Support Structure Height 1285.42 feet
Ground Elevation Above Mean Sea Level (AMSL) 698.81 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Entravision Communications Corporation
Date Constructed 10/01/2004

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

Facility ID Call Sign Service
74467 WAAF FM

Primary Tower

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Tower Construction Costs

Section Question Response
Construct New Tower Use Primary (Main)
Description of Use N/A
Is this a request for upgraded equipment? No
Height 1285.00 feet
Justification for New Tower The cost to upgrade the existing tower to meet the structural capacity needs as a result of WUNI's new antenna and line would be significantly more than the cost to construct a new tower capable of holding the new equipment.

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? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Existing Tower Structural

After the mapping, a structural was run to analyze the existing tower. This led to determination of need for a new tower.

Existing Tower Mapping

Mapping was necessary in order to be able to run a structural on the existing tower.

Existing Tower Rigging

The interim antenna and line will be installed on the existing tower, and will need a separate Rigging charge.

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 712
Explanation WUNI does not have sufficient resource capacity and expertise in house to handle all of the reimbursement filing by the construction deadline for Phase 4 on August 2, 2019. WUNI will hire an outside firm to ensure a timely and well managed transition.
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 Yes
Environmental Assessment Yes
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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

Other Expenses

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Other Expenses Not Listed

Name Description

Generator

Generator

ATC Site Coordination

ATC Site Coordination Meeting

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 $2,574,636.02 $2,468,836.02 N/A $927,526.08 N/A
Total for all systems $5,261,833.16 $3,697,644.62 N/A $1,922,061.22 N/A
Primary Transmitter ULXTE-120 $2,574,636.02 $2,468,836.02 $927,526.08
Primary Transmitter - Installation $71,788.02 $71,788.02 Please see WUTF-TV Primary Transmitter Installation Budget Revision Justification Letter $21,671.45 N/A
New Electrical Sub-panels $10,000.00 $10,000.00 See WUTF-TV American Tower Customer Project Cost Estimation - Needham Heights $10,000.00 N/A
4 Inch Rigid Conduit and Wiring - Cost per foot $4,050.00 $4,050.00 Please see attached WUTF-TV American Tower Customer Project Cost Estimation - Needham Heights $4,050.00 N/A
Other -- Building Addition Size: 1500.0 $9,387.95 $9,387.95 Please see attached WUTF-TV American Tower Customer Project Cost Estimation - Needham Heights $9,387.95 N/A
20 Ton system $115,500.00 $47,000.00 WUTF's share of HVAC system at new shared transmitter site per WUTF 282685 Needham Heights 399 cost estimates 5-30-2018 $18,800.00 N/A
Other Electrical Service: The new main transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, WUNI estimated the electrical work cost. $187,919.00 $187,919.00 Per Estimated Cost JustificationWUTF-110-Electrical Service New 1st Primary Transmitter V2 $187,918.00 N/A
2" Rigid Conduit and Wiring (Cost per foot) $6,500.00 $6,000.00 Please see attached WUTF-TV American Tower Customer Project Cost Estimation - Needham Heights $6,000.00 N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $0.00 Superfluous category. This item is now included in Estimated Cost Justification WUTF-110-New 1st Primary Transmitter v1 as part of the transmitter cost. $0.00 All invoices in this category should be rejected
Transmitter - Other Expenses $10,862.30 $10,862.30 Please see GatesAir quote Q-88310 $10,862.30 N/A
UHF - Liquid Cooled Solid State Transmitter 75.1 kW $2,119,818.80 $2,119,818.80 Please see attached Estimated Cost Justification WUTF-110-New 1st Primary Transmitter v1 $656,826.43 N/A
UHF - Liquid Cooled Solid State Transmitter 64.0 kW $2,009.95 $2,009.95 ***System Notice: Estimate adjusted and locked because line has been superseded.***see Estimated Cost Justification WUTF-110-New 1st Primary Transmitter v1 $2,009.95 N/A

