TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
CENTRAL MICHIGAN UNIVERSITY	1999 East Campus Drive Mount Pleasant, MI 48859 United States	+1 (989) 774-3105	radem2je@cmich.edu	Government Entity

Applicant

Address

Phone

Applicant Type

CENTRAL MICHIGAN UNIVERSITY

1999 East Campus Drive

Mount Pleasant, MI 48859

United States

+1 (989) 774-3105

radem2je@cmich.edu

Government Entity

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant	Address	Phone	Email
[Confidential]

Preparer Contact Information

Preparer Contact Name and Information

Applicant	Address	Phone	Email
Wayne Henderson Director Technical Services Central Michigan University	Wayne Henderson Public Broadcasting 1999 E. Campus Dr. Mt. Pleasant, MI 48859 United States	+1 (989) 774-6864	hende1ww@cmich.edu

Applicant

Address

Phone

Wayne Henderson

Director Technical Services

Central Michigan University

Wayne Henderson

Public Broadcasting

1999 E. Campus Dr.

Mt. Pleasant, MI 48859

United States

+1 (989) 774-6864

hende1ww@cmich.edu

Broadcaster Information and Transition Plan

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.	Yes
Briefly describe transition plan	New transmitters and combiner for WPBN-TV, WGTU, and WCMV to be installed, tested, and working into load prior to end of Transition Phase 6. It is not anticipated the buildup will affect current operations until night of cutover. See attached doc.

Transmitters

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

Primary Transmitter

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	NV7930V
	Year	2004
	Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power Capacity	15.6 kW

Primary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Primary (Main)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Manufacturer
	Model	ULXTE-30
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	19.2 kW
	Justification for New Transmitter	Transmitter no longer supported, end of life, no field service available, many parts required for retune not available, will not make new operating power. See attached notice from Rohde & Schwarz.

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	No
	Transformer (480V)	No
	Power	N/A
	Rigid Conduit and Wiring	No
	Size	N/A
	Length	N/A
	Other Electrical Service	Yes
	Description	Electrical firm 1st site visit for evaluation. 2nd Visit install conduit, pull electrical wiring, and activate electrical to interim transmitter, 3rd trip get electrical activated to permanent transmitter via new panel.
HVAC Service	Does the replacement transmitter require HVAC Service?	Yes
	Type	Heating and Cooling
	Size	Other
	Other Size	7 tons
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

Other Transmitter Cost Not Listed

Name	Description
Concrete Pad for Heat Exchangers and AC Heat Pump Units	Concrete Pad to be added under existing and new ice bridge for the Heat Exchangers and AC Heat Pump outdoor Units to be placed on and protected.
Replacement Building Outside Wall Panels	To Replace Building Outside Wall Panels to repair openings left when existing old AC Wall Mounted Units are Removed. Supplied by the building manufacturer.
GatesAir Transmitter Install Services	WCMV Interim UAXTE-8 Installation-Commissioning, WCMV ULXTE-30 Installation-Commissioning, WCMV HE-Pump Install Test, GatesAir Program Management at WCMV Site.

Interim Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Interim
	Description of Use	N/A
	Change Type	Purchase
	Manufacturer
	Model	UAXTE-8R44
	Transmitter Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power capacity	4.8 kW
	Justification for New Transmitter	Space constraints due to the 3 cabinet Rohde & Schwarz, existing 4 channel high power combining system, 3 pumps stands, and other systems will have to be removed before space will be available for the new transmitter and combiner system can be installed.

Interim Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	No
	Transformer (480V)	No
	Power	N/A
	Rigid Conduit and Wiring	No
	Size	N/A
	Length	N/A
	Other Electrical Service	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
Inside RF System	Is an additional interior RF system required to support this interim transmitter?	Yes

Interim Transmitter

Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Retune Existing
	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?	Yes
	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	Horizontal
	Type	Broadband Panel
	Number of Stations Supported	3
	Number of Panels	48
	Design power capacity in use	35.0 %
	Lower Limit	482.00 MHz
	Upper Limit	608.00 MHz
	Other Antenna Type	N/A
	ERP:	338.0 kW
	Manufacturer	Dielectric
	Model	TUF-P4-12/48H-1
	Year	2002

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID	Call Sign
59280	WGTU
21253	WPBN-TV

Primary Antenna

Adjustment to Existing Antenna

Section	Question	Response
Sweep Test of Existing Antenna	Do you need a sweep test of existing antenna?	Yes

Primary Antenna

Other Antenna Costs

Section	Question	Response
Combiner for Shared Antenna	Do you need a Combiner for a Shared Antenna?	Yes
	Type	New
	Number of channels supported	3
	Frequencies of channels supported	RF channel
	Frequency	N/A

Enter a list of RF channel numbers.

RF Channel Number
34
29
35

Primary Antenna

Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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?	Yes
	Is Transmission Line in operating condition?	Yes
Existing Transmission Line Manufacturer and Type	Manufacturer	Dielectric
	Type	Rigid
	Diameter	6 1/8 inches
	Other Diameter	N/A
	Segment Length	Broadband
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	1260 feet per run

Facility ID's and Call Signs of all stations with whom the transmission line is shared.

