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:
35584
Service:
DTV
Call Sign:
KSAX
Channel:
24 (UHF)
File Number:
0000025416
FRN:
0002629566
Date Submitted:
05/13/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

KSAX-TV, INC.

Doing Business As: KSAX-TV, INC.

Ryan Vandewiele

3415 UNIVERSITY AVE., WEST

ST. PAUL, MN 55114

United States

+1 (651) 642-4334 KShuldes@hbi.com Corporation

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

Charles R. Naftalin

LEGAL COUNSEL

HOLLAND & KNIGHT LLP

Charles Naftalin

Holland & Knight, 800 17th Street, NW

Suite 1100

Washington, DC 20006

United States

+1 (202) 955-3000 charles.naftalin@hklaw.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 station will replace its owned antenna on its existing tower with a new antenna on a top-mounted omni-directional pylon on a supporting pole. The station also expects to require an interim antenna to avoid notable service disruptions. See Exhibit 1.

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 DHD-15P1
Year 2002
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 15 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? No
Manufacturer
Model THU9evo-4
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 6.5 kW
Justification for New Transmitter Current primary solid state transmitter has been classified by manufacturer as unable to be re-tuned to new UHF channel. Price includes new exciters and mask filter.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service Yes
Description Electrical service related to a transformer of a size not specified above.
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

Information not provided.

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: 80.0 kW
Manufacturer
Model TFU-25J
Year 1985

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Top
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 55.3 kW
Manufacturer
Model ATW22H3-ETO-24L
Year 2017
Justification for New Antenna Existing antenna is unable to be re-tuned to new repacked channel. See Exhibit 1.

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?
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 4 1/16 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 Purchase New
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 80.0 kW
Manufacturer
Model ALP32L3-HSO-42
Year 2017
Justification for New Antenna Interim antenna is necessary to avoid loss of broadcast service during transition to new (repacked) channel. See Exhibit 1.

Interim Antenna

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Other Antenna Costs

Section Question Response
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 an antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
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 Waveguide
Diameter N/A
Other Diameter N/A
Segment Length N/A
Other Segment Length 11.95 feet
Number of parallel runs 1
Length 1250 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 4 1/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1200 feet per run
Justification for New Transmission Line Current transmission line could not be used due to frequency change. See Exhibit 1.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Rigid
Diameter 6 1/8 inches
Segment Length 20'
Other Segment Length
Number of parallel runs 1
Length 1100 feet per run
Justification for New Transmission Line Additional transmission line needed for interim facility to facilitate smooth transition to new channel. See Exhibit 1.

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? No
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1025694
Coordinates (NAD83) Latitude (NAD83) 45° 41' 59.0" N-
Longitude (NAD83) 095° 10' 36.0" W-
Overall Structure Height 1191.91 feet
Support Structure Height 1139.75 feet
Ground Elevation Above Mean Sea Level (AMSL) 1356.94 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner KSAX-TV, INC.
Date Constructed 09/01/1987


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

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? No
Number of Hours N/A
Explanation N/A
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility 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 Yes
Address transition timing and coordination issues w/ other stations and wireless providers No
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Internal Staff Work

See Exhibit 1.

RF exposure measurements, interim antenna

RF exposure measurements for interim antenna operations. See Exhibit 1.

Outside Legal Analysis and Advice

Analysis and guidance provided by outside legal counsel with respect to repacking deadlines and other FCC requirements. See Exhibit 2 (Jan 2018).

Coverage Verification, Interim Antenna

Coverage verification (field study) for interim antenna operations. See Exhibit 1.

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 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

Transmitter control

Remote control needed to comply with FCC requirements for main studio control of transmitters.

