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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:
21258
Service:
DTV
Call Sign:
WSES
Channel:
36 (UHF)
File Number:
0000028837
FRN:
0024377780
Date Submitted:
08/11/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

HSH BIRMINGHAM (WSES & WGWW) LICENSE, LLC

201 MASSACHUSETTS AVENUE, NE

SUITE C-1

WASHINGTON, DC 20002

United States

 +1 (202) 546-5400 arightside@aol.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

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 Diamond DHD60P2
Year 2009
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 13.2 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-40
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 61 kW
Justification for New Transmitter The current transmitter cannot be retuned.

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 Yes
Description Electrical Installation
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 15 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

Additional Equipment

Additional Equipment

Single Cabinet Conversion

Single Cabinet Conversion

RF System

RF System

Additional Install Materials

Additional Install Materials

Transient Voltage Surge Suppressor

Transient Voltage Surge Suppressor

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Lease New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Leased
Owner Sinclair Television Stations, LLC
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 Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
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: 300.0 kW
Manufacturer
Model ATW30H3-ETC1-33S
Year 2009

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Lease New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 319.0 kW
Manufacturer
Model TFU-36ETT/VP-R O6
Year 2019
Justification for New Antenna Current antenna is a single channel antenna that cannot be used for the new post-auction channel.

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 6 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna?
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Lease New
Ownership Leased
Owner SINCLAIR TELEVISION STATIONS, LLC
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 1
Number of Panels/Bays 8
Lower Limit 470.00 MHz
Upper Limit 598.00 MHz
Design power capacity in use 100.0 %
Other Antenna Type N/A
ERP: 100.0 kW
Manufacturer
Model TFU-8WB/VP
Year 2017
Justification for New Antenna Interim antenna to be used to stay on the air while the main antenna undergoes construction for the post-auction channel change.

Interim Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? B
Feed Line Size 4 1/16 inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for an antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Interim Antenna

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Other Antenna Cost Not Listed

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 Leased
Owner Sinclair Television Stations, LLC
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 ERI
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 19 3/4 inches
Other Segment Length N/A
Number of parallel runs 1
Length 2020 feet per run

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 Lease New
Type Rigid
Diameter 3 1/8 inches
Segment Length 20'
Other Segment Length
Number of parallel runs 1
Length 600 feet per run
Justification for New Transmission Line Interim transmission line will feed the interim antenna.

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1033524
Coordinates (NAD83) Latitude (NAD83) 33° 28' 48.0" N-
Longitude (NAD83) 087° 25' 50.0" W-
Overall Structure Height 1999.98 feet
Support Structure Height 1930.09 feet
Ground Elevation Above Mean Sea Level (AMSL) 640.08 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner TV Alabama, Incorporated
Date Constructed 09/19/1996


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

Name Description

Structural engineering tower load study for well documented tower

Structural engineering tower load study for well documented tower

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 No
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 Yes
Non-zoning permits Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application No
FCC Special Temporary Authority Application No
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

Tax

Tax

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 $2,196,244.01 $973,678.19 N/A $898,228.19 N/A
Total for all systems $3,805,326.67 $2,497,213.85 N/A $1,607,243.62 N/A
Primary Transmitter THU9evo-40 $2,196,244.01 $973,678.19 $898,228.19
Transient Voltage Surge Suppressor $2,629.75 $2,629.75 N/A $2,629.75 N/A
Additional Install Materials $52,862.12 $52,862.12 N/A $52,862.12 N/A
RF System $26,265.80 $26,265.80 N/A $26,265.80 N/A
Additional Equipment $20,355.34 $20,355.34 N/A $20,355.34 Invoice #9500102253 with status Need More Information can be removed. A revised version has been uploaded.
Single Cabinet Conversion $45,531.00 $45,531.00 N/A $45,531.00 N/A
15 Ton system $88,400.00 $5,879.26 N/A $5,879.26 N/A
Other Electrical Service: Electrical Installation $76,400.00 $76,400.00 N/A $76,400.00 N/A
2" Rigid Conduit and Wiring (Cost per foot) $20,800.00 $20,000.00 N/A $3,550.00 N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $35,000.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A $12,300.00 N/A
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW $1,788,000.00 $652,454.92 N/A $652,454.92 The "$652,454.92" should be deleted.