Facility ID	Call Sign
59280	WGTU
21253	WPBN-TV

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Name	Description
Core two Holes through Building Walls	The interbuilding transmission line will enter one building with a concrete block wall and the other building a 4 inch outside aggregate paneled wall; both require 9 inch holes cored for the line to enter.
InterBuilding Transmission Line Installation Services	The GatesAir installation group does not install outdoor transmission line; our Tower Consultants will secure a tower company to provide the line installation services.
Expand Ice Shielding	New Inter Building Transmission Line and Heat Exchangers Requires Ice Shield.
WCMV WPBN WGTU CIF Combiner Output Connection to Antenna Feed	3 Stations combined requires CIF/Combiner Output to be connected to the Antenna Feed the night of cutover. Items 6 1/8": 2 Transmission Lines, 1 Dir. Coupler, 3 Elbows, 1 Gas Stop, 3 Flange Field Soft Solder, 3 Anchor Connectors, 1 Fine Matcher, 4 Hngrs
WGTU Transmitter Connection to Branch Combiner	All Items 3 1/8": 2 Transmission Lines, 6 Elbows, 1 Fine Matcher, 5 Flange Field Soft Solder, 5 Anchor Connectors, 5 "O" Rings, 1 Ballast Load Kit, 4 Hangers.
WPBN Transmitter Connection to Branch Combiner	All Items 4 1/16": 2 Transmission Lines, 6 Elbows, 1 Fine Matcher, 5 Flange Field Soft Solder, 5 Anchor Connectors, 5 "O" Rings, 1 Ballast Load Kit, 4 Hangers.
InterBuilding Horizontal Line Run Between Branch and CIF Combiner	2 Buildings; 1 with Branch Combiner and 2nd Building with CIF/Combiner. Need Inter-Building Horizontal Line Run. All Items 6 1/8": 9 Transmission Lines, 7 Elbows, 1 Fine Matcher, 2 Gas Stops, 4 Flange Field Soft Solder, 6 Anchors, 2 "O" Rings, plus Misc
Spare Transmission Components	Qty 1 of each transmission line items as construction spares or in the event of shortage. 3 Elbows each size, 3 Flange Field Soft Solder each size, 3 Transmission Lines each size, 9 anchor connectors each size, 18 "O" Rings each size, 12 Caps & Hangers

Tower Equipment And Rigging Costs

Section	Question	Response
Tower Equipment or Rigging Costs Changes	Do you have tower equipment or rigging costs changes?	No

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	No
	Number of Hours	N/A
	Explanation	N/A
Outside RF consulting Engineering Services	Perform engineering study for new channel assignment and antenna development	Yes
	Prepare engineering section of Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare engineering section of Form FCC License to Cover Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	Yes
	Quantity	1
	Do you have Distributed Transmission System engineering services?	N/A
	Critical Facility	N/A
	Terrain-Shielded Facility	N/A
Attorney and Other Outside Consulting Services	Prepare and file Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare and file Form FCC License to Cover Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	Yes
	Quantity	1
	NEPA Section 106 environmental review	No
	Environmental Assessment	No
	ASR Modification	No
	FAA Consultation (including preparation of FAA Form 7460)	No
	Negotiation of Lease and other Matter for Shared Locations	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	No
	RF exposure measurements	No
	Additional Field Engineering Service	No
	Number of Days	N/A
	Justification	N/A

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

Section	Question	Response
AM Pattern Disturbance	Is an Impact Study needed?	No
AM Pattern Disturbance	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	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)?	No
	Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs?	Yes
	Does this relocation require Equipment Storage?	No
	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

Other Expenses Not Listed

Name	Description
Internal Field Engineering Staff Expenses	Field Engineering Staff Initial Investigative Site Visits. Print workup, Manage Deliveries, On Site for Installations, Signal and Remote Control Wiring, Ice Bridge and RF Transmission Line Installation.
Demolition Services	Demolition Services to Remove old 4 Channel Manifold Combiner System from Ceiling including Disposal.
Internal Project Management	Director of Technical Services Project Management. CP, Form 399, Site Investigation, Bid Specs, Purchasing Activity, On Site during Construction, License to Cover. See Detailed Doc Attached.

Cost Information

Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$1,191,458.09	$685,097.08	N/A	$667,231.95	N/A
Total for all systems	$1,500,628.92	$1,150,112.51	N/A	$1,080,054.13	N/A
Interim Transmitter UAXTE-8R44	$384,000.00	$93,840.74		$93,840.74
UHF - Air Cooled Solid State Transmitter 4 - 6 kW	$236,500.00	$91,446.00	N/A	$91,446.00	ACTUAL COST PER QUOTE
UHF inside RF system including switching	$147,500.00	$2,394.74	N/A	$2,394.74	ACTUAL COST PER QUOTE
Primary Transmitter ULXTE-30	$807,458.09	$591,256.34		$573,391.21
GatesAir Transmitter Install Services	$61,254.45	$61,254.45	N/A	$61,254.45	ACTUAL COST PER QUOTE
Other Electrical Service: Electrical firm 1st site visit for evaluation. 2nd Visit install conduit, pull electrical wiring, and activate electrical to interim transmitter, 3rd trip get electrical activated to permanent transmitter via new panel.	$36,732.00	$36,732.00	Electrical firm 4 site visits, new distribution panel and breakers. This expense covers both main and interim transmitters full electrical hookup. Building wide Lightning and Surge Suppression also included as existing obsolete and modules are blown.	$36,732.00	N/A
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW	$684,000.00	$467,798.25	N/A	$449,933.12	Actual cost per quote from GatesAir
Replacement Building Outside Wall Panels	$1,678.20	$1,678.20	Building manufacturer is providing replacement wall panels to repair opening left when old AC Units are removed.	$1,678.20	N/A
Concrete Pad for Heat Exchangers and AC Heat Pump Units	$2,931.00	$2,931.00	Additional Concrete Pad for the new AC Heat Pump Units and TV Transmitter outdoor exchangers to sit on under ice shield protection.	$2,931.00	N/A
Other -- HVAC Service Type: H Size:7 (Other)	$20,862.44	$20,862.44	Existing AC Units are 20 years old and are wall mounted right where the very large Waveguide CIF_Combiner has to be placed. Access to these will be cut off; the replacement units mount high on the walls out of the way.	$20,862.44	N/A

