TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
Nexstar Media Inc.	Elizabeth Ryder 545 E. John Carpenter Freeway Suite 700 Irving, TX 75062 United States	+1 (972) 373-8800	eryder@nexstar.tv	Corporation

Applicant

Address

Phone

Applicant Type

Nexstar Media Inc.

Elizabeth Ryder

545 E. John Carpenter Freeway

Suite 700

Irving, TX 75062

United States

+1 (972) 373-8800

eryder@nexstar.tv

Corporation

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
Elizabeth Ryder General Counsel Nexstar Media Inc.	Elizabeth Ryder 545 E. John Carpenter Freeway Suite 700 Irving, TX 75062 United States	+1 (972) 373-8800	eryder@nexstar.tv

Applicant

Address

Phone

Elizabeth Ryder

General Counsel

Nexstar Media Inc.

Elizabeth Ryder

545 E. John Carpenter Freeway

Suite 700

Irving, TX 75062

United States

+1 (972) 373-8800

eryder@nexstar.tv

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.	No
Briefly describe transition plan	Replace transmitter and transmission line, using existing antenna. Acquire temporary antenna and line for continued operation during construction. Map and analyze tower; design and implement modifications if required. See attached

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	CD3200P2
	Year	2005
	Type	Inductive Output Tube
	IOT Power Type	Two
	Power Capacity	42 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	THU9-EVO
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	73.5 kW
	Justification for New Transmitter	The manufacturer of the existing IOT transmitter advises that it cannot be re-tuned to the assigned channel. A THU9EVO 40 liquid cooled solid state or equivalent is required for a 55.1 kW TPO. A one step up equates to a THU9EVO 48 or equivalent for $1.9M

Primary Transmitter

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	3 inches
	Length	100.0 feet
	Other Electrical Service	No
	Description	N/A
HVAC Service	Does the replacement transmitter require HVAC Service?	No
	Type	N/A
	Size	N/A
	Other Size	N/A
Transmitter Building Addition/Modification or Leasehold Improvement	Does the Transmitter Building require an addition, modification, other leashold improvement?	No
	Size	N/A
Channel 14 Costs	Is an RF Consulting Engineer needed?	N/A
	Is a channel 14 Mask Filer needed?	N/A
	Is additional field engineering time needed?	N/A
	Number of Days	N/A

Primary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Additional Interior RF System	Interior RF System Existing Transmitter to Interim Transmission line
Transmitter Electrical Services	Transmitter Electrical Services
Transmitter Remote Control	Transmitter Remote Control
Electric Heater	Electric Heater

Interim Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Interim
	Description of Use	N/A
	Change Type	Purchase
	Manufacturer
	Model	TMU9-3
	Transmitter Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power capacity	1.8 kW
	Justification for New Transmitter	Required to replace existing ACSS interim TX that will not work on the post-auction channel.

Interim Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	Yes
	Switchgear (industrial 800 amp)	Yes
	Transformer (480V)	No
	Power	N/A
	Rigid Conduit and Wiring	Yes
	Size	2 inches
	Length	300.0 feet
	Other Electrical Service	No
	Description	N/A
HVAC Service	Does the replacement transmitter require HVAC Service?	Yes
	Type	Cooling Only
	Size	5 tons
	Other Size	N/A
Transmitter Building Addition/Modification or Leasehold Improvement	Does the Transmitter Building require an addition, modification, other leashold improvement?	No
	Size	N/A
Channel 14 Costs	Is an RF Consulting Engineer needed?	N/A
	Is a channel 14 Mask Filer needed?	N/A
	Is additional field engineering time needed?	N/A
	Number of Days	N/A
Inside RF System	Is an additional interior RF system required to support this interim transmitter?	No

Interim Transmitter

Other Transmitter Cost Not Listed

Name	Description
Transmitter Installation	Transmitter Installation
Transmitter Electrical Services	Transmitter Electrical Services