Components

Actual Information Description File Name
Transient Voltage Surge Suppressor

Component Description:
Transmitter related cost. #002337
Amount:
$2,629.75
Additional Install Materials

Component Description:
Transmitter related cost. #9500127311
Amount:
$19,275.93

Component Description:
Transmitter related cost. #002824
Amount:
$33,586.19
RF System

Component Description:
Transmitter related cost. #9500113016
Amount:
$26,265.80

Component Description:
RF system cost. #9500113016
Amount:
$26,265.80
Additional Equipment

Component Description:
Transmitter equipment cost. #9500106500
Amount:
$3,498.90

Component Description:
Additional transmitter parts. #9500102253
Amount:
$11,324.50

Component Description:
Transmitter parts. #9500111159
Amount:
$5,531.94

Component Description:
Transmitter related cost. #9500102253
Amount:
$11,324.50
Single Cabinet Conversion

Component Description:
Transmitter related cost. #9500127991
Amount:
$45,531.00
15 Ton system

Component Description:
15 ton split system cost. #5487
Amount:
$5,879.26
Other Electrical Service: Electrical Installation

Component Description:
Transmitter electrical cost. #005A
Amount:
$14,400.00

Component Description:
Transmitter electrical cost. #3
Amount:
$34,560.00

Component Description:
Transmitter electrical cost. #002
Amount:
$19,800.00

Component Description:
Transmitter electrical cost. #3
Amount:
$34,500.00

Component Description:
Transmitter electrical installation cost. #002
Amount:
$19,800.00

Component Description:
Transmitter related cost. #007
Amount:
$7,640.00

Component Description:
Transmitter electrical cost. #005
Amount:
$14,400.00
2" Rigid Conduit and Wiring (Cost per foot)

Component Description:
Transmitter related cost. #77-987
Amount:
$3,550.00
Transformer 3 phase/480v - 300 KVA Information not provided.
Switchgear - industrial 800 amp

Component Description:
Transmitter related cost. #003
Amount:
$12,300.00
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW

Component Description:
Transmitter cost. #9500093609
Amount:
$652,454.92

Component Description:
Transmitter related cost. #9500093609
Amount:
$502,809.29

Component Description:
Transmitter related cost. #9500082603
Amount:
$149,645.63

Component Description:
Resubmitted under Transient Voltage Surge Suppressor. #002337
Amount:
N/A

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate 		Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $452,460.00 $420,811.33 N/A $226,577.29 N/A
Total for all systems $3,805,326.67 $2,497,213.85 N/A $1,607,243.62 N/A
Interim Antenna TFU-8WB/VP $143,930.00 $129,336.93 $47,878.27
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 N/A N/A N/A
UHF - Lower Power Side Mount, One Station antenna . medium power (50-200 kW), elliptically or circularly polarized $103,100.00 $98,000.00 N/A $38,541.34 N/A
Sweep test of existing antenna $6,730.00 $4,774.40 N/A $4,774.40 N/A
Elbow complex, broadband, at antenna input, per 4 1/16. feedline (if needed) $10,950.00 $4,562.53 N/A $4,562.53 N/A
Primary Antenna TFU-36ETT/VP-R O6 $308,530.00 $291,474.40 $178,699.02
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $11,700.00 N/A $2,093.22 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $275,000.00 N/A $171,831.40 N/A
Sweep test of existing antenna $6,730.00 $4,774.40 N/A $4,774.40 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), elliptically or circularly polarized

Component Description:
Total invoice amount reduced by 25.40%. #591004
Amount:
$38,541.34
Sweep test of existing antenna

Component Description:
Total invoice amount reduced by 25.40%. #659019
Amount:
$4,774.40
Elbow complex, broadband, at antenna input, per 4 1/16. feedline (if needed)

Component Description:
Total invoice amount reduced by 25.40%. #594030
Amount:
$4,562.53
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Total invoice amount reduced by 26.40%. #605021
Amount:
$2,093.22
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Total invoice amount reduced by 25.40%. #496005
Amount:
$9,374.98

