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:
48360
Service:
DTV
Call Sign:
KRXI-TV
Channel:
23 (UHF)
File Number:
0000028814
FRN:
0022463871
Date Submitted:
06/04/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

KRXI LICENSEE, LLC

Doing Business As: KRXI LICENSEE, LLC

Harvey Arnold

10706 Beaver Dam Road

Cockeysville, MD 21030

United States

+1 (410) 568-1500 FCCContacts@sbgtv.com Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Paul A. Cicelski , Esq .

Lerman Senter PLLC

2001 L Street NW

Suite 400

Washington, DC 20036

United States

+1 (202) 416-6756 pcicelski@lermansenter.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 See Exhibit A.

Transmitters

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

Auxiliary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use KRXI (Backup) Transmitter
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 CZ1000/Ranger
Year 2006
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1 kW

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model TMU9evo-8
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 3 kW
Justification for New Transmitter Per the manufacturer, this auxiliary transmitter cannot be retuned. See Exhibit C.

Auxiliary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 2 inches
Length 200.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Name Description

UHF and VHF - minor banding issues

UHF and VHF - minor banding issues

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 CD3200P2
Year 2002
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 50 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 THU9EVO-16
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 25.5 kW
Justification for New Transmitter Per the manufacturer, the current transmitter cannot be retuned. See Exhibit B.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring Yes
Size 2 inches
Length 800.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 5 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

RF System

RF System

Exterior Cable Tray

Exterior Cable Tray

Installation

Installation

Additional Field Engineering Time

Additional Field Engineering Time

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? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side 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: 950.0 kW
Manufacturer
Model TFU-24DSB-J (C)
Year 2003

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? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 619.0 kW
Manufacturer
Model TFU 26DSC/VP-R C170
Year 2017
Justification for New Antenna Current antenna is a single channel antenna that cannot be used for the new post-auction channel. Pattern compliance for the new channel requires that this antenna be mounted on a top-mounted pole.

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? Yes
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.

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 Utilize Existing
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer Dielectric
Type Rigid
Diameter 4 1/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 500 feet per run

Primary 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 1010555
Coordinates (NAD83) Latitude (NAD83) 39° 35' 23.0" N-
Longitude (NAD83) 119° 55' 41.0" W-
Overall Structure Height 195.86 feet
Support Structure Height 149.93 feet
Ground Elevation Above Mean Sea Level (AMSL) 8226.61 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner KRXI Licensee, LLC
Date Constructed 08/01/1996


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: Major 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

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? Yes
Number of Hours 470
Explanation Outside consulting engineering, legal work, and accounting services, as well as project management for regional and comprehensive repack execution.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility 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 2
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility 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 2
NEPA Section 106 environmental review Yes
Environmental Assessment Yes
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Sinclair Internal Costs

Internal Employee Time Costs

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

Information not provided.

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 $2,391,977.10 $964,348.99 N/A $871,122.56 N/A
Total for all systems $3,557,980.19 $2,016,585.00 N/A $1,380,978.44 N/A
Primary Transmitter THU9EVO-16 $2,230,132.10 $913,393.60 $825,167.17
Installation $88,089.83 $88,089.83 N/A $82,495.40 N/A
Exterior Cable Tray $6,148.40 $6,148.40 N/A $6,148.40 N/A
RF System $73,107.00 $73,107.00 N/A $73,107.00 N/A
Other -- HVAC Service Type: H Size:5 (Other) $61,162.72 $61,162.72 N/A $61,162.72 N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $35,000.00 N/A $6,898.00 N/A
Additional Field Engineering Time $274,824.15 $274,824.15 Check the Bruce Purves Construction Quote. $274,824.15 N/A
2" Rigid Conduit and Wiring (Cost per foot) $20,800.00 $20,000.00 N/A $1,770.00 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $252,264.87 N/A $252,264.87 N/A
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW $684,000.00 $66,496.63 ***System Notice: Estimate adjusted and locked because line has been superseded.***See Response to August 28 Inquiry. $66,496.63 N/A
Auxiliary Transmitter TMU9evo-8 $161,845.00 $50,955.39 $45,955.39
UHF and VHF - minor banding issues $1,045.00 $1,045.00 N/A $1,045.00 N/A
2" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $5,000.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW $155,600.00 $44,910.39 N/A $44,910.39 N/A