Components

Actual Information Description File Name
Primary Transmitter - Installation

Component Description:
Work included the unloading of the transmitter, the installation of a GatesAir ULXTE-120 transmitter and the connection of the transmitter to 2 different combiners.
Amount:
$21,671.45
New Electrical Sub-panels

Component Description:
4. WUTF-110-New Electrical Sub-Panels for New 1st Primary Transmitter
Amount:
$7,500.00

Component Description:
2. WUTF-110-New Electrical Sub-Panels for New 1st Primary Transmitter
Amount:
$2,500.00
4 Inch Rigid Conduit and Wiring - Cost per foot

Component Description:
2. WUTF-110-4" Rigid conduit and wiring 1st Primary Transmitter
Amount:
$4,050.00
Other -- Building Addition Size: 1500.0

Component Description:
3. WUTF-110-Primary Transmitter - Building Addition
Amount:
$9,387.95
20 Ton system

Component Description:
1. WUTF-110-HVAC New 1st Primary Transmitter:
Amount:
$18,800.00
Other Electrical Service: The new main transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, WUNI estimated the electrical work cost.

Component Description:
CAPITAL CONTRIBUTION - BOSTON T1 MA / 282685 / ASSET#282685 / OAA727372 / ASR/FID: 1003433 / 30577
Amount:
$11,786.00

Component Description:
Job Description: Invoice for 50% of WUTF Generator
Amount:
$114,607.00

Component Description:
Job Description: Invoice for 50% WUTF Transmitter
Amount:
$88,066.50

Component Description:
Invoice for 100% of WUTF Generator
Amount:
$126,487.00

Component Description:
Invoice for remaining 50% WUTF Transmitter 140 Cabot St. Needham, MA
Amount:
$88,065.50
2" Rigid Conduit and Wiring (Cost per foot)

Component Description:
1. WUTF-110-2" Rigid conduit and wiring 1st Primary Transmitter
Amount:
$4,750.00

Component Description:
CAPITAL CONTRIBUTION - BOSTON T1 MA / 282685
Amount:
$1,250.00
Transformer 3 phase/480v - 300 KVA

Component Description:
Please deny this invoice, it is all reimbursed in Transmitter category now.
Amount:
N/A

Component Description:
Please deny this invoice, it is all reimbursed in Transmitter category now.
Amount:
N/A
Transmitter - Other Expenses

Component Description:
FIELD SERVICE, TV
Amount:
$10,862.30
UHF - Liquid Cooled Solid State Transmitter 75.1 kW

Component Description:
Transmitter
Amount:
$292,027.53

Component Description:
Transmitter
Amount:
$364,798.90
UHF - Liquid Cooled Solid State Transmitter 64.0 kW

Component Description:
RDCR. STEP 6-1/8" - 3-1/8"
Amount:
$2,009.95

Component Description:
Invoice has been moved, category has been superseded.
Amount:
N/A

Component Description:
Invoice has been moved, category has been superseded.
Amount:
N/A