Components

Actual Information Description	File Name
UHF - Air Cooled Solid State Transmitter 4 - 6 kW	Component Description: 5kW INTERIM TRANSMITTER INVOICE LINE - K QOUTE LINES 101-106 Amount: $46,239.78 Component Description: 5KW INTERM TRANSMITTER Amount: $46,239.78 Component Description: 5kW INTERIM TRANSMITTER INVOICE LINE - K QUOTE LINES 109-114 Amount: $45,206.22 Component Description: 5KW INTERM TRANSMITTER Amount: $45,206.22
UHF inside RF system including switching	Component Description: HELAIX TRANSMISSION LINE FOR TEMPORARY CONNECTION OF 5kW INTERIM TRANSMITTER INVOICE LINE - L QUOTE LINES 107-114 Amount: $1,604.48 Component Description: HELAIX TRANSMISSION LINE FOR TEMPORARY CONNECTION OF 5kW INTERIM TRANSMITTER INVOICE LINE - L QUOTE LINES 115-122 Amount: $790.26 Component Description: HELAIX TRANSMISSION LINE FOR UHF INSIDE RF SYSTEM INCLUDING SWITCHING Amount: $1,604.48 Component Description: HELAIX TRANSMISSION LINE FOR UHF INSIDE RF SYSTEM INCLUDING SWITCHING Amount: $790.26
GatesAir Transmitter Install Services	Component Description: INSTALL SERVICES FOR 5kW INTERIM TRANSMITTER INVOICE LINE - M QUOTE LINES 115-118 Amount: $12,308.43 Component Description: GatesAir Invoice Item #K - Transmitter Install Service Amount: $24,473.01 Component Description: Transmitter Install Service Amount: $24,473.01 Component Description: INSTALL SERVICES FOR 5kW INTERIM TRANSMITTER INVOICE LINE - M QUOTE LINES 123-126 Amount: $24,473.01 Component Description: Transmitter Install Service Amount: $12,308.43
Other Electrical Service: Electrical firm 1st site visit for evaluation. 2nd Visit install conduit, pull electrical wiring, and activate electrical to interim transmitter, 3rd trip get electrical activated to permanent transmitter via new panel.	Component Description: INSTALL 3/4" CONDUIT PER PO LINE 10 / ADD PUMP STANDS PER PO LINE 40 / ADD NEW CONDENSING UNIT PER PO LINE 50 Amount: $36,732.00
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW	Component Description: CREDIT FOR PAYMENT ON GATES AIR INVOICE JW30004612-1 DIELECTRIC NITROGEN GENERATOR GA999TO INVOICE LINE ITEM A QUOTE LINE ITEM 21 Amount: ($4,737.83) Component Description: PRIMARY TRANSMITTER Amount: $43,386.33 Component Description: PRIMARY TRANSMITTER-ULXTE-30 INVOICE LINE - A QUOTE LINES 2-34 Amount: $100,750.63 Component Description: GatesAir WCMV 20 KW Transmitter - PO Line Item 10 Amount: $158,972.22 Component Description: CREDIT FOR PAYMENT ON GATES AIR INVOICE JW30004612-1 SPARE PARTS KIT HE II PUMP MODULE9900160014 INVOICE LINE ITEM A QUOTE LINE ITEM 22 Amount: ($1,336.31) Component Description: Transmitter 20kW INVOICE LINE ITEM A Amount: $152,898.08 Component Description: TRANSMITTER Amount: $149,853.81 Component Description: TRANSMITTER Amount: $158,972.22
Replacement Building Outside Wall Panels	Component Description: Replacement Building Outside Wall Panels Amount: $1,678.20
Concrete Pad for Heat Exchangers and AC Heat Pump Units	Component Description: INSTALL 4" DEEP CONCRETE PAD PER PO Amount: $2,931.00
Other -- HVAC Service Type: H Size:7 (Other)	Component Description: PURCHASE AND INSTALLATION OF TWO HEAT PUMP SYSTEMS Amount: $1,431.22 Component Description: PURCHASE AND INSTALLATION OF TWO HEAT PUMP SYSTEMS Amount: $10,431.22 Component Description: PURCHASE AND INSTALLATION OF TWO HEAT PUMP SYSTEMS Amount: $9,000.00