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	Purchase New
	Antenna Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing antenna shared with another station or stations?	No
	Is the existing antenna directional?	No
	Is antenna in operating condition?	Yes
	Is antenna located on or in close proximity to an antenna farm?	No
Existing Antenna Manufacturer and Type	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels	N/A
	Design power capacity in use	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Other Antenna Type	N/A
	ERP:	1000.0 kW
	Manufacturer
	Model	TUV-28GTH/3L-R O4SP/O4
	Year	2005

Primary Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Primary (Main)
	Description of Use	N/A
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	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	Horizontal
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels/Bays	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Design power capacity in use	N/A
	Other Antenna Type	N/A
	ERP:	1000.0 kW
	Manufacturer
	Model	TFU series
	Year	2018
	Justification for New Antenna	The existing primary antenna is a single channel slotted coaxial which cannot accommodate the assigned channel.

Primary Antenna

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

Other Antenna Cost Not Listed

Name	Description
Additional Antenna Costs	Additional Antenna Costs

Interim Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Interim
	Description of Use	N/A
	Change Type	Purchase New
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	No
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Type	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels/Bays	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Design power capacity in use	N/A
	Other Antenna Type	N/A
	ERP:	1000.0 kW
	Manufacturer
	Model	TFU-16WB C160
	Year	2018
	Justification for New Antenna	An interim antenna is necessary to keep station on the air during main line replacement.

Interim Antenna

Other Antenna Costs

Section	Question	Response
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	Yes
	Broadband or Single Channel?	S
	Feed Line Size	3 1/8 inches
Side Mount Brackets	Do you require the separate purchase of side mount brackets for an antenna?	No
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

Other Antenna Cost Not Listed

Name	Description
Additional Antenna Costs	Additional Antenna Costs

Transmission Line

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

Interim Transmission Line

New Transmission Line

Section	Question	Response
New Transmission Line Costs	Use	Interim
	Description of Use	N/A
	Change Type	Purchase New
	Type	Rigid
	Diameter	7 3/16 inches
	Segment Length	20'
	Other Segment Length
	Number of parallel runs	1
	Length	1330 feet per run
	Justification for New Transmission Line	An interim line is necessary for the interim antenna to keep station on the air during main line replacement.

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

Existing Tower

Section	Question	Response
Existing Tower Description	Type of change	Modify Existing
	Tower Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Is this tower consider Complex?	No
	Is this tower currently shared with any other stations?	No
	One or more FM, AM or TV radio broadcaster(s)	N/A
	Others Types of Users	N/A
	Is tower documented for structural analysis?	No
	Is tower compliant with Rev G?	No
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1049788
Coordinates (NAD83)	Latitude (NAD83)	32° 03' 31.7" N-
	Longitude (NAD83)	081° 17' 54.4" W-
	Overall Structure Height	1478.98 feet
	Support Structure Height	1426.16 feet
	Ground Elevation Above Mean Sea Level (AMSL)	16.08 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	Nexstar Broadcasting, Inc.
	Date Constructed	03/30/2004

Primary Tower

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

Tower Rigging Costs

Section	Question	Response
Tower Rigging Costs	Complex Tower	N/A
Helicopter Services Required	Are helicopter services required?	No

Primary Tower

Other Tower Expenses Not Listed

Name	Description
Weather Delays, Additional Charges	Weather Delays, Additional Charges
Tower Site Preparation Costs	Tower Site Preparation Costs

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	350
	Explanation	Schedule and coordinate multiple vendors, complete progress reports, and update Schedule 399. Station does not have available personnel or personnel trained in project management for such complex projects. Internal accounting and Project management.
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	Yes
	FAA Consultation (including preparation of FAA Form 7460)	Yes
	Negotiation of Lease and other Matter for Shared Locations	No
	Prepare or Review FCC Form 399 for Reimbursement	Yes
	Address transition timing and coordination issues w/ other stations and wireless providers	Yes
RF Field Engineering Services	Comprehensive coverage verification via field study	No
	RF exposure measurements	No
	Additional Field Engineering Service	Yes
	Number of Days	17
	Justification	It will be necessary to survey the site, plan the equipment, develop specifications for purchasing, and oversee multiple vendor RF projects. Station does not have available personnel or personnel trained in such services.