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 $443,563.21 $428,191.04 N/A $406,338.74 N/A
Total for all systems $5,261,833.16 $3,697,644.62 N/A $1,922,061.22 N/A
Interim Antenna TFU-24WB-1-R C170 $227,645.61 $203,348.45 $195,864.02
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $21,600.00 See WUTF American Tower Cost Estimate Needham Heights Boston T1 MA_282685 $14,282.24 N/A
Ice Shield $1,175.00 $1,175.00 WUTF 282685 Needham Heights 399 cost estimates 5-30-2018 $1,175.00 N/A
UHF - High Power, Side Mount, basic slot antenna, 24 bay,, 75 kW input, horizontally polarized $93,440.61 $93,440.61 WUTF's portion of antenna equipment and installation costs on shared interim antenna. Please see attached WUTF-TV American Tower Customer Project Cost Estimation - Needham Heights $93,440.61 N/A
Elbow complex, broadband, at antenna input, per 8 3/16. feedline (if needed) $18,950.00 $2,677.50 Per Estimated Cost Justification WUTF-280-New Interim Antenna - Elbow complex for interim antenna v0 $2,677.50 N/A
Sweep test of existing antenna $6,730.00 $2,250.00 WUTF's portion of sweep test costs on shared interim antenna per WUTF 282685 Needham Heights 399 cost estimates 5-30-2018 $2,083.33 N/A
Adding a module to existing combiner (without antenna) $84,200.00 $82,205.34 WUTF’s portion of shared combiner module purchase and installation costs on shared interim antenna. Please see attached WUTF-TV American Tower Customer Project Cost Estimation - Needham Heights. $82,205.34 N/A
Primary Antenna PEP70E $215,917.60 $224,842.59 $210,474.72
UHF - High Power Top Mount Five Station broadband panel antenna elliptically or circularly polarized $106,037.60 $106,037.60 Please see attached WUTF-TV American Tower Customer Project Cost Estimation - Needham Heights $92,086.40 N/A
Elbow complex, broadband, at antenna input, per 8 3/16. feedline (if needed) $18,950.00 $8,000.00 WUTF's portion of elbow complex costs on shared primary antenna per WUTF 282685 Needham Heights 399 cost estimates 5-30-2018 $8,000.00 N/A
New combiner, cost per channel (without antenna) $84,200.00 $108,304.99 WUTF’s portion of new combiner purchase ($93,105.41) and installation ($15,199.58). Please see attached WUTF-TV American Tower Customer Project Cost Estimation - Needham Heights. $108,304.99 N/A
Sweep test of existing antenna $6,730.00 $2,500.00 WUTF's portion of sweep test costs on shared Primary antenna per WUTF 282685 Needham Heights 399 cost estimates 5-30-2018 $2,083.33 N/A

Components

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

Component Description:
24. WUTF-280-New Interim Antenna - Side Mount Brackets
Amount:
$2,980.54

Component Description:
22. WUTF-280-New Interim Antenna - Side Mount Brackets
Amount:
$993.50

Component Description:
WUTF-280-New Interim Antenna - Side Mount Brackets
Amount:
$10,308.20
Ice Shield

Component Description:
28. WUTF-280-New Interim Antenna - Ice Shield
Amount:
$881.25

Component Description:
26. WUTF-280-New Interim Antenna - Ice Shield
Amount:
$293.75
UHF - High Power, Side Mount, basic slot antenna, 24 bay,, 75 kW input, horizontally polarized

Component Description:
20. WUTF-280-New Interim Antenna
Amount:
$70,080.53

Component Description:
18. WUTF-280-New Interim Antenna
Amount:
$23,360.08
Elbow complex, broadband, at antenna input, per 8 3/16. feedline (if needed)

Component Description:
23. WUTF-280-New Interim Antenna - Elbow complex for interim antenna
Amount:
$2,007.99

Component Description:
21. WUTF-280-New Interim Antenna - Elbow complex for interim antenna
Amount:
$669.33

Component Description:
WUTF-280-New Interim Antenna - Elbow complex for interim antenna
Amount:
$0.18
Sweep test of existing antenna

Component Description:
22. WUTF-280-New Interim Antenna - Sweep test of existing antenna
Amount:
$1,562.50

Component Description:
20. WUTF-280-New Interim Antenna - Sweep test of existing antenna
Amount:
$520.83
Adding a module to existing combiner (without antenna)

Component Description:
21. WUTF-280-New Interim Antenna - Combiner Module
Amount:
$65,830.34

Component Description:
19. WUTF-280-New Interim Antenna - Combiner Module
Amount:
$16,375.00
UHF - High Power Top Mount Five Station broadband panel antenna elliptically or circularly polarized

Component Description:
5. WUTF-210-New Primary Antenna
Amount:
$67,070.10

Component Description:
3. WUTF-210-New Primary Antenna
Amount:
$20,677.50

Component Description:
CAPITAL CONTRIBUTION
Amount:
$4,338.80
Elbow complex, broadband, at antenna input, per 8 3/16. feedline (if needed)