Cost Information

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	$90,930.00	$258,225.10	N/A	$258,225.10	N/A
Total for all systems	$1,500,628.92	$1,150,112.51	N/A	$1,080,054.13	N/A
Primary Antenna TUF-P4-12/48H-1	$90,930.00	$258,225.10		$258,225.10
New combiner, cost per channel (without antenna)	$84,200.00	$250,695.69	CMU is sole owner of the channel combiner; by lease agreement we are responsible for its replacement in exchange for the property and tower use. CMU has entered the total cost for the three station combiner system as in the uploaded GatesAir Bid/Quotation	$250,695.69	ACTUAL COST PER QUOTE / INVOICE
Sweep test of existing antenna	$6,730.00	$7,529.41	See uploaded GatesAir Bid/Quote for Dielectric Field Engineer On-Site for One Day, Travel, Expenses, and Report. Sweep the Line Between Buildings, Align Fine Matchers, and Checkout Branch and CIF Combiners.	$7,529.41	ACTUAL COST PER QUOTE

Components

Actual Information Description	File Name
New combiner, cost per channel (without antenna)	Component Description: COMBINER INSTALL SERVICES INVOICE LINE - E QUOTE LINE 50 Amount: $13,961.14 Component Description: RF Accessories Invoice Item - D Quote Line No 48 & 49 Amount: $5,790.27 Component Description: WGTU-TV/WPBN-TV BRANCH COMBINER INVOICE LINE - C QUOTE LINE 47 Amount: $13,744.42 Component Description: RF ACCESSORIES / ASSY, TEST LOAD COOLING INVOICE LINE - D QUOTE LINES 41-42 Amount: $5,786.80 Component Description: MASK FILTER / COMBINER SYSTEM INVOICE LINE - B QUOTE LINES 35-39 Amount: $50,056.06 Component Description: COMBINER INSTALL SERVICES INVOICE LINE - E QUOTE LINE 43 Amount: $13,952.77 Component Description: WGTU-TV / WPBN-TV BRANCH COMBINER INVOICE LINE - C QUOTE LINE 40 Amount: $13,736.16 Component Description: Invoice Item #D - RF Accessories Amount: $5,790.27 Component Description: Invoice Item #C - WGTU-TV/WPBN-TV Branch Combiner Amount: $13,744.42 Component Description: Invoice Item #B - Mask Filter / Combiner System Amount: $50,086.12 Component Description: Invoice Item #E - Combiner Install Services Amount: $13,961.14 Component Description: INVOICE ITEM D - RF ACCESSORIES Amount: $5,790.27 Component Description: INVOICE ITEM C - WGTU-TV / WPBN-TV BRANCH COMBINER Amount: $13,744.42 Component Description: INVOICE ITEM C - WGTU-TV / WPBN-TV BRANCH COMBINER Amount: $13,736.16 Component Description: INVOICE ITEM E - COMBINER INSTALL SERVICES Amount: $13,952.77 Component Description: MASK FILTER / COMBINER SYSTEM INVOICE LINE - B QUOTE LIEN ITEMS 42-46 Amount: $50,086.12 Component Description: INVOICE ITEM B - MASK FILTER / COMBINER SYSTEM Amount: $50,086.12 Component Description: INVOICE ITEM D - RF ACCESSORIES Amount: $5,786.80 Component Description: INVOICE ITEM E - COMBINER INSTALL SERVICES Amount: $13,961.14 Component Description: INVOICE ITEM B - MASK FILTER / COMBINER SYSTEM Amount: $50,056.06
Sweep test of existing antenna	Component Description: DIELECTRIC SERVICES/SWEEP LINE BETWEEN BUILDINGS AND ALIGN FINE MATCHERS INVOICE LINE - L QUOTE LINE 119 Amount: $2,508.79 Component Description: GatesAir Invoice Item #L - Dielectric Service/Sweep Test of existing antenna Amount: $2,510.31 Component Description: Dielectric Service/Sweep Test of existing antenna Amount: $2,510.31 Component Description: DIELECTRIC SERVICES/SWEEP LINE BETWEEN BUILDINGS AND ALIGN FINE MATCHERS INVOICE LINE - L QUOTE LINE 127 Amount: $2,510.31 Component Description: Dielectric Service/Sweep Test of existing antenna Amount: $2,508.79

Actual Information Description

File Name

New combiner, cost per channel (without antenna)

Component Description:: COMBINER INSTALL SERVICES INVOICE LINE - E QUOTE LINE 50
Amount:: $13,961.14

Component Description:: RF Accessories Invoice Item - D Quote Line No 48 & 49
Amount:: $5,790.27

Component Description:: WGTU-TV/WPBN-TV BRANCH COMBINER INVOICE LINE - C QUOTE LINE 47
Amount:: $13,744.42

Component Description:: RF ACCESSORIES / ASSY, TEST LOAD COOLING INVOICE LINE - D QUOTE LINES 41-42
Amount:: $5,786.80

Component Description:: MASK FILTER / COMBINER SYSTEM INVOICE LINE - B QUOTE LINES 35-39
Amount:: $50,056.06

Component Description:: COMBINER INSTALL SERVICES INVOICE LINE - E QUOTE LINE 43
Amount:: $13,952.77