Components

Actual Information Description File Name
Installation

Component Description:
Electrical cost. #667907
Amount:
$4,921.78

Component Description:
Electrical cost. #667908
Amount:
$672.65

Component Description:
Transmitter related cost. #201941-1
Amount:
$13,643.00

Component Description:
Transmitter related cost. #002252
Amount:
$47,740.40

Component Description:
Transmitter related cost. #20941-2
Amount:
$13,643.00

Component Description:
Transmitter related cost. #002366
Amount:
$7,469.00
Exterior Cable Tray

Component Description:
Transmitter related cost. #673915
Amount:
$553.97

Component Description:
Transmitter related cost. #667908
Amount:
$672.65

Component Description:
Transmitter related cost. #667907
Amount:
$4,921.78
RF System

Component Description:
RF system cost. #002237
Amount:
$73,107.00
Other -- HVAC Service Type: H Size:5 (Other)

Component Description:
Transmitter related cost. #310264273
Amount:
$2,735.86

Component Description:
Transmitter related cost. #310252858
Amount:
$13,424.86

Component Description:
Transmitter related cost. #190097
Amount:
$45,002.00
Transformer 3 phase/480v - 300 KVA

Component Description:
Transmitter related cost. #002175
Amount:
$6,898.00
Additional Field Engineering Time

Component Description:
Transmitter related cost. #2019005
Amount:
$56,727.36

Component Description:
Transmitter related cost. #2018207
Amount:
$136,258.87

Component Description:
Transmitter related cost. #190065
Amount:
$53,019.07

Component Description:
Transmitter related cost. #190110-A
Amount:
$28,818.85

Component Description:
Transmitter related cost. #2019005
Amount:
$56,727.36

Component Description:
Transmitter related cost. #1910-03
Amount:
N/A
2" Rigid Conduit and Wiring (Cost per foot)

Component Description:
Transmitter related cost. #NE118584
Amount:
$1,770.00
Switchgear - industrial 800 amp Information not provided.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
Transmitter related cost. #002175
Amount:
$82,714.00

Component Description:
Transmitter cost, upgrade excluded. #9500081350
Amount:
$169,550.87
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW

Component Description:
Transmitter downpayment. #9500074886
Amount:
$66,496.63

Component Description:
Transmitter downpayment. 65.19% of total amount is reimbursable. #9500074886
Amount:
$66,394.78

Component Description:
Transmitter 75% balance. #9500081350
Amount:
$208,887.44
UHF and VHF - minor banding issues

Component Description:
Auxiliary Transmitter related cost. #6126
Amount:
$1,045.00
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW

Component Description:
Transmitter related cost. #9500135765
Amount:
$44,910.39

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 $311,060.00 $252,676.00 N/A $202,712.10 N/A
Total for all systems $3,557,980.19 $2,016,585.00 N/A $1,380,978.44 N/A
Primary Antenna TFU 26DSC/VP-R C170 $311,060.00 $252,676.00 $202,712.10
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 N/A N/A N/A
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed) $9,570.00 $12,100.00 Updated cost of estimated amount per FCC requirement. $11,639.88 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $5,118.72 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $229,176.00 See Response to August 28 Inquiry. $185,953.50 N/A

Components

Actual Information Description File Name
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)

Component Description:
Antenna elbow complex cost reduced by 20.02%. #257010
Amount:
$8,496.27

Component Description:
Antenna elbow complex related cost reduced by 20.02%. #257009
Amount:
$3,143.61
Sweep test of existing antenna

Component Description:
Antenna related cost. #286017
Amount:
$5,118.72
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Antenna related cost reduced by 20.02%. #246028
Amount:
$185,953.50

Component Description:
Antenna related cost minus the non-reimbursable, reduced by 20.02%. #246028
Amount:
$185,953.50

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 $0.00 $0.00 N/A $0.00 N/A
Total for all systems $3,557,980.19 $2,016,585.00 N/A $1,380,978.44 N/A
Primary Transmission Line $0.00 $0.00 $0.00