Sales Tax

Minnesota state and local taxes

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 $286,170.00 $286,170.00 N/A $278,504.95 N/A
Total for all systems $1,948,897.51 $1,965,625.64 N/A $1,380,693.82 N/A
Primary Transmitter THU9evo-4 $286,170.00 $286,170.00 $278,504.95
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW $273,500.00 $273,500.00 N/A $265,834.95 N/A
Other Electrical Service: Electrical service related to a transformer of a size not specified above. $12,670.00 $12,670.00 N/A $12,670.00 N/A

Components

Actual Information Description File Name
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW

Component Description:
Materials for transmission line components that will connect the new channel 24 transmitter to the new channel 24 antenna.
Amount:
$2,158.88

Component Description:
Materials are for transmission line components that will connect the new channel 24 transmitter to the new channel 24 antenna.
Amount:
$5,532.11

Component Description:
Work performed on primary transmitter.
Amount:
$145,711.10

Component Description:
One of multiple invoices under PO #106640 for the KSAX new primary channel 24 transmitter.
Amount:
$14,811.49

Component Description:
Work performed on primary transmitter.
Amount:
$24,285.19

Component Description:
Work performed on the primary transmitter.
Amount:
$72,855.55

Component Description:
One cable attenuator for connnecting non-linear sample to transmitter; one cable for monitoring forward RF power; and one cable for monitoring reflected power.
Amount:
$480.63
Other Electrical Service: Electrical service related to a transformer of a size not specified above.

Component Description:
Work performed on the station's primary transmitter.
Amount:
$2,670.00

Component Description:
Work performed on the station's primary transmitter.
Amount:
$10,000.00

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $430,340.00 $349,649.88 N/A $285,662.93 N/A
Total for all systems $1,948,897.51 $1,965,625.64 N/A $1,380,693.82 N/A
Interim Antenna ALP32L3-HSO-42 $124,540.00 $95,926.70 $70,792.93
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $14,977.00 N/A N/A N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized $89,400.00 $68,245.32 N/A $60,588.55 N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $2,500.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $10,204.38 Please see attached letter dated April 29, 2019. $10,204.38 Please see letter attached to Electronics Research, Inc., - Inv 52367 dated November 30, 2018.
Primary Antenna ATW22H3-ETO-24L $305,800.00 $253,723.18 $214,870.00
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed) $9,570.00 $5,000.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,250.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $242,323.18 N/A $208,620.00 N/A

Components

Actual Information Description File Name
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized

Component Description:
Portion of invoice for work performed on interim antenna.
Amount:
$37,601.05

Component Description:
Please disregard.
Amount:
N/A

Component Description:
Portion of invoice for work performed on interim antenna.
Amount:
$22,987.50
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Sweep test of existing antenna

Component Description:
Portion of invoice regarding sweep test of the interim antenna.
Amount:
$3,954.38

Component Description:
Portion of work regarding the system sweep of the interim antenna.
Amount:
$3,125.00

Component Description:
Portion of invoice regarding system sweep of the interim antenna.
Amount:
$3,125.00
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed) Information not provided.
Sweep test of existing antenna

Component Description:
Work performed on sweep test.
Amount:
$625.00

Component Description:
Portion of invoice regarding sweep test of the primary antenna.
Amount:
$1,875.00

Component Description:
Portion of invoice for work performed on sweet test of primary antenna.
Amount:
$3,750.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Portion of invoice for work performed on the primary antenna.
Amount:
$45,186.00

Component Description:
Remove existing primary 42 top mount antenna and install new Ch. 24 top mount antenna and transmission line.
Amount:
$45,000.00

Component Description:
Portion of invoice for work performed on primary antenna. Please see attached cover letter.
Amount:
$90,372.00

Component Description:
Please disregard
Amount:
N/A

Component Description:
Please disregard
Amount:
N/A

Component Description:
Installation of 50' ERI top mounted TV antenna.
Amount:
$13,000.00

Component Description:
Work performed on the primary antenna.
Amount:
$15,062.00

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 $392,600.00 $302,183.00 N/A $299,240.28 N/A
Total for all systems $1,948,897.51 $1,965,625.64 N/A $1,380,693.82 N/A
Interim Transmission Line $222,200.00 $177,998.00 $175,056.10
Rigid Transmission Line - copper, 6 1/8" $222,200.00 $177,998.00 N/A $175,056.10 N/A
Primary Transmission Line $170,400.00 $124,185.00 $124,184.18
Rigid Transmission Line - copper, 4 1/16" $170,400.00 $124,185.00 Please see attached quote for the updated cost information, which remains far less than the default cost for this line item. $124,184.18 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 6 1/8"