Component Description:
8. WUTF-210-Elbow Complex New Primary Antenna
Amount:
$6,000.00

Component Description:
6. WUTF-210-Elbow Complex New Primary Antenna
Amount:
$2,000.00
New combiner, cost per channel (without antenna)

Component Description:
6. WUTF-210-New Primary Antenna - New Combiner
Amount:
$91,929.99

Component Description:
4. WUTF-210-New Primary Antenna - New Combiner
Amount:
$16,375.00
Sweep test of existing antenna

Component Description:
7. WUTF-210-Sweep Test New Primary Antenna
Amount:
$1,562.50

Component Description:
5. WUTF-210-Sweep Test New Primary Antenna
Amount:
$520.83

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,526,493.52 $94,478.52 N/A $23,983.52 N/A
Total for all systems $5,261,833.16 $3,697,644.62 N/A $1,922,061.22 N/A
Interim Transmission Line $473,685.50 $27,500.50 $12,175.50
Interim Transmission Line - Additional Pieces $12,175.50 $12,175.50 Please see American Tower Customer Project Cost Estimation (Needham Heights Boston T1 MA /282685) WUTF $12,175.50 N/A
Rigid Transmission Line - copper, 8 3/16" $461,510.00 $15,325.00 WUTF's share of refurbishing existing transmission line at ATC shared site. Please see ATC document WUTF 282685 Needham Heights 399 cost estimates 5-30-2018 N/A N/A
Primary Transmission Line $1,052,808.02 $66,978.02 $11,808.02
Primary Transmission Line - Additional Pieces $11,808.02 $11,808.02 Please see American Tower Customer Project Cost Estimation (Needham Heights Boston T1 MA /282685) WUTF $11,808.02 N/A
Rigid Transmission Line - copper, 8 3/16" $1,041,000.00 $55,170.00 WUTF's share of refurbishing existing transmission line at ATC shared site. Please see ATC document WUTF 282685 Needham Heights 399 cost estimates 5-30-2018 N/A N/A

Components

Actual Information Description File Name
Interim Transmission Line - Additional Pieces

Component Description:
WUTF-380-Interim Transmission Line - Additional Pieces
Amount:
$12,175.50
Rigid Transmission Line - copper, 8 3/16" Information not provided.
Primary Transmission Line - Additional Pieces

Component Description:
WUTF-310-Primary Transmission Line - Additional Pieces
Amount:
$11,808.02
Rigid Transmission Line - copper, 8 3/16" Information not provided.

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 $446,043.73 $400,338.31 N/A $374,616.65 N/A
Total for all systems $5,261,833.16 $3,697,644.62 N/A $1,922,061.22 N/A
Primary Tower TOWER $0.00 $0.00 $0.00
Primary Tower TOWER $434,771.72 $389,066.30 $363,344.64
Structural Engineering Tower Load Study $7,100.00 $7,100.00 Please see Estimated Cost Justification WUTF-410-Tower Load Study on Newly Leased Tower v1 $7,099.99 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $7,008.95 see Estimated Cost Justification WUTF-410-Tower Mapping on newly leased tower v0 $4,960.00 N/A
Construction Project Management - Tower Modification Reinforcements and Facilities $23,565.72 $23,565.72 See Estimated Cost Justification WUTF-410-Construction Project Management-Equipment installation on Newly Leased Tower v0 $23,565.71 N/A
Tall Tower (greater than 500') $210,500.00 $277,219.09 see Estimated Cost Justification WUTF-410-Complex Tower-Tower Rigging v0 $258,419.07 N/A
Minor tower reinforcement/modifications $158,000.00 $64,866.54 See WUTF-TV American Tower Customer Project Cost Estimation - Needham Heights $64,866.53 N/A
Ground and Building A and E Permit Drawing Package - Cost Per Customer $4,606.00 $4,606.00 WUTF's portion of Building Permit Package on shared tower owned by ATC. Please see document WUTF 282685 Needham Heights 399 cost estimates 5-30-2018 $1,566.67 N/A
Tower Permit Drawing Package - Cost Per Customer $4,700.00 $4,700.00 WUTF's portion of Tower Modification costs on shared tower owned by ATC for Primary Antenna. Please see document WUTF 282685 Needham Heights 399 cost estimates 5-30-2018 $2,866.67 N/A
Primary Tower $11,272.01 $11,272.01 $11,272.01
Existing Tower Mapping $11,272.01 $11,272.01 ***System Notice: Estimate adjusted and locked because line has been superseded.***See H.C.Jeffries Invoice #20081789 - Superseded - WUTF will no longer be constructing a new tower, but will be moving to shared ATC tower location. Please see ATC Boston Repack Market Plan_WUTF_15May2018 for specifics. $11,272.01 N/A