Component Description:: WGTU-TV / WPBN-TV BRANCH COMBINER INVOICE LINE - C QUOTE LINE 40
Amount:: $13,736.16

Component Description:: Invoice Item #D - RF Accessories
Amount:: $5,790.27

Component Description:: Invoice Item #C - WGTU-TV/WPBN-TV Branch Combiner
Amount:: $13,744.42

Component Description:: Invoice Item #B - Mask Filter / Combiner System
Amount:: $50,086.12

Component Description:: Invoice Item #E - Combiner Install Services
Amount:: $13,961.14

Component Description:: INVOICE ITEM D - RF ACCESSORIES
Amount:: $5,790.27

Component Description:: INVOICE ITEM C - WGTU-TV / WPBN-TV BRANCH COMBINER
Amount:: $13,744.42

Component Description:: INVOICE ITEM C - WGTU-TV / WPBN-TV BRANCH COMBINER
Amount:: $13,736.16

Component Description:: INVOICE ITEM E - COMBINER INSTALL SERVICES
Amount:: $13,952.77

Component Description:: MASK FILTER / COMBINER SYSTEM INVOICE LINE - B QUOTE LIEN ITEMS 42-46
Amount:: $50,086.12

Component Description:: INVOICE ITEM B - MASK FILTER / COMBINER SYSTEM
Amount:: $50,086.12

Component Description:: INVOICE ITEM D - RF ACCESSORIES
Amount:: $5,786.80

Component Description:: INVOICE ITEM E - COMBINER INSTALL SERVICES
Amount:: $13,961.14

Component Description:: INVOICE ITEM B - MASK FILTER / COMBINER SYSTEM
Amount:: $50,056.06

Sweep test of existing antenna

Component Description:: DIELECTRIC SERVICES/SWEEP LINE BETWEEN BUILDINGS AND ALIGN FINE MATCHERS INVOICE LINE - L QUOTE LINE 119
Amount:: $2,508.79

Component Description:: GatesAir Invoice Item #L - Dielectric Service/Sweep Test of existing antenna
Amount:: $2,510.31

Component Description:: Dielectric Service/Sweep Test of existing antenna
Amount:: $2,510.31

Component Description:: DIELECTRIC SERVICES/SWEEP LINE BETWEEN BUILDINGS AND ALIGN FINE MATCHERS INVOICE LINE - L QUOTE LINE 127
Amount:: $2,510.31

Component Description:: Dielectric Service/Sweep Test of existing antenna
Amount:: $2,508.79

Cost Information

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	$121,499.85	$121,499.85	N/A	$106,726.27	N/A
Total for all systems	$1,500,628.92	$1,150,112.51	N/A	$1,080,054.13	N/A
Primary Transmission Line	$121,499.85	$121,499.85		$106,726.27
WGTU Transmitter Connection to Branch Combiner	$8,564.40	$8,564.40	Reference the uploaded WCMV GatesAir Bid/Quotation Q-81065 Page 9.	$8,564.40	ACTUAL COST
Spare Transmission Components	$14,773.58	$14,773.58	Qty 1 of each transmission line items as construction spares or in the event of shortage. 3 Elbows each size, 3 Flange Field Soft Solder each size, 3 Transmission Lines each size, 9 anchor connectors each size, 18 "O" Rings each size, 12 Caps & Hangers.	$0.00	ACTUAL COST PER QUOTE
InterBuilding Horizontal Line Run Between Branch and CIF Combiner	$41,001.80	$41,001.80	Reference the uploaded WCMV GatesAir Bid/Quotation Q-81065 Page 10 & 11.	$41,001.80	ACTUAL COST PER QUOTE
WPBN Transmitter Connection to Branch Combiner	$12,806.07	$12,806.07	Reference the uploaded WCMV GatesAir Bid/Quotation Q-81065 Page 9 & 10.	$12,806.07	ACTUAL COST PER QUOTE
InterBuilding Transmission Line Installation Services	$16,220.00	$16,220.00	Tower consulting Company is providing the tower crews to install the interbuilding transmission line run.	$16,220.00	N/A
Core two Holes through Building Walls	$617.50	$617.50	Core two holes through two concrete building walls so the interbuilding transmission line can enter.	$617.50	N/A
Expand Ice Shielding	$6,767.00	$6,767.00	Ice Shield expansion for TV Transmitter heat exchangers and AC outdoor units; attached quotation from Isenhart Electric and CO to Purchase Orders.	$6,767.00	N/A
WCMV WPBN WGTU CIF Combiner Output Connection to Antenna Feed	$20,749.50	$20,749.50	Reference the uploaded WCMV GatesAir Bid/Quotation Q-81065 Page 11.	$20,749.50	ACTUAL COST PER QUOTE