Component Description:
Total invoice amount reduced by 20.40%. #504030
Amount:
$162,456.42
Sweep test of existing antenna

Component Description:
Total invoice amount reduced by 25.40%. #659022
Amount:
$4,774.40

Component Description:
Antenna cost reduced by 100%. #1075044
Amount:
N/A

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 $62,400.00 $59,400.00 N/A $39,744.28 N/A
Total for all systems $3,805,326.67 $2,497,213.85 N/A $1,607,243.62 N/A
Interim Transmission Line $62,400.00 $59,400.00 $39,744.28
Rigid Transmission Line - copper, 3 1/8" $62,400.00 $59,400.00 N/A $39,744.28 N/A
Primary Transmission Line $0.00 $0.00 $0.00

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 3 1/8"

Component Description:
Total invoice amount reduced by 25.40%. #652005
Amount:
$721.68

Component Description:
Total invoice amount reduced by 25.40%. #591004
Amount:
$38,567.60

Component Description:
Transmission line cost. #15287
Amount:
$455.00

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 $682,800.00 $660,552.20 N/A $297,708.00 N/A
Total for all systems $3,805,326.67 $2,497,213.85 N/A $1,607,243.62 N/A
Primary Tower TOWER $682,800.00 $660,552.20 $297,708.00
Tall Tower (greater than 500') $210,500.00 $210,552.20 See FDH Infrastructure Services quotes. $210,552.20 N/A
Structural engineering tower load study for well documented tower $25,000.00 $25,000.00 N/A $4,194.00 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 $3,250.00 N/A
Major tower reinforcement/modifications $421,000.00 $400,000.00 N/A $79,711.80 N/A

Components

Actual Information Description File Name
Tall Tower (greater than 500')

Component Description:
30% invoiced upon order. #E-182378
Amount:
$18,693.90

Component Description:
Tower related cost. #SIN000893
Amount:
$28,482.30

Component Description:
Tower related cost. #SIN000879
Amount:
$163,376.00
Structural engineering tower load study for well documented tower

Component Description:
Tower analysis cost. #4981
Amount:
$944.00

Component Description:
Tower related cost. #E-168420
Amount:
$3,250.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Final balance upon analysis completion. #E-178897
Amount:
$3,250.00
Major tower reinforcement/modifications

Component Description:
30% invoiced upon order. #E-182378
Amount:
$19,372.50

Component Description:
Resubmitted under Tall Tower. #SIN000879
Amount:
N/A

Component Description:
Tower related cost. #SIN000893
Amount:
$60,339.30

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 $218,061.27 $189,960.74 N/A $90,223.79 N/A
Total for all systems $3,805,326.67 $2,497,213.85 N/A $1,607,243.62 N/A
Outside Professional Services $218,061.27 $189,960.74 $90,223.79
Sinclair Internal Costs $541.27 $541.27 N/A $541.27 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 $1,784.47 N/A $1,784.47 N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 N/A $712.50 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $1,496.25 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,135.00 N/A $3,135.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $2,332.79 N/A
Project management of the transition $74,260.00 $70,500.00 N/A $53,221.51 N/A

Components

Actual Information Description File Name
Sinclair Internal Costs

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 35 stations.
Amount:
$30.43

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 45 stations.
Amount:
$5.66

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:
$7.96

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

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

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:
$11.39

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:
$15.08

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:
$5.37

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 52 stations.
Amount:
$9.79

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 45 stations.
Amount:
$25.78

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 46 stations.
Amount:
$23.56

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 100 stations.
Amount:
$23.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$33.53

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

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 42 stations.
Amount:
$10.78

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 52 stations.
Amount:
$41.33
Comprehensive coverage verification via field study, if needed

Component Description:
Coverage cost. #207049
Amount:
$27,000.00
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:
Legal services cost. #478310
Amount:
$1,562.55

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

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

Component Description:
Outside professional service cost. #325-06-0006
Amount:
$712.50
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Consulting engineering service cost. #325-06-0004
Amount:
$1,496.25
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Outside professional service cost. #325-06-0007
Amount:
$1,211.25