Component Description:
Portion of invoice for work performed on interim transmission line.
Amount:
$87,528.05

Component Description:
Credit Invoice
Amount:
($4,315.36)

Component Description:
Portion of invoice for work performed on interim transmission line.
Amount:
$87,528.05
Rigid Transmission Line - copper, 4 1/16"

Component Description:
Portion of invoice for work performed on primary transmission line.
Amount:
$71,235.24

Component Description:
Work performed on the primary transmission line.
Amount:
$11,872.54

Component Description:
Credit Invoice
Amount:
($1,074.81)

Component Description:
Flanged elbows for primary transmission line.
Amount:
$1,303.56

Component Description:
Portion of invoice for work performed on primary transmission line.
Amount:
$35,617.62

Component Description:
Hardware and tools needed for installing transmission line on KSAX transmitter.
Amount:
$45.76

Component Description:
Equipment for the station's primary transmission line.
Amount:
$2,181.74

Component Description:
Cost of additional parts for the station's primary transmission line.
Amount:
$3,002.53

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 $481,800.00 $462,000.00 N/A $223,843.55 N/A
Total for all systems $1,948,897.51 $1,965,625.64 N/A $1,380,693.82 N/A
Primary Tower TOWER $481,800.00 $462,000.00 $223,843.55
Tall Tower (greater than 500') $210,500.00 $200,000.00 N/A N/A N/A
Tower Helicopter Lift $87,000.00 $87,000.00 N/A $74,000.00 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $25,000.00 N/A $7,000.00 N/A
Minor tower reinforcement/modifications $158,000.00 $150,000.00 N/A $142,843.55 N/A

Components

Actual Information Description File Name
Tall Tower (greater than 500') Information not provided.
Tower Helicopter Lift

Component Description:
Helicopter rental for placement of 50' antenna. The helicopter lift was determined to be necessary to meet the FCC repacking deadline. See attached letter and quotes.
Amount:
$74,000.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Tower mapping
Amount:
$7,000.00
Minor tower reinforcement/modifications

Component Description:
Costs to remove side mounted interim TV antenna, 6" rigid coax line, hangers, and all associated hardware from KSAX tower.
Amount:
$21,880.00

Component Description:
Design structural modifications as required by structural analysis results and prepare modification working drawings and technical specification notes.
Amount:
$7,000.00

Component Description:
Work performed regarding the installation of the interim antenna, including labor, subsistence, job materials and tax.
Amount:
$62,052.72

Component Description:
Modification materials per Malouf Engineering (includes tax).
Amount:
$6,790.83

Component Description:
Perform structural analysis and engineering report.
Amount:
$6,000.00

Component Description:
Perform top section, plate structural analysis and structural reanalysis of site for new scenario.
Amount:
$5,500.00

Component Description:
Items for tower modification to allow structure to support the primary and interim antennas.
Amount:
$33,620.00

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 $270,071.50 $478,051.75 N/A $244,950.12 N/A
Total for all systems $1,948,897.51 $1,965,625.64 N/A $1,380,693.82 N/A
Outside Professional Services $270,071.50 $478,051.75 $244,950.12
Prepare and or review reimbursement form $2,630.00 $209,037.00 See Exhibit 2 (January 2018) and quote attached to invoices. $202,509.75 See Exhibit 2. Costs included significant revisions to reimbursement form due to changes in repacked facility design and responding to FCC requests (and changing contact information).
Coverage Verification, Interim Antenna $80,000.00 $80,000.00 See Exhibit 1. N/A N/A
Outside Legal Analysis and Advice $16,067.50 $16,067.50 These costs were incurred in obtaining advice from outside counsel regarding the FCC requirements other than the Form 2100 or reimbursement, including periodic progress reports, repacking deadlines and other FCC requirements. See Exhibit 2. $15,725.50 See Exhibit 2.
RF exposure measurements, interim antenna $20,000.00 $20,000.00 See Exhibit 1. N/A N/A
Internal Staff Work $20,674.00 $20,674.00 See Exhibit 1. $4,724.62 Although subtotal is not greater than approved estimates, additional explanation is provided in Exhibit 2 and 2a. Exhibit 2a links travel expenses with the correct Internal Labor Invoice (355841).
RF Exposure Measurements $21,050.00 $20,000.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $8,500.00 See quote attached to invoices. $5,628.50 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $3,600.00 Please see quote attached to invoices. $2,601.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $7,173.25 See Exhibit 2. Unexpected additional costs resulted from necessary changes in repacked facility and post-filing follow-up with the FCC to address issues in online database. $7,173.25 See Exhibit 2. Necessary changes included revisions to initial repacked facility as well as follow-up regarding appearance of application in FCC system, among other matters.
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $750.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $500.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $5,337.50 N/A