Components

Actual Information Description	File Name
WGTU Transmitter Connection to Branch Combiner	Component Description: WGTU TRANSMITTER CONNECTION TO BRANCH COMBINER INVOICE LINE - F QUOTE LINE 51-58 Amount: $3,770.19 Component Description: GatesAir Invoice Item #F - WGTU Transmitter Connection to Branch Combiner Amount: $4,794.21 Component Description: WGTU TRANSMITTER CONNECTION TO BRANCH COMBINER Amount: $3,770.19
Spare Transmission Components	Component Description: Credit Memo for payment of non-reimbursable items on Gates Air, Inc. invoice # JW3004612-1 Amount: ($5,793.66) Component Description: GatesAir Invoice Item #J - Spare Transmission Components Amount: $5,793.66 Component Description: NON-REIMBURSABLE SPARE TRANSMISSION COMPONENTS FOR INSTALLATION OF TRANSMISSION LINES INVOICE LINE - J QUOTE LINES 79-99 Amount: N/A Component Description: Spare Transmission Components Amount: $3,186.26 Component Description: Spare Transmission Components Amount: $5,793.66 Component Description: NON-REIMBURSABLE SPARE TRANSMISSION COMPONENTS FOR INSTALLATION OF TRANSMISSION LINES INVOICE LINE - J QUOTE LINES 87-107 Amount: N/A
InterBuilding Horizontal Line Run Between Branch and CIF Combiner	Component Description: INTER-BUILDING HORIZONTAL RUN BETWEEN BRANCH & CIF COMBINERS INVOICE LINE - H QUOTE LINE 67-78 Amount: $13,433.60 Component Description: INTER-BUILDING HORIZONTAL RUN BETWEEN BRANCH & CIF COMBINERS INVOICE LINE - H QUOTE LINES 58-70 Amount: $14,134.60 Component Description: GatesAir Invoice Item #H - Inter-Building Horizontal Run Between Branch & CIF Combiners Amount: $13,433.60 Component Description: InterBuilding Horizontal Line Run Between Branch and CIF Combiner Amount: $13,433.60 Component Description: InterBuilding Horizontal Line Run Between Branch and CIF Combiner Amount: $14,134.60
WPBN Transmitter Connection to Branch Combiner	Component Description: WPBN TRANSMITTER CONNECTION TO BRANCH COMBINER INVOICE LINE - G QUOTE LINE 59-66 Amount: $5,590.63 Component Description: GatesAir Line Item #G - WPBN Transmitter Connection to Branch Combiner Amount: $7,215.44 Component Description: WPBN TRANSMITTER CONNECTION TO BRANCH COMBINER Amount: $5,590.63
InterBuilding Transmission Line Installation Services	Component Description: InterBuilding Transmission Line Installation Services Amount: $8,110.00 Component Description: InterBuilding Transmission Line Installation Services Amount: $4,055.00 Component Description: InterBuilding Transmission Line Installation Services Amount: $4,055.00
Core two Holes through Building Walls	Component Description: Labor and materials to add a 9" cored hole at WCMV. Per Attachment C of PO Amount: $617.50
Expand Ice Shielding	Component Description: ADD ICE MAT PER PO Amount: $6,767.00
WCMV WPBN WGTU CIF Combiner Output Connection to Antenna Feed	Component Description: WCMV/WPBN/WGTU CIF COMBINER OUTPUT CONNECTION TO ANTENNA FEED INVOICE LINE I QUOTE LINE 79-86 Amount: $7,150.93 Component Description: WCMV /WPBN / WGTU CIF COMBINER OUTPUT CONNECTION TO ANTENNA FEED INVOICE LINE - I QUOTE LINES 71-78 Amount: $6,447.64 Component Description: GatesAir Invoice Item #I - WCMV/WPBN/WGTU CIF Combiner Output Connection to Antenna Feed Amount: $7,150.93 Component Description: WCMV/WPBN/WGTU CIF Combiner Output Connection to Antenna Feed Amount: $7,150.93 Component Description: WCMV/WPBN/WGTU CIF Combiner Output Connection to Antenna Feed Amount: $6,447.64

Cost Information

Tower Equipment and Rigging Costs

Information not provided.

Cost Information

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	$34,920.00	$32,834.50	N/A	$15,047.75	N/A
Total for all systems	$1,500,628.92	$1,150,112.51	N/A	$1,080,054.13	N/A
Outside Professional Services	$34,920.00	$32,834.50		$15,047.75
Prepare request for Special Temporary Authorization	$2,050.00	$1,500.00	N/A	$918.50	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	$241.00	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$3,000.00	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	$2,718.75	N/A
Address transition timing and coordination issues w/ other stations and wireless	$2,630.00	$2,584.50	Total cost slightly higher than estimated cost.	$2,584.50	N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization	$3,680.00	$3,500.00	N/A	$234.00	N/A
Attorney Fees - Negotiation of lease and other matters for shared locations	$4,210.00	$4,000.00	N/A	$1,414.00	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,250.00	N/A	$393.00	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$5,000.00	N/A	$2,428.50	N/A
Prepare and or review reimbursement form	$2,630.00	$2,500.00	N/A	$1,115.50	N/A