Components

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 $531,500.00 $505,000.00 N/A $181,226.25 N/A
Total for all systems $3,557,980.19 $2,016,585.00 N/A $1,380,978.44 N/A
Primary Tower TOWER $531,500.00 $505,000.00 $181,226.25
Major tower reinforcement/modifications $421,000.00 $400,000.00 N/A $119,607.20 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 $18,986.00 N/A
Short Tower (less than 500') $84,200.00 $80,000.00 N/A $42,633.05 N/A

Components

Actual Information Description File Name
Major tower reinforcement/modifications

Component Description:
Tower related cost. #SIN007223
Amount:
$44,936.00

Component Description:
Tower related cost. #E-182130
Amount:
$39,739.80

Component Description:
30% downpayment. #E-149998
Amount:
$34,931.40
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Structural analysis-balance. #148375
Amount:
$9,493.00

Component Description:
Engineering structural analysis.
Amount:
$9,493.00

Component Description:
Engineering structural analysis. #136764
Amount:
$9,493.00
Short Tower (less than 500')

Component Description:
Tower related cost. #14013
Amount:
$866.25

Component Description:
Tower related cost. #E-182367
Amount:
$11,643.80

Component Description:
Tower related cost. #E-182130
Amount:
$30,123.00

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 $220,780.61 $192,977.53 N/A $94,001.05 N/A
Total for all systems $3,557,980.19 $2,016,585.00 N/A $1,380,978.44 N/A
Outside Professional Services $220,780.61 $192,977.53 $94,001.05
Project management of the transition $74,260.00 $70,500.00 N/A $48,480.35 N/A
Sinclair Internal Costs $630.61 $630.61 N/A $630.61 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A $27,000.00 N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A N/A N/A
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 $7,360.00 $0.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $0.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $0.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $221.92 N/A $221.92 N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 N/A $1,882.50 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $3,495.00 See Carl T Jones invoices. $3,495.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $2,865.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $5,872.50 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A $0.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,630.00 N/A $3,553.17 The actual cost came out to more than the Widelity Report estimate.

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1069
Amount:
$246.68

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 46 stations. #247
Amount:
$1,105.31

Component Description:
Legal Service Cost. #473890
Amount:
$1,649.33

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #479285
Amount:
$372.60

Component Description:
Legal services cost. #485258
Amount:
$50.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.#475744
Amount:
$305.99

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #476885
Amount:
$403.34

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #477820
Amount:
$320.19

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$716.28

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472985
Amount:
$282.68

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #478780
Amount:
$271.41

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1058
Amount:
$187.24

Component Description:
Legal services cost. #485631
Amount:
$50.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 54 stations. #236
Amount:
$1,117.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$818.59

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1093
Amount:
$269.71

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1055
Amount:
$243.38

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 52 stations. #153
Amount:
$1,287.27

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #474809
Amount:
$395.77

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$943.95

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #132
Amount:
$589.44

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$20.91

Component Description:
Legal Service Cost. #480764
Amount:
$436.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #118
Amount:
$468.97

Component Description:
Legal Service Cost. #473543
Amount:
$1,483.66

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #480175
Amount:
$377.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 52 stations. #481318
Amount:
$814.01

Component Description:
Legal Service Cost. #484310
Amount:
$57.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 48 stations. #206
Amount:
$1,354.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #141
Amount:
$1,800.46

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1141
Amount:
$406.17

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1156
Amount:
$399.52

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #470923
Amount:
$406.65

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1145
Amount:
$369.98

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1167
Amount:
$313.41

Component Description:
Legal services cost. #476889
Amount:
$51.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #470237
Amount:
$436.37

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1151
Amount:
$388.07

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1099
Amount:
$266.93

Component Description:
Legal Service Cost. #470279
Amount:
$417.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #476367
Amount:
$364.80

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1130
Amount:
$281.49

Component Description:
Legal Service Cost. #471529
Amount:
$172.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #474405
Amount:
$490.56

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #478288
Amount:
$194.86

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1098
Amount:
$238.07

Component Description:
Legal services cost. #479290
Amount:
$57.50

Component Description:
Legal services cost. #481319
Amount:
$310.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1117
Amount:
$282.68

Component Description:
Legal services cost. #474815
Amount:
$108.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #473506
Amount:
$421.40

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 48 stations. #483809
Amount:
$407.18

Component Description:
Consulting engineering services cost. #858-39-0010
Amount:
$2,208.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 48 stations. #483809
Amount:
$868.77