Components

Actual Information Description File Name
Prepare and or review reimbursement form

Component Description:
Preparation of reimbursement form.
Amount:
$7,573.00

Component Description:
Invoice relevant to preparation of reimbursement form.
Amount:
$12,607.00

Component Description:
Review and prepare reimbursement form.
Amount:
$5,684.50

Component Description:
Review and prepare reimbursement form.
Amount:
$526.50

Component Description:
Preparation of reimbursement form.
Amount:
$4,881.00

Component Description:
Invoice relevant to preparation of reimbursement form.
Amount:
$4,025.00

Component Description:
Preparation of reimbursement form.
Amount:
$13,173.00

Component Description:
Invoice relevant to preparation of reimbursement form.
Amount:
$5,158.00

Component Description:
Invoice relevant to preparation of reimbursement form.
Amount:
$10,823.00

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$8,960.50

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$7,085.50

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$4,101.50

Component Description:
Portion of invoice relevant to review and preparation of reimbursement form.
Amount:
$1,716.00

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$1,903.50

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$4,657.00

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$1,990.50

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$3,115.50

Component Description:
Portion of invoice relevant to review and preparation of reimbursement form.
Amount:
$5,370.00

Component Description:
Portion of invoice relevant to review and preparation of reimbursement form.
Amount:
$6,523.00

Component Description:
Preparation of reimbursement form.
Amount:
$5,708.00

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$7,349.50

Component Description:
Portion of form relevant to the review and preparation of reimbursement form.
Amount:
$3,542.00

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$562.00

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$79.50

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$981.00

Component Description:
Attorney fees related to the review and preparation of reimbursement form.
Amount:
$2,854.50

Component Description:
Attorney fees related to the review and preparation of reimbursement form.
Amount:
$3,006.50

Component Description:
Attorney fees related to the review and preparation of reimbursement form.
Amount:
$6,244.00

Component Description:
Portion of invoice relevant to review and preparation of reimbursement form.
Amount:
$5,141.00

Component Description:
Portion of invoice relevant to preparation and review of reimbursement forms, including responding to further FCC requests.
Amount:
$252.50

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$3,434.50

Component Description:
Portion of invoice relevant to review and preparation of reimbursement form.
Amount:
$658.50

Component Description:
Portion of invoice relevant to review and preparation of reimbursement form.
Amount:
$13,829.00

Component Description:
Portion of invoice relevant to preparation of reimbursement request
Amount:
$7,757.50

Component Description:
Portion of invoice relevant to reimbursement form.
Amount:
$1,991.00

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$2,358.50

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$1,230.50

Component Description:
Portion of invoice relevant to review and preparation of reimbursement information, including responses to FCC requests.
Amount:
$4,338.00

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$2,553.50

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$1,198.00

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$8,234.50

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$354.00

Component Description:
Portion of invoice relevant to preparation of reimbursement forms
Amount:
$244.25

Component Description:
Portion of invoice relevant to preparation of reimbursement form.
Amount:
$378.00

Component Description:
Portion of invoice relevant to preparation for reimbursement form.
Amount:
$159.00

Component Description:
Portion of invoice relevant to review and preparation of reimbursement form.
Amount:
$8,196.50
Coverage Verification, Interim Antenna Information not provided.
Outside Legal Analysis and Advice

Component Description:
Portion of invoice relevant to FCC transition requirement.
Amount:
$1,026.00

Component Description:
Portion of invoice relevant to FCC transition requirement.
Amount:
$1,539.00