Components

Actual Information Description	File Name
Prepare request for Special Temporary Authorization	Component Description: 08/05/19 - Prepare online FCC reduced power notification and Special Temporary Authority application/exhibit for WCMV Amount: $390.00 Component Description: 08/22/19 - Review FCC Public Notices and databases re grant of Special Temporary Authority application for WCMV (TV) interim facility... Amount: $39.00 Component Description: Email to J. Rademaker regarding grant of WCMV reduced power repack STA. Amount: $35.00 Component Description: Work on WCMV repack issues for interim STA for reduced power operation as part of repack work and overall repack plan Amount: $404.00 Component Description: Work on WCMV reduced power operations and STA for same Amount: $50.50 Component Description: Work on WCMV reduced power operations and STA for same Amount: $50.50
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Component Description: Prepare WCMV repack license to cover application; email to J. Rademaker regarding same Amount: $140.00 Component Description: Work on WCMV repack and covering license application for permanent repack facility Amount: $101.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: Prepare and upload Engineering Section of FCC Form 2100 Construction Permit Application Amount: $3,000.00
Perform engineering study for new channel assignment and antenna development	Component Description: ENGINEERING STUDY FOR NEW CHANNEL ASSIGNMENT. EXPLORE UPGRADE. POWER INCREASE.REVIEW UPGRADE APPLICATION. COVERAGE MAPS Amount: $2,718.75
Address transition timing and coordination issues w/ other stations and wireless	Component Description: WORK ON WCMV REPACK ISSUES REGARDING COORDINATION WITH LINKED STATION SET Amount: $151.50 Component Description: Work on WCMV repack issues regarding consumer education campaign and crawls and FCC concern over same Amount: $202.00 Component Description: Email regarding online public file obligations associated with WCMV repack; research regarding same. Amount: $70.00 Component Description: Review repack-related certifications for WCMV; email regarding same Amount: $35.00 Component Description: Work on WCMV repack issues and quarterly repack progress report; telephone call with W. Henderson (WCMV engineering) regarding Phase 6 repack readiness and required FCC filings Amount: $101.00 Component Description: Prepare WCMV repack viewer notification certification; email to W. Henderson regarding repack progress and status Amount: $105.00 Component Description: Work on WCMV repack and interpretation of timing for FCC required 10-day reports Amount: $101.00 Component Description: Work on status of WCMV repack and upcoming Phase 6 transition deadline Amount: $151.50 Component Description: Work on transition timing and coordination issues Amount: $497.50 Component Description: Prepare Chart for transition timing and coordination issues. Amount: $225.50 Component Description: TELEPHONE CALL REGARDING WCMV REPACK TIMING AND ISSUES Amount: $140.00 Component Description: Transition Timing and Coordination Issues of transitioning stations Amount: $136.00 Component Description: EMAIL REGARDING WCMV REPACK LINKED STATION SET Amount: $70.00 Component Description: EMAIL REGARDING WCMV'S REPACK LINKED STATION SET Amount: $140.00 Component Description: Revise WCMV repack viewer notification certification; email to W. Henderson regarding same Amount: $105.00 Component Description: Work on WCMV repack status, combiner issues, back up plan and phase 6 deadline issues Amount: $151.50 Component Description: WORK ON WCMV ISSUES WITH LINKED STATION SETS AND COORDINATION Amount: $202.00
Attorney Fees - Prepare and File request for Special Temporary Authorization	Component Description: 08/06/19 - Review, edit, complete and file online FCC reduced power notification and Special Temporary Authority application for WCMV (TV)... Amount: $234.00
Attorney Fees - Negotiation of lease and other matters for shared locations	Component Description: Work on issues WPBN's use of WCMV equipment. Review WGTU minor modification application. Review WGTU antenna change/upgrade issue. Followup on shared equipment ownership issues. Amount: $707.00 Component Description: Research WCMV repack issues for shared antenna and combiner and documentation for WPBN's authorization for use of same. Amount: $707.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Component Description: Launch repack license to cover application for WCMV; email to W. Henderson regarding same Amount: $105.00 Component Description: Review FCC Public Notices and databases re submission and acceptance for filling of WCMV license to cover application for post-auction transition repack facilities; update station tracking records re same Amount: $39.00 Component Description: Review grant of WCMV repack covering license; email to J. Rademaker regarding same Amount: $70.00 Component Description: File WCMV repack license to cover; emails to J. Rademaker and W. Henderson regarding same Amount: $140.00 Component Description: Review FCC grant of license to cover application for WCMV post-auction transition repack facilities; update station records re same and channel change Amount: $39.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: Analysis re upcoming FCC post-auction transition repack construction permit expiration and deadline for WCMV (TV) facilities. Amount: $39.00 Component Description: WCMV repack issues; Form 399; review, complete and file minor modification channel change appplication. Review WCMV Repack CP issued by FCC Amount: $1,667.00 Component Description: Review and file WCMV repack CP application Amount: $610.50 Component Description: Review Modified repack construction permit Amount: $112.00
Prepare and or review reimbursement form	Component Description: Email reminder regarding WCMV repack progress report deadline Amount: $35.00 Component Description: Email reminder regarding WCMV repack progress report deadline Amount: $35.00 Component Description: Email to W. Henderson regarding WCMV repack progress report due date Amount: $35.00 Component Description: Telephone call with W. Henderson regarding WCMV repack dependencies; prepare for same Amount: $140.00 Component Description: Follow up on WCMV repack status and Phase 6 deadline Amount: $151.50 Component Description: Follow up on WCMV repack status and various required FCC repack filings Amount: $101.00 Component Description: Prepare WCMV repack checklist; email to W. Henderson regarding same Amount: $105.00 Component Description: Reminder regarding WCMV repack quarterly progress report required by FCC Amount: $50.50 Component Description: Analysis regarding WCMV post-transition repack filing obligations Amount: $70.00 Component Description: Analysis regarding WCMV repack status and issues Amount: $35.00 Component Description: Follow up on WCMV repack status and Phase 6 deadline Amount: $101.00 Component Description: Review W. Henderson message regarding WCMV repack status Amount: $70.00 Component Description: Prepare summary of FCC releases regarding FM/TV translator/LPTV reimbursement of repack-related expenses Amount: $35.00 Component Description: Prepare a summary of FCC releases regarding FM/TV translator/LPTV reimbursement of repack-related expenses Amount: $35.00 Component Description: Follow up on WCMV repack status and equipment installation Amount: $151.50