Components

Actual Information Description File Name
Structural Engineering Tower Load Study

Component Description:
26. WUTF-410-Tower Load Study on Newly Leased Tower
Amount:
$2,375.00

Component Description:
24. WUTF-410-Tower Load Study on Newly Leased Tower
Amount:
$791.66

Component Description:
WUTF-410-Tower Load Study on Newly Leased Tower
Amount:
$633.33

Component Description:
Structural Analysis
Amount:
$3,300.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
25. WUTF-410-Tower Mapping on newly leased tower
Amount:
$3,100.00

Component Description:
23. WUTF-410-Tower Mapping on newly leased tower
Amount:
$1,033.33

Component Description:
WUTF-410-Tower Mapping on newly leased tower
Amount:
$826.67
Construction Project Management - Tower Modification Reinforcements and Facilities

Component Description:
12. WUTF-410-Construction Project Management - Equipment installation on Newly Leased Tower
Amount:
$12,906.25

Component Description:
10. WUTF-410-Construction Project Management - Equipment installation on Newly Leased Tower
Amount:
$1,093.74

Component Description:
WUTF-410-Construction Project Management-Equipment installation on Newly Leased Tower
Amount:
$9,565.72
Tall Tower (greater than 500')

Component Description:
10. WUTF-410-Complex Tower-Tower Rigging
Amount:
$160,542.74

Component Description:
8. WUTF-410-Complex Tower-Tower Rigging
Amount:
$19,181.24

Component Description:
WUTF-410-Complex Tower-Tower Rigging
Amount:
$78,695.09
Minor tower reinforcement/modifications

Component Description:
9. WUTF-410-Minor Tower Modification - Newly Leased Tower
Amount:
$57,574.87

Component Description:
7. WUTF-410-Minor Tower Modification - Newly Leased Tower
Amount:
$7,291.66
Ground and Building A and E Permit Drawing Package - Cost Per Customer

Component Description:
27. WUTF-410-Ground and Building A & E Permit Drawing Package Newly Leased Tower
Amount:
$391.67

Component Description:
25. WUTF-410-Ground and Building A & E Permit Drawing Package Newly Leased Tower
Amount:
$1,175.00
Tower Permit Drawing Package - Cost Per Customer

Component Description:
Preliminary Design
Amount:
$1,300.00

Component Description:
11. WUTF-410-Tower Permit Drawing Package on Newly Leased Tower
Amount:
$391.67

Component Description:
9. WUTF-410-Tower Permit Drawing Package on Newly Leased Tower
Amount:
$1,175.00
Existing Tower Mapping

Component Description:
Tower mapping and prep of doc necessary for tower load study
Amount:
$11,272.01

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 $181,086.00 $216,355.05 N/A $168,917.55 N/A
Total for all systems $5,261,833.16 $3,697,644.62 N/A $1,922,061.22 N/A
Outside Professional Services $181,086.00 $216,355.05 $168,917.55
Project management of the transition $112,496.00 $151,105.05 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $151,105.05 N/A
RF Exposure Measurements $21,050.00 $20,000.00 N/A $5,000.00 N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $10,000.00 N/A N/A N/A
NEPA Section 106 environmental review, if needed $6,310.00 $6,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A $1,000.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $500.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $2,625.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $5,687.50 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $3,000.00 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $3,000.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Project Management
Amount:
$1,680.05