Component Description:
Outside professional service cost. #325-06-0005
Amount:
$1,923.75
Perform engineering study for new channel assignment and antenna development Information not provided.
Prepare and or review reimbursement form

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

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

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

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

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

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 42 stations. #257
Amount:
$1,209.02

Component Description:
Legal Service Cost. #481355
Amount:
$425.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 33 stations. #288
Amount:
$1,726.96

Component Description:
Legal Service Cost. #486848
Amount:
$57.50

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 100 stations. #477305
Amount:
$393.53

Component Description:
Legal services cost. #477352
Amount:
$281.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #453972
Amount:
$716.28

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

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

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

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 46 stations. #485240
Amount:
$541.57

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1093
Amount:
$265.72

Component Description:
Legal services cost. #477867
Amount:
$141.25

Component Description:
Legal services cost. #484774
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. #479829
Amount:
$458.99

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 100 stations. #132
Amount:
$589.44

Component Description:
Legal services cost. #478820
Amount:
$77.50

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. #1105
Amount:
$216.88

Component Description:
Legal services cost. #472214
Amount:
$57.50

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

Component Description:
Legal services cost. #472633
Amount:
$157.50

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. #1141
Amount:
$406.17

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

Component Description:
Legal services cost. #476423
Amount:
$228.75

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

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

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 52 stations. #481318
Amount:
$814.01

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. #1114
Amount:
$242.25

Component Description:
Legal services cost. #474454
Amount:
$57.50

Component Description:
Legal services cost. #479332
Amount:
$135.00

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

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

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 33 stations. #486788
Amount:
$583.82

Component Description:
Legal Service Cost. #476934
Amount:
$4,037.75

Component Description:
Legal services cost. #469635
Amount:
$106.25

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 98 stations. #467378
Amount:
$576.96

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

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

Component Description:
Legal Service Cost. #479862
Amount:
$3,112.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 42 stations. #485630
Amount:
$405.83

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 98 stations. #461759
Amount:
$29.98

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

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

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

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 100 stations. #118
Amount:
$468.97

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 93 stations. #461289
Amount:
$91.50

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

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

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

Component Description:
Legal Service Cost. #484339
Amount:
$600.00

Component Description:
$26,919.78 credit to be split across 93 Sinclair stations reimbursed $999.20 for Invoice 461759 (correct reimbursement amount is $709.74). #CM-11-21-2019-461759
Amount:
($289.46)

Component Description:
Legal services cost. #482272
Amount:
$312.50

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

Component Description:
Legal services cost. #485649
Amount:
$57.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #1010
Amount:
$86.88

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

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

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

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

Component Description:
Legal Service Cost. #483838
Amount:
$380.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #1032.
Amount:
$43.71

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1090
Amount:
$176.70

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

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

Component Description:
Legal Service Cost. #480206
Amount:
$1,981.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #450412
Amount:
$999.04

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

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

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 93 stations.
Amount:
$43.72

Component Description:
Legal services cost. #464749
Amount:
$172.50

Component Description:
Legal services cost. #474867
Amount:
$532.50

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

Component Description:
Legal services cost. #478317
Amount:
$45.00

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

Component Description:
Legal services cost. #460890
Amount:
$115.40

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

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

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

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

Component Description:
Legal services cost. #471579
Amount:
$221.25

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

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

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$731.71

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$912.82

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

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

Component Description:
Legal services cost. #470331
Amount:
$283.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$107.53

Component Description:
Legal services cost. #475801
Amount:
$602.50

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

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 93 stations. #453686
Amount:
$943.95

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$1,954.93

Component Description:
Legal services cost. #480792
Amount:
$57.50

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 93 stations. #1012
Amount:
$20.64

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

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

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

Component Description:
Legal Service Cost. #467946
Amount:
$175.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #457331
Amount:
$836.44

Component Description:
Legal services cost. #481931
Amount:
$57.50

Component Description:
Legal Service Cost. #465235
Amount:
$177.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #457851
Amount:
$818.59