Component Description:
Portion of invoice relevant to FCC transition requirement.
Amount:
$835.50

Component Description:
Portion of invoice relevant to FCC transition requirement.
Amount:
$79.50

Component Description:
Portion of invoice relevant to FCC transition requirement.
Amount:
$265.50

Component Description:
Portion of invoice relevant to FCC transition requirement.
Amount:
$1,840.00

Component Description:
Portion of invoice relevant to FCC transition requirement.
Amount:
$1,111.50

Component Description:
Portion of invoice relevant to FCC transition requirement.
Amount:
$2,067.00

Component Description:
Portion of invoice relevant to FCC transition requirement.
Amount:
$459.50

Component Description:
Portion of invoice relevant to FCC transition requirement.
Amount:
$1,009.00

Component Description:
Please disregard.
Amount:
N/A

Component Description:
Portion of invoice relevant to FCC transition requirement.
Amount:
$366.00

Component Description:
Portion of invoice relevant to FCC transition requirement.
Amount:
$3,796.50

Component Description:
Portion of invoice relevant to FCC transition requirement.
Amount:
$715.50

Component Description:
Portion of invoice relevant to FCC transition requirement.
Amount:
$342.00

Component Description:
Fee for attorney work regarding FCC repacking requirements, including transition progress reports
Amount:
$118.00

Component Description:
Portion of invoice relevant to FCC transition requirement.
Amount:
$155.00
RF exposure measurements, interim antenna Information not provided.
Internal Staff Work

Component Description:
This material document summarizes costs, as reimbursed by licensee parent, for travel expenses for trip to KSAX antenna site. Supporting documentation for all expenses reimbursed is also attached. See also Exhibit 2a per staff request.
Amount:
$222.91

Component Description:
Including pay stubs from an entity that is commonly owned with the licensee KSAX-TV, Inc.
Amount:
$1,098.12

Component Description:
Including pay stubs from an entity that is commonly owned with the licensee of KSAX-TV, Inc.
Amount:
$923.95

Component Description:
Expenses related to repack project.
Amount:
$343.25

Component Description:
Ed Smith travel expenses (July 2018)
Amount:
$353.82

Component Description:
Including pay stubs from an entity that is commonly owned with the licensee of KSAX-TV, Inc.
Amount:
$1,777.57

Component Description:
Cannot delete cost component section. Please disregard.
Amount:
N/A

Component Description:
Copy and document expenses for blueprint creation and transmission for new KSAX facility.
Amount:
$5.00
RF Exposure Measurements Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Portion of invoice relevant to STA application.
Amount:
$1,669.00

Component Description:
Portion of invoice relevant to preparation of STA application.
Amount:
$556.50

Component Description:
Portion of invoice relevant to STA application.
Amount:
$1,506.50

Component Description:
Portion of invoice relevant to preparation of STA application.
Amount:
$1,896.50
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Portion of invoice relevant to preparation of license to cover application.
Amount:
$2,601.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Portion of invoice (including allocations as marked on invoice) relevant to construction permit work.
Amount:
$4,639.50

Component Description:
Portion of invoice relevant to construction permit work.
Amount:
$1,356.25

Component Description:
Portion of invoice (as appropriately allocated and marked on invoice) relevant to construction permit work.
Amount:
$513.50

Component Description:
Portion of invoice (as appropriately allocated on invoice) relevant to construction permit work.
Amount:
$447.00

Component Description:
Portion of invoice relevant to preparation of construction permit application.
Amount:
$217.00
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Preparation of technical portion of application for license to cover construction permit for re-pack channel 24.
Amount:
$750.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Portion allocable to relevant line item. The selected attachment has requested detail. Please ignore other versions of Invoice 240733.
Amount:
$500.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Engineering consultation for KSAX-TV FCC repack channel assignment.
Amount:
$3,587.50

Component Description:
Portion allocable to relevant line item. The selected attachment also has requested detail. Please ignore other versions of Invoice 240733.
Amount:
$1,000.00

Component Description:
Work performed regarding STA request for interim antenna.
Amount:
$750.00