Component Description:
Project Management
Amount:
$1,712.85

Component Description:
Project management
Amount:
$2,560.15

Component Description:
13. WUTF-510-Project Management
Amount:
$7,109.98

Component Description:
Project Management
Amount:
$3,758.85

Component Description:
Project Management
Amount:
$4,542.60

Component Description:
Project Management
Amount:
$3,449.10

Component Description:
11. WUTF-510-Project Management
Amount:
$2,370.00

Component Description:
Project management
Amount:
$148.20

Component Description:
Project management
Amount:
$778.60

Component Description:
Project Management
Amount:
$116.25

Component Description:
Project Management
Amount:
$2,727.95

Component Description:
Project Management
Amount:
$2,486.85

Component Description:
Project Management
Amount:
$5,752.65

Component Description:
Project Management
Amount:
$2,528.75

Component Description:
Project Management
Amount:
$1,879.35

Component Description:
Project Management
Amount:
$4,486.60

Component Description:
Project management
Amount:
$1,643.65

Component Description:
Project Management
Amount:
$1,360.45

Component Description:
Project management
Amount:
$1,408.15

Component Description:
WUTF-510-Project Management
Amount:
$0.02

Component Description:
Project Management
Amount:
$2,511.45

Component Description:
Project Management
Amount:
$4,917.00

Component Description:
Project Management
Amount:
$3,143.15

Component Description:
Project Management
Amount:
$2,378.40

Component Description:
Project Management
Amount:
$3,033.45

Component Description:
Project management
Amount:
$3,390.40

Component Description:
Project management
Amount:
$6,049.75

Component Description:
Project management
Amount:
$1,987.95

Component Description:
Project Management
Amount:
$3,502.90

Component Description:
Project management
Amount:
$2,815.75

Component Description:
Project management
Amount:
$2,484.45

Component Description:
Project management
Amount:
$1,460.85

Component Description:
Project Management
Amount:
$2,542.85

Component Description:
Project Management
Amount:
$5,319.00

Component Description:
Project Management
Amount:
$3,689.45

Component Description:
Project Management
Amount:
$3,638.25

Component Description:
Project Management
Amount:
$2,466.70

Component Description:
Project Management
Amount:
$2,962.55

Component Description:
Project Management
Amount:
$2,064.85

Component Description:
Project Management
Amount:
$4,855.15

Component Description:
Project Management
Amount:
$3,518.05

Component Description:
Project Management
Amount:
$4,130.45

Component Description:
Project Management
Amount:
$3,882.50

Component Description:
Project Management
Amount:
$3,720.15

Component Description:
Project Management
Amount:
$1,653.00

Component Description:
Project Management
Amount:
$2,084.10

Component Description:
Project management
Amount:
$1,240.65

Component Description:
Project Management
Amount:
$1,792.55

Component Description:
Project Management
Amount:
$4,694.65

Component Description:
Project Management
Amount:
$3,615.60

Component Description:
Project Management
Amount:
$1,864.30

Component Description:
Project management
Amount:
$1,193.70
RF Exposure Measurements

Component Description:
17. WUTF-580-RF Measurements
Amount:
$3,750.00

Component Description:
15. WUTF-580-RF Measurements
Amount:
$1,250.00
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet Information not provided.
NEPA Section 106 environmental review, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization

Component Description:
Professional Services: Prepare the technical portion of an STA/Temporary antenna request on FCC Form 2100.
Amount:
$1,000.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Professional Services
Amount:
$500.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Preparation of the engineering section of FCC Form 2100
Amount:
$875.00

Component Description:
Preparation of the engineering section of FCC Form 2100
Amount:
$1,250.00