Cost Information

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	$61,820.98	$52,455.98	N/A	$32,823.06	N/A
Total for all systems	$1,500,628.92	$1,150,112.51	N/A	$1,080,054.13	N/A
Other Expenses	$61,820.98	$52,455.98		$32,823.06
Internal Project Management	$10,524.00	$10,524.00	Dir. of Technical Services Project Management. CP, Form 399, Site Investigation, Bid Specs, Purchasing Activity, On Site during Construction, License to Cover. See Detailed Doc Attached.	$1,697.89	N/A
Demolition Services	$1,272.00	$1,272.00	Demolition Services to Remove old Manifold Combiner from Building Ceiling and Dispose of the System.	$0.00	N/A
Internal Field Engineering Staff Expenses	$10,909.00	$10,909.00	Field Engineering Staff Initial Investigative Site Visits. Print workup, Manage Deliveries, On Site for Installations, Signal and Remote Control Wiring, Ice Bridge and RF Transmission Line Installation. See Detailed Doc.	$1,759.19	N/A
DTV Medical Facility Notification	$11,550.00	$2,185.00	Quote from DTV Notifications for WCMV Medical Facility Notifications.	$2,185.00	N/A
MVPD Notification of Channel Change	$1,752.00	$1,752.00	Initial Work Up of Addresses and Contact Info for MVPD and Satellite Companies; then Preparation and Certified Mailing of Notices, Phone Time Working with Reception and Specifics of Receiving Station.	$1,752.00	N/A
Equipment Delivery and Handling Charges	$25,428.98	$25,428.98	Reference the uploaded WCMV GatesAir Bid/Quotation Q-84664 Page 18. Final Freight costs.	$25,428.98	N/A
Develop and air announcement of upcoming channel change	$385.00	$385.00	Set Up Scope of Effort and Make Assignments. Write and record copy; shoot, edit, export, and ingest the spot. Traffic and Programming staff efforts of spot placement and ensure FCC compliance.	N/A	N/A

Components

Actual Information Description	File Name
Internal Project Management	Component Description: Review of TX-Combiner bid spec draft Amount: $275.60 Component Description: Process quotes for concrete work and transmitter exchange. Prepare bid specs and vendor list for Air Conditioning systems Amount: $196.18 Component Description: Work with Dielectric and prepare bid specs for WCMV Amount: $931.84 Component Description: Internal labor for resubmission of FCC form 399 and discussion with GatesAir regarding electrical hookup configuration for WCMV transmitter Amount: $294.27
Demolition Services	Information not provided.
Internal Field Engineering Staff Expenses	Component Description: Meet with potential bidders and vendors for site visit at WCMV Amount: $760.22 Component Description: Detailed measurements at WCMV for placement of new larger diplexer RF filtering. And, meet with potential bidders. Amount: $998.97
DTV Medical Facility Notification	Component Description: Transmitter Medical Facility Notification Amount: $2,185.00
MVPD Notification of Channel Change	Component Description: MVPD NOTIFICATION SERVICES Amount: $1,752.00
Equipment Delivery and Handling Charges	Component Description: TOTAL FREIGHT COST Amount: $25,428.98 Component Description: Final Freight Cost Amount: $25,428.98
Develop and air announcement of upcoming channel change	Information not provided.

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$1,500,628.92	$1,150,112.51	$1,080,054.13

Reimbursement Status

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

Certification

Section	Question	Response
Submission of Final Allocation or Accounting Information Statements	WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates. 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. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. 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.	Shannon Franz Manager Business Operations 09/29/2021

Section

Question

Response

Submission of Final Allocation or Accounting Information Statements

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

The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.
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.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
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.

Shannon Franz

Manager Business Operations

09/29/2021

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

Applicant Information

Applicant Name, Type, and Contact Information

Reimbursement Contact Information

Reimbursement Contact Name and Information

Preparer Contact Information

Preparer Contact Name and Information

Broadcaster Information and Transition Plan

Transmitters

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Interim Transmitter

New Transmitter Costs

Interim Transmitter

Other Transmitter Costs

Interim Transmitter

Other Transmitter Cost Not Listed

Antennas

Primary Antenna

Existing Antenna Information

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Primary Antenna

Adjustment to Existing Antenna

Primary Antenna

Other Antenna Costs

Enter a list of RF channel numbers.

Primary Antenna

Other Antenna Cost Not Listed

Transmission Line

Primary Transmission Line

Existing Transmission Line

Facility ID's and Call Signs of all stations with whom the transmission line is shared.

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Tower Equipment And Rigging Costs

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Components

Cost Information

Tower Equipment and Rigging Costs

Cost Information

Outside Professional Services

Components