Component Description:
Legal Service Cost. #472992
Amount:
$515.00

Component Description:
Legal services cost. #477824
Amount:
$51.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #471524
Amount:
$322.83

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #464321
Amount:
$683.07

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$91.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #479829
Amount:
$458.99

Component Description:
Legal Service Cost. #479832
Amount:
$162.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #467861
Amount:
$470.30

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 45 stations. #226
Amount:
$1,364.80

Component Description:
Legal services cost. #468707
Amount:
$106.65

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$29.98

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 99 stations. #469573
Amount:
$377.14

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #473885
Amount:
$318.62

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1090
Amount:
$176.70

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1039
Amount:
$30.47

Component Description:
Legal Service Cost. #473890
Amount:
$1,649.33

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #480760
Amount:
$1,326.43

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1161
Amount:
$267.48

Component Description:
Legal Service Cost. #473890
Amount:
$1,649.33

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1072
Amount:
$237.64

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1105
Amount:
$216.88

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472173
Amount:
$311.78

Component Description:
Legal Service Cost. #467894
Amount:
$120.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1111
Amount:
$159.58

Component Description:
Legal Service Cost. #476371
Amount:
$102.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$836.44

Component Description:
Legal services cost. #477308
Amount:
$183.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #466690
Amount:
$446.87

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$999.04

Component Description:
Legal Service Cost. #472588
Amount:
$512.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1078
Amount:
$215.68

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #463026
Amount:
$801.57

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$20.65

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #463026
Amount:
$815.02

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1051
Amount:
$105.97

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1045
Amount:
$185.10

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 99 stations. #468718
Amount:
$349.51

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #465173
Amount:
$654.26

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$43.72

Component Description:
$26,919.78 credit to be split across 93 Sinclair stations reimbursed $999.20 for invoice #461759 (correct reimbursement amount is $709.74).
Amount:
($289.46)

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #477305
Amount:
$393.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 99 stations. #1086
Amount:
$275.35

Component Description:
Legal services cost. #466698
Amount:
$120.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #465001
Amount:
$596.30

Component Description:
Legal services cost. #465183
Amount:
$355.00

Component Description:
Legal Service Cost. #467386
Amount:
$62.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #475283
Amount:
$384.08

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #107
Amount:
$602.28

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #463567
Amount:
$566.48

Component Description:
Legal services cost. #473543
Amount:
$1,483.66

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1079
Amount:
$177.14

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1133
Amount:
$307.72

Component Description:
$207.48 credit to be split across 52 Sinclair stations reimbursed $269.71 for invoice #1093 (correct reimbursement amount is $265.72). #CM-7-29-2019-1093
Amount:
($3.99)

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1123
Amount:
$342.14

Component Description:
Legal Service Cost. #483810
Amount:
$310.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$86.88

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1114
Amount:
$242.25

Component Description:
Resubmitted under Prepare engineering section of FCC Form 2100 (main), License to Cover Application. #858-39-0008
Amount:
N/A

Component Description:
Consulting account services.
Amount:
$32.35

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #467378
Amount:
$576.96

Component Description:
Revised invoice number. Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1051
Amount:
$105.97

Component Description:
Legal Service Cost. #468721
Amount:
$318.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1063
Amount:
$262.29

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1143
Amount:
$436.90

Component Description:
Legal Service Cost. #470874
Amount:
$163.75

Component Description:
Legal Service Cost. #474410
Amount:
$351.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472583
Amount:
$279.89

Component Description:
Legal services cost. #469583
Amount:
$376.25
Sinclair Internal Costs

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 46 stations.
Amount:
$50.03

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations.
Amount:
$58.48

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 42 stations.
Amount:
$39.39

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 42 stations.
Amount:
$10.78

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 46 stations.
Amount:
$23.56

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$23.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 45 stations.
Amount:
$5.66

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 54 stations.
Amount:
$23.95

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 48 stations.
Amount:
$6.78

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$7.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$5.37

Component Description:
Portion of general repack matter internal time card attributable to this station - divided by 100.
Amount:
$66.55

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$8.66

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$9.47

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 46 stations.
Amount:
$1.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$15.08

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 54 stations.
Amount:
$8.64

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$11.03

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 48 stations.
Amount:
$31.70