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	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

Other Expenses Not Listed

Name	Description
Sales Tax	Sales and use tax on goods and services at the sate rate of 7.0%.
Equipment Rentals	Equipment Rentals

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	$4,186,365.57	$1,982,649.32	N/A	$1,854,771.00	N/A
Total for all systems	$6,108,746.57	$3,712,257.57	N/A	$2,817,906.36	N/A
Interim Transmitter TMU9-3	$223,636.00	$189,396.00		$155,646.00
Transmitter Electrical Services	$686.00	$686.00	See Braddy Electric proposal 4/20/19	$686.00	N/A
5 Ton system	$20,250.00	$19,250.00	N/A	N/A	N/A
2" Rigid Conduit and Wiring (Cost per foot)	$7,800.00	$7,500.00	N/A	$7,500.00	N/A
Switchgear - industrial 800 amp	$38,200.00	$36,300.00	N/A	$36,300.00	N/A
Service entrance 3 phase/800 amp/208 volt	$14,400.00	$13,700.00	N/A	$13,700.00	N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW	$126,000.00	$95,660.00	Adjusted down from 120,000 to 95,660; See Rohde & Schwarz quote 123821.1 attached.	$81,160.00	N/A
Transmitter Installation	$16,300.00	$16,300.00	See Land Communications estimate 1144	$16,300.00	N/A
Primary Transmitter THU9-EVO	$3,962,729.57	$1,793,253.32		$1,699,125.00
Electric Heater	$1,790.00	$1,790.00	Add heat to existing HVAC system	$0.00	N/A
Transmitter Remote Control	$2,459.57	$2,459.57	See Heartland Video quote WISQ50985-01	$0.00	N/A
Transformer 3 phase/480v - 300 KVA	$36,800.00	$85,450.00	Increased from $35,000 to $85,450 by transferring from "Additional Interior RF System" to "Transformer 3 Phase/480v-300 KVA" to cover the required electrical costs. See attached cover letter and quote.	$85,450.00	N/A
Switchgear - industrial 800 amp	$38,200.00	$36,300.00	N/A	$36,300.00	N/A
UHF - Liquid Cooled Solid State Transmitter 68.5 - 75 kW	$1,999,000.00	$391,000.00	See Rohde & Schwarz quote 802-045879.1 and Rohde & Schwarz quote 118458.0, less costs previously submitted on different transmitter line	$390,721.25	N/A
Transmitter Electrical Services	$1,680.00	$1,680.00	See Braddy Electric proposal 3/22/19	$1,680.00	N/A
Additional Interior RF System	$89,600.00	$89,600.00	Reduced from $140,000 to $89,600 and moved difference to the "Transformer 3 phase/480v - 300 KVA" component in order to cover the required electrical costs (see attached cover letter and quote)	N/A	N/A
3" Rigid Conduit and Wiring (Cost per foot)	$5,200.00	$4,900.00	N/A	$4,900.00	N/A
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW	$1,788,000.00	$1,180,073.75	*System Notice: Estimate adjusted and locked because line has been superseded.*	$1,180,073.75	N/A

Components

Actual Information Description	File Name
Transmitter Electrical Services	Component Description: Connect transformer for aux transmitter Amount: $686.00
5 Ton system	Information not provided.
2" Rigid Conduit and Wiring (Cost per foot)	Component Description: Various electrical. Amount: $7,500.00
Switchgear - industrial 800 amp	Component Description: Various electrical. Amount: $36,300.00
Service entrance 3 phase/800 amp/208 volt	Component Description: Electrical costs interim transmitter Amount: $13,700.00
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW	Component Description: Credit for cancelled installation Amount: ($14,500.00) Component Description: Interim transmitter Amount: $95,660.00
Transmitter Installation	Component Description: Auxiliary transmitter installation Amount: $16,300.00
Electric Heater	Component Description: Electrical Heater for Transmitter building Amount: $1,790.00
Transmitter Remote Control	Component Description: Transmitter remote control; see also shipping and sales tax Amount: $2,459.57
Transformer 3 phase/480v - 300 KVA	Component Description: Various electrical. Amount: $85,450.00
Switchgear - industrial 800 amp	Component Description: Various electrical. Amount: $36,300.00
UHF - Liquid Cooled Solid State Transmitter 68.5 - 75 kW	Component Description: Steel heat exchanger stacking stands. See also sales tax. Amount: $4,500.00 Component Description: Final installment due on transmitter; see also sales tax. Amount: $386,221.25
Transmitter Electrical Services	Component Description: Connect transformers for main transmitter Amount: $1,680.00
Additional Interior RF System	Information not provided.
3" Rigid Conduit and Wiring (Cost per foot)	Component Description: Various electrical. Amount: $4,900.00
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW	Component Description: Additional transmitter components Amount: $21,410.00 Component Description: Installment #2 THU9-EVO Transmitter package, due at delivery 3/30/18 Amount: $772,442.50 Component Description: Downpayment 25% of THU9-EVO 73.5kW ATSC / 67Kw OFDM - Transmitter Package Amount: $386,221.25