Component Description:
Legal Service Cost. #467438
Amount:
$120.00

Component Description:
Legal services cost. #482457
Amount:
$115.00

Component Description:
Legal services cost. #461754
Amount:
$453.70

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:
$32.35

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

Component Description:
Legal services cost. #464407
Amount:
$177.90

Component Description:
Legal services cost. #485288
Amount:
$50.00

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. #473568
Amount:
$51.25

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 $193,361.39 $192,811.39 N/A $54,762.07 N/A
Total for all systems $3,805,326.67 $2,497,213.85 N/A $1,607,243.62 N/A
Other Expenses $193,361.39 $192,811.39 $54,762.07
MVPD Notification of Channel Change $5,000.00 $5,000.00 See Exhibit J. N/A N/A
Non-zoning permits $10,000.00 $10,000.00 See Exhibit J. N/A N/A
Tax $41.11 $41.11 N/A $41.11 N/A
Develop and air announcement of upcoming channel change $75,000.00 $75,000.00 See Response to August 4 Inquiry. N/A N/A
Equipment Storage $15,000.00 $15,000.00 See Exhibit J. $13,882.54 N/A
Equipment Delivery and Handling Charges $28,204.28 $28,204.28 See Exhibit J. $28,204.28 Invoice #10207 with status Need More Information can be removed. A revised version has been uploaded.
Disposal Costs (for equipment and other waste, net of any salvage value) $28,566.00 $28,566.00 See Response to August 4 Inquiry. $9,359.14 N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $3,275.00 N/A
Local Zoning $20,000.00 $20,000.00 See Exhibit J. N/A N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change Information not provided.
Non-zoning permits Information not provided.
Tax

Component Description:
Sales tax. #Tax20-0013
Amount:
$41.11
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage

Component Description:
Equipment storage cost. #10207
Amount:
$500.00

Component Description:
Total invoice amount reduced by 25.40%. #666036
Amount:
$3,782.22

Component Description:
Equipment storage cost. #11329
Amount:
$650.00

Component Description:
Equipment storage cost. #10033
Amount:
$500.00

Component Description:
Equipment storage cost. #11323
Amount:
$500.00

Component Description:
Equipment storage cost. #10531
Amount:
$500.00

Component Description:
Equipment storage cost. #10841
Amount:
$500.00

Component Description:
Equipment storage cost. #11498
Amount:
$3,900.00

Component Description:
Equipment storage cost. #10934
Amount:
$700.00

Component Description:
Equipment storage cost. #10330
Amount:
$500.00

Component Description:
Total invoice amount reduced by 8.40%. #710016
Amount:
$1,850.32

Component Description:
Equipment storage cost. #10207
Amount:
$500.00
Equipment Delivery and Handling Charges

Component Description:
Equipment handling cost. #10207
Amount:
$750.00

Component Description:
Total invoice amount reduced by 25.40%. #666036
Amount:
$9,478.64

Component Description:
Equipment delivery and handling cost. #10033
Amount:
$1,100.00

Component Description:
Total invoice amount reduced by 8.40%. #710016
Amount:
$15,774.88

Component Description:
Equipment delivery and handling cost. #10207
Amount:
$750.00

Component Description:
Total invoice amount reduced by 25.40%. #654005
Amount:
$1,100.76

Component Description:
Equipment delivery and handling cost. #10207
Amount:
$750.00

Component Description:
Equipment storage cost. #10207
Amount:
$500.00

Component Description:
Resubmitted under Transmission Line. #15287
Amount:
N/A
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Disposal cost. #6198184
Amount:
$595.15

Component Description:
Disposal cost. #6178601
Amount:
$263.99

Component Description:
Disposal cost. #77-983
Amount:
$6,500.00

Component Description:
Disposal related cost. #6198184
Amount:
$859.14

Component Description:
Disposal costs. #383
Amount:
$2,000.00

Component Description:
Disposal related cost. #6178601
Amount:
$263.99
DTV Medical Facility Notification

Component Description:
Medical notification cost. #1218
Amount:
$3,275.00
Local Zoning Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate 		Estimated Cost Actual Cost
Total for all systems $3,805,326.67 $2,497,213.85 $1,607,243.62

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.

Armstrong Williams

CFO


08/11/2021

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.

Armstrong Williams

CFO


08/11/2021

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