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$6.09

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$11.39

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$16.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 45 stations.
Amount:
$25.78

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$32.09

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$1.69

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 52 stations.
Amount:
$41.33

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$26.93

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$17.02

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$7.86

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$25.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 52 stations.
Amount:
$9.79
Comprehensive coverage verification via field study, if needed

Component Description:
Remaining coverage cost. #197015
Amount:
$24,080.00

Component Description:
Coverage related cost. #187004
Amount:
$2,920.00
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
ASR modification (prepare FCC Form 854) Information not provided.
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 - Negotiation of lease and other matters for shared locations Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$99.92

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$122.00
Prepare request for Special Temporary Authorization

Component Description:
Outside Engineering Consulting cost. #858-39-0006
Amount:
$427.50

Component Description:
Outside engineering consulting cost. #858-39-0005
Amount:
$1,455.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Outside Engineering Consulting Cost. #858-39-0007
Amount:
$1,785.00

Component Description:
Consulting engineer cost. #858-39-0008
Amount:
$1,710.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Consulting engineering cost.
Amount:
$2,865.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Consulting engineering cost.
Amount:
$5,872.50
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
Legal services cost.
Amount:
$287.50

Component Description:
Legal services cost. #461805
Amount:
$143.88

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$152.01

Component Description:
Legal services cost. #461286
Amount:
$367.50

Component Description:
Legal services cost. #457855
Amount:
$244.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$869.30

Component Description:
Legal services cost. #464355
Amount:
$177.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$1,311.48

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 $102,662.48 $101,582.48 N/A $31,916.48 N/A
Total for all systems $3,557,980.19 $2,016,585.00 N/A $1,380,978.44 N/A
Other Expenses $102,662.48 $101,582.48 $31,916.48
MVPD Notification of Channel Change $5,000.00 $5,000.00 See Exhibit J. N/A N/A
Develop and air announcement of upcoming channel change $28,050.00 $28,050.00 See Response to August 28 Inquiry. N/A N/A
Equipment Storage $15,235.28 $15,235.28 See Exhibit J. $15,235.28 N/A
Equipment Delivery and Handling Charges $13,731.20 $13,731.20 See Exhibit J. $13,731.20 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $28,566.00 $28,566.00 See Response to August 28 Inquiry. N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $0.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $2,950.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $0.00 N/A N/A N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage

Component Description:
Storage costs. #905063629
Amount:
$452.56

Component Description:
Equipment storage cost. #9006203399
Amount:
$152.56

Component Description:
Equipment storage cost. #9006358619
Amount:
$152.56

Component Description:
Equipment Storage cost. #9005895929
Amount:
$152.56

Component Description:
Equipment storage related cost. #9005233633
Amount:
$152.56

Component Description:
Equipment storage cost. #9006668824
Amount:
$152.56

Component Description:
Equipment storage cost. #9005407040
Amount:
$152.56

Component Description:
Equipment storage cost. #9006987361
Amount:
$152.56

Component Description:
Equipment storage cost. #9006987361
Amount:
$152.56

Component Description:
Equipment storage related cost. #285020
Amount:
$13,104.56

Component Description:
Equipment Storage related cost. #9005570545
Amount:
$152.56

Component Description:
Equipment storage cost. #9006513479
Amount:
$152.56

Component Description:
Equipment storage cost. #9006050519
Amount:
$152.56

Component Description:
Equipment storage cost. #9006987361
Amount:
$152.56

Component Description:
Equipment related cost. #9005735748
Amount:
$152.56
Equipment Delivery and Handling Charges

Component Description:
Equipment delivery and handling cost. #12804
Amount:
$9,841.20

Component Description:
Equipment delivery and handling cost. #14123
Amount:
$1,890.00

Component Description:
Equipment delivery and handling cost. #002175
Amount:
$2,000.00
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
DTV Medical Facility Notification

Component Description:
Medical notification. #1048
Amount:
$2,950.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,557,980.19 $2,016,585.00 $1,380,978.44

Reimbursement Status

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

Certification

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Section Question Response
Submission of Estimated Expenses Statements

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

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

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

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

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

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

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

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

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

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

Lucy Rutishauser

CFO


06/04/2021

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.

Lucy Rutishauser

CFO


06/04/2021

Attachments

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