Component Description:
Preparation of the engineering section of FCC Form 2100
Amount:
$500.00
Perform engineering study for new channel assignment and antenna development

Component Description:
15. WUTF-530-RF Eng Study
Amount:
$3,750.00

Component Description:
13. WUTF-530-RF Eng Study
Amount:
$1,250.00

Component Description:
"Determine minimum ERP that would provide 48 dbu, f(50,90) city grade service to 100% of Worcester."
Amount:
$250.00

Component Description:
Engineering study work for new channel assignment including antenna development
Amount:
$437.50
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
14. WUTF-510-Transition Timing and Coordination
Amount:
$1,500.00

Component Description:
WUTF-510-Transition Timing and Coordination
Amount:
$1,000.00

Component Description:
12. WUTF-510-Transition Timing and Coordination
Amount:
$500.00
Prepare and or review reimbursement form Information not provided.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $90,010.68 $89,445.68 N/A $20,678.68 N/A
Total for all systems $5,261,833.16 $3,697,644.62 N/A $1,922,061.22 N/A
Other Expenses $90,010.68 $89,445.68 $20,678.68
Generator $2,500.00 $2,500.00 WUTF 282685 Needham Heights 399 cost estimates 5-30-2018 N/A N/A
MVPD Notification of Channel Change $1,250.00 $1,250.00 N/A $1,250.00 N/A
Develop and air announcement of upcoming channel change $15,000.00 $15,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $4,450.00 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
Local Zoning $5,000.00 $5,000.00 N/A $750.00 N/A
Non-zoning permits $2,500.00 $2,500.00 N/A N/A N/A
Equipment Delivery and Handling Charges $20,000.00 $20,000.00 N/A $4,500.00 N/A
Equipment Storage $1,456.20 $1,456.20 Please see American Tower Customer Project Cost Estimation (Needham Heights Boston T1 MA /282685) WUTF $1,456.20 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $25,000.00 $25,000.00 N/A $3,048.00 N/A
ATC Site Coordination $5,224.48 $5,224.48 See Estimated Cost Justification WUTF-610-ATC Site Coordination v0 $5,224.48 N/A

Components

Actual Information Description File Name
Generator Information not provided.
MVPD Notification of Channel Change

Component Description:
MVPD Notification
Amount:
$1,250.00
Develop and air announcement of upcoming channel change Information not provided.
DTV Medical Facility Notification

Component Description:
Medical Notification
Amount:
$4,450.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
Local Zoning

Component Description:
18. WUTF-610-Zoning Costs
Amount:
$472.50

Component Description:
16. WUTF-610-Zoning Costs
Amount:
$277.50
Non-zoning permits Information not provided.
Equipment Delivery and Handling Charges

Component Description:
19. WUTF-610-Equipment Delivery
Amount:
$3,375.00

Component Description:
17. WUTF-610-Equipment Delivery
Amount:
$1,125.00
Equipment Storage

Component Description:
WUTF-610-Equipment Storage
Amount:
$1,456.20
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
WUTF-610-Disposal Costs
Amount:
$3,048.00
ATC Site Coordination

Component Description:
16. WUTF-610-ATC Site Coordination
Amount:
$1,571.50

Component Description:
14. WUTF-610-ATC Site Coordination
Amount:
$428.50

Component Description:
WUTF-610-ATC Site Coordination
Amount:
$3,224.48

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $5,261,833.16 $3,697,644.62 $1,922,061.22

Reimbursement Status

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

Certification

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Section Question Response
Submission of Estimated Expenses Statements

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

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

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

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

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

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

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

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

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

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

Manuel Cavazos , III .

EVP - Director of Technology


06/21/2021

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.

Manuel Cavazos , III .

EVP - Director of Technology


06/21/2021

Certification

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Section Question Response
Submission of Final Allocation or Accounting Information Statements

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

  1. The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

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

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

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

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

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

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

Manuel Cavazos , III .

EVP - Director of Technology


06/21/2021

Attachments

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