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	$402,350.50	$406,512.00	N/A	$318,298.75	N/A
Total for all systems	$6,108,746.57	$3,712,257.57	N/A	$2,817,906.36	N/A
Interim Antenna TFU-16WB C160	$119,885.00	$119,355.00		$105,555.00
Additional Antenna Costs	$3,630.00	$3,630.00	See Dielectric order confirmation SO 692002	$3,630.00	N/A
Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed)	$7,600.00	$7,400.00	N/A	N/A	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$0.00	N/A
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, horizontally polarized	$101,925.00	$101,925.00	See Dielectric quote 700416CMZ-3	$101,925.00	N/A
Primary Antenna TFU series	$282,465.50	$287,157.00		$212,743.75
Additional Antenna Costs	$16,435.50	$16,435.50	See related invoices and costs per attached Dielectric order confirmations SO 692003, SO 1328002 and SO 1354002	$16,435.50	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$0.00	N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized	$247,000.00	$235,000.00	N/A	$166,986.75	N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	$12,300.00	$29,321.50	See related invoices	$29,321.50	Costs for other components exceeded original estimate by $7,711. Request is made for adjustment. Revised costs for other components exceeded original estimate. See attached change order on invoice 136002. Request for adjustment of $17,621.50.

Components

Actual Information Description	File Name
Additional Antenna Costs	Component Description: Additional antenna component Amount: $3,630.00
Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed)	Information not provided.
Sweep test of existing antenna	Component Description: Repack Sweep - one field engineer on-site for one day, travel expenses and report; item 22 on invoice. Amount: $2,880.00 Component Description: Repack Sweep - one field engineer on-site for one day, travel expenses and report; item 22 on invoice. Amount: $2,880.00 Component Description: Cost was not incurred with this vendor as previously quoted. Amount: ($5,760.00)
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, horizontally polarized	Component Description: UHF-Broadband panel, side mount aux, interim; item 1 on invoice Amount: $45,866.25 Component Description: Remaining balance due on component. Amount: $10,192.50 Component Description: UHF-Broadband panel, side mount aux, interim; item 1 on invoice Amount: $45,866.25
Additional Antenna Costs	Component Description: Additional antenna costs Amount: $11,148.00 Component Description: Additional antenna costs Amount: $3,052.50 Component Description: Additional antenna cost Amount: $2,235.00
Sweep test of existing antenna	Component Description: Second payment on component. Amount: $2,880.00 Component Description: Service not provided by this vendor and credited from final invoice. Amount: ($5,760.00) Component Description: First payment due. Amount: $2,880.00
UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized	Component Description: First payment due on component. Amount: $71,732.25 Component Description: Balance due Antenna component - see summary at bottom of invoice Amount: $23,522.25 Component Description: Second payment due on component. Amount: $71,732.25
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	Component Description: Second payment due on component. Amount: $5,572.35 Component Description: First payment due on component. Amount: $5,572.35 Component Description: Balance due on components. See change order attached to invoice. Amount: $11,851.60 Component Description: First payment due for component. Amount: $1,005.75 Component Description: Second payment due on component. Amount: $1,005.75 Component Description: First payment due on component. Amount: $2,156.85 Component Description: Second payment due on component. Amount: $2,156.85