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 $87,916.01 $87,571.01 N/A $48,491.99 N/A
Total for all systems $1,948,897.51 $1,965,625.64 N/A $1,380,693.82 N/A
Other Expenses $87,916.01 $87,571.01 $48,491.99
Sales Tax $19,604.02 $19,604.02 N/A $19,604.02 N/A
MVPD Notification of Channel Change $1,000.00 $1,000.00 See Exhibit 1. N/A N/A
Develop and air announcement of upcoming channel change $4,100.00 $4,100.00 See Exhibit 1. N/A N/A
Equipment Storage $4,205.99 $4,205.99 N/A $4,530.91 Equipment storage costs were slightly higher than initially budgeted because equipment had to be stored longer than expected due to certain construction delays that were outside the control of the licensee.
Equipment Delivery and Handling Charges $35,200.00 $35,200.00 See Exhibit 1. $18,972.06 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $7,146.00 $7,146.00 See Exhibit 1. $900.00 N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $400.00 Pursuant to FCC rules, the fee for filing STA applications is $200. $400.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A $335.00 N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $3,750.00 N/A
Transmitter control $4,580.00 $4,580.00 See Exhibit 1. N/A N/A

Components

Actual Information Description File Name
Sales Tax

Component Description:
Sales tax for the primary antenna and transmission line.
Amount:
$19,514.40

Component Description:
Sales tax
Amount:
$89.62
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage

Component Description:
Please see attached cover letter.
Amount:
$369.78

Component Description:
Equipment storage.
Amount:
$299.26

Component Description:
Please see attached cover letter.
Amount:
$299.26

Component Description:
Please see attached cover letter.
Amount:
$270.75

Component Description:
Equipment storage (July 2019).
Amount:
$299.26

Component Description:
Equipment storage (August 2019)
Amount:
$299.26

Component Description:
Storage equipment (September 2018)
Amount:
$299.26

Component Description:
Storage equipment (November 2018)
Amount:
$299.26

Component Description:
Equipment storage (December 2018)
Amount:
$299.26

Component Description:
Equipment storage.
Amount:
$299.26

Component Description:
Storage equipment (August 2018)
Amount:
$299.26

Component Description:
Storage equipment (October 2018)
Amount:
$299.26

Component Description:
Equipment storage.
Amount:
$299.26

Component Description:
Equipment storage.
Amount:
$299.26

Component Description:
Equipment storage (October 2019)
Amount:
$299.26
Equipment Delivery and Handling Charges

Component Description:
Shipping cost to site
Amount:
$55.00

Component Description:
Freight
Amount:
$466.14

Component Description:
Please disregard
Amount:
N/A

Component Description:
Freight for transmitter equipment.
Amount:
$9.00

Component Description:
Portion of invoice regarding equipment delivery and handling charges (interim antenna and transmission line).
Amount:
$4,208.63

Component Description:
Freight cost for additional parts for the station's primary transmission line.
Amount:
$128.22

Component Description:
Portion of invoice regarding equipment delivery and handling charges (primary antenna and transmission line).
Amount:
$8,250.54

Component Description:
Portion of invoice regarding equipment delivery and handling charges (interim antenna and transmission line).
Amount:
$4,208.63

Component Description:
Freight for primary transmission line.
Amount:
$655.90

Component Description:
Telehandler and forklift rental to load and unload equipment. Mr. Malecha owns the land where the KSAX tower is located.
Amount:
$990.00
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Tele-handler and dumpster rental (including tax)
Amount:
$900.00
FCC Filing Fees - Special Temporary Authorization request

Component Description:
STA application filing fee.
Amount:
$200.00

Component Description:
STA application filing fee
Amount:
$200.00
FCC Filing Fees - Form 2100 license to cover application

Component Description:
License to cover application filing fee.
Amount:
$335.00
DTV Medical Facility Notification

Component Description:
Medical notification mailing.
Amount:
$3,750.00
Transmitter control Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,948,897.51 $1,965,625.64 $1,380,693.82

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.

Ryan Vandewiele

Vice President


05/13/2021

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.

Ryan Vandewiele

Vice President


05/13/2021

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.

Ryan Vandewiele

Vice President


05/13/2021

Attachments

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