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	$385,700.00	$227,085.75	N/A	$218,145.75	N/A
Total for all systems	$6,108,746.57	$3,712,257.57	N/A	$2,817,906.36	N/A
Interim Transmission Line	$385,700.00	$227,085.75		$218,145.75
Rigid Transmission Line - copper, 7 3/16"	$385,700.00	$227,085.75	See Dielectric quote 700416CMZ-3	$218,145.75	N/A

Components

Actual Information Description	File Name
Rigid Transmission Line - copper, 7 3/16"	Component Description: Rigid Transmission line, copper; item 2 on invoice. Amount: $102,188.59 Component Description: Balance due on component. Amount: $13,768.57 Component Description: Rigid Transmission line, copper; item 2 on invoice. Amount: $102,188.59

Cost Information

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	$701,460.50	$668,660.50	N/A	$215,918.90	N/A
Total for all systems	$6,108,746.57	$3,712,257.57	N/A	$2,817,906.36	N/A
Primary Tower TOWER	$701,460.50	$668,660.50		$215,918.90
Weather Delays, Additional Charges	$42,000.00	$42,000.00	See related invoices	$41,862.40	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	$16,000.00	N/A
Major tower reinforcement/modifications	$421,000.00	$400,000.00	N/A	$237,045.00	N/A
Tall Tower (greater than 500')	$210,500.00	$200,000.00	N/A	($80,649.00)	N/A
Tower Site Preparation Costs	$1,660.50	$1,660.50	Site prep required by Coast to Coast prior to tower work; see related invoices	$1,660.50	N/A

Components

Actual Information Description	File Name
Weather Delays, Additional Charges	Component Description: Weather delays and additional work Amount: $28,185.00 Component Description: Weather delays and additional charges Amount: $13,677.40
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	Component Description: Tower Analysis Amount: $6,000.00 Component Description: Post Modification Inspection Amount: $2,500.00 Component Description: Construction Drawings for Tower Modifications Amount: $7,500.00
Major tower reinforcement/modifications	Component Description: Deposit for Repack Interim Antenna Installation and Top Mount TV Antenna Replacement Services - see also invoice 1829 Amount: $36,750.00 Component Description: Progress billing for tower services Amount: $68,705.00 Component Description: Progress billing for tower services Amount: $85,000.00 Component Description: Completion of tower services Amount: $17,706.00 Component Description: Materials relating to tower reinforcement; see tax amount added in sales tax line. Amount: $1,660.50 Component Description: Deposit for Repack Tower Modification Services, Interim Antenna Installation and Top Mount TV Antenna Replacement Services - see also invoice 1949 for amount applied Amount: $5,000.00 Component Description: Progress billing Tower Services Amount: $29,245.80 Component Description: Progress billing Tower Services Amount: $13,677.40 Component Description: Progress billing Tower services Amount: $23,884.00
Tall Tower (greater than 500')	Component Description: Deposit for Repack Tower Modification Services, Interim Antenna Installation and Top Mount TV Antenna Replacement Services - see also invoice 1944 for amount applied Amount: $5,000.00 Component Description: Decrease due to incorrect mapping on first submission. See Major tower reinforcement/modifications. Amount: ($85,000.00) Component Description: Progress billing Tower Service Amount: $17,706.00 Component Description: Decrease is due to incorrect mapping on first submission. See Major tower reinforcement/modifications. Amount: ($68,705.00) Component Description: Decrease due to incorrect mapping on previous submission. See Major tower reinforcements/ modifications Amount: ($17,706.00) Component Description: Deposit for Repack Tower Modification Services - see also invoice 1829 Amount: $36,750.00 Component Description: Progress billing Tower Services Amount: $68,705.00 Component Description: Clearing costs for Tower and Rigging Amount: $13,600.00 Component Description: Progress billing Tower Services Amount: $85,000.00
Tower Site Preparation Costs	Component Description: Tower site prep materials Amount: $1,660.50

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	$124,220.00	$119,250.00	N/A	$39,191.00	N/A
Total for all systems	$6,108,746.57	$3,712,257.57	N/A	$2,817,906.36	N/A
Outside Professional Services	$124,220.00	$119,250.00		$39,191.00
Additional Field Engineering Service, 17 Days	$34,000.00	$34,000.00	N/A	N/A	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	$550.00	N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization	$3,680.00	$3,500.00	N/A	N/A	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,250.00	N/A	$0.00	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$5,000.00	N/A	$0.00	N/A
Prepare request for Special Temporary Authorization	$2,050.00	$1,500.00	N/A	$1,000.00	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	$625.00	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$2,500.00	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	N/A	N/A
Address transition timing and coordination issues w/ other stations and wireless	$2,630.00	$2,500.00	N/A	N/A	N/A
Prepare and or review reimbursement form	$2,630.00	$2,500.00	N/A	N/A	N/A
Project management of the transition	$55,300.00	$52,500.00	N/A	$34,516.00	N/A
ASR modification (prepare FCC Form 854)	$2,105.00	$2,000.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Additional Field Engineering Service, 17 Days	Information not provided.
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	Component Description: FAA Consultation and preparation of FCC Form 7460, item 6 from invoice summary Amount: $550.00 Component Description: FAA Consultation, item 6 from invoice summary Amount: $550.00
Attorney Fees - Prepare and File request for Special Temporary Authorization	Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Component Description: License to Cover application, item 9 from invoice summary Amount: $625.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: Prepare engineering section of FCC Form 2100, modification, item 4 from invoice summary Amount: $2,500.00
Prepare request for Special Temporary Authorization	Component Description: Prepare request for STA, item 7 from invoice summary Amount: $1,000.00 Component Description: Prepare request for Special Temporary Authorization, item 7 from invoice summary Amount: $1,000.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Component Description: Prepare License to Cover application Amount: $625.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: Prepare FCC Form 2100, item 3 from invoice summary Amount: $2,500.00 Component Description: Prepare engineering section FCC Form 2100, item 3 from invoice summary Amount: $2,500.00
Perform engineering study for new channel assignment and antenna development	Information not provided.
Address transition timing and coordination issues w/ other stations and wireless	Information not provided.
Prepare and or review reimbursement form	Information not provided.
Project management of the transition	Component Description: Project management services, item 1 from invoice summary Amount: $4,212.50 Component Description: Project management services, item 8 from invoice summary Amount: $5,424.00 Component Description: Project management services, item 2 from invoice summary Amount: $300.00 Component Description: Project management services Amount: $50.00 Component Description: Project management services Mar 2019 Amount: $117.00 Component Description: Project management services Apr 2019 Amount: $162.50 Component Description: Engineering Consulting - 11/2018 Amount: $100.00 Component Description: Project management services April 2019 Amount: $50.00 Component Description: Project management services Amount: $520.00 Component Description: Project management services 3.30.19 through 4.26.19 Amount: $150.00 Component Description: Project management services 3.2.19 through 3.29.19 Amount: $5,075.00 Component Description: Project Management for Structural Analysis and Tower Modifications. Services from October 27, 2017 through December 31, 2017. Amount: $1,612.50 Component Description: Engineering Consulting - 10/2018 Amount: $125.00 Component Description: Project management services,various, item 8 from invoice summary Amount: $5,424.00 Component Description: Project management services, item 5 from invoice summary Amount: $150.00 Component Description: Project management services 6.30.18 through 7.27.18 Amount: $150.00 Component Description: Engineering Consulting - 8/2018 Amount: $200.00 Component Description: Project management services May 2019 Amount: $162.50 Component Description: Project management services Amount: $880.00 Component Description: Project Management services 1.27.18 to 2.23.18 Amount: $300.00 Component Description: Project Management for Structural Analysis and Tower Modifications. Services from January 1, 2018 through January 26, 2018. Amount: $525.00 Component Description: Prepare FCC Schedule 387, item 5 from invoice summary Amount: $150.00 Component Description: Project management services, item 1 from invoice summary Amount: $4,212.50 Component Description: Project Management for Structural Analysis and Tower Modifications with Kessler & Gehman consultant Amount: $13,500.00 Component Description: Project management services 5.26.18 through 6.29.18 Amount: $450.00 Component Description: Project management services 7.28.18 through 9.28.18 Amount: $150.00 Component Description: Project management services 9.29.18 through 10.26.18 Amount: $150.00 Component Description: Prepare FCC Schedule 387 Progress Report, item 2 from invoice summary Amount: $300.00
ASR modification (prepare FCC Form 854)	Information not provided.

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	$308,650.00	$308,100.00	N/A	$171,580.96	N/A
Total for all systems	$6,108,746.57	$3,712,257.57	N/A	$2,817,906.36	N/A
Other Expenses	$308,650.00	$308,100.00		$171,580.96
Equipment Rentals	$1,100.00	$1,100.00	See related invoices	$1,060.50	N/A
Sales Tax	$252,500.00	$252,500.00	Sales and use tax on goods and services based on GA state rate of 7.0%.	$153,971.23	N/A
MVPD Notification of Channel Change	$2,000.00	$2,000.00	N/A	N/A	N/A
Develop and air announcement of upcoming channel change	$3,500.00	$3,500.00	N/A	N/A	N/A
Equipment Storage	$9,000.00	$9,000.00	N/A	$1,648.23	N/A
Equipment Delivery and Handling Charges	$20,000.00	$20,000.00	N/A	$12,397.00	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$9,000.00	$9,000.00	N/A	N/A	N/A
Non-zoning permits	$0.00	$0.00	N/A	N/A	N/A
DTV Medical Facility Notification	$11,550.00	$11,000.00	N/A	$2,504.00	N/A

Components

Actual Information Description	File Name
Equipment Rentals	Component Description: Equipment rentals Amount: $1,060.50
Sales Tax	Component Description: Tax on storage container Amount: $36.60 Component Description: Tax on tower site prep materials Amount: $116.24 Component Description: Tax due on transmitter Amount: $71,500.00 Component Description: Tax on storage container Amount: $40.79 Component Description: Tax due on antenna components Amount: $36,718.51 Component Description: Sales tax on interim transmitter Amount: $5,681.20 Component Description: Sales tax related to transmitter components Amount: $1,498.70 Component Description: Sales tax on heat exchanger stacking stands Amount: $315.00 Component Description: Sales tax on 25% installment Amount: $25,135.69 Component Description: Sales tax on transmitter remote control Amount: $175.30 Component Description: Sales tax on materials; Amount: $116.24 Component Description: Sales tax relating to R&S electrical invoice. Amount: $12,890.50 Component Description: Tax on storage container Amount: $38.00
MVPD Notification of Channel Change	Information not provided.
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Storage	Component Description: Storage container for antenna Amount: $522.81 Component Description: Storage container for antenna Amount: $582.66 Component Description: Storage container for antenna Amount: $542.76
Equipment Delivery and Handling Charges	Component Description: Freight cost for additional antenna components Amount: $1,938.94 Component Description: Freight cost for additional antenna components Amount: $381.36 Component Description: Freight cost for additional aux antenna components Amount: $1,395.50 Component Description: Freight cost for transmission line component Amount: $623.20 Component Description: Freight costs Amount: $8,058.00 Component Description: Shipping costs, transmitter remote control Amount: $44.75
Disposal Costs (for equipment and other waste, net of any salvage value)	Information not provided.
Non-zoning permits	Information not provided.
DTV Medical Facility Notification	Component Description: Notification of Medical Facilities Amount: $2,504.00

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$6,108,746.57	$3,712,257.57	$2,817,906.36

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.	Yes

Certification

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.
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. 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 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). 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 certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred. 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.	Elizabeth Ryder General Counsel 10/08/2021

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.

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.
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 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).
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 certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.
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.

Elizabeth Ryder

General Counsel

10/08/2021

Certification

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).
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 certifies that the statements in this form and attached documentation are true, complete, and correct. 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 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) . 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 certifies that the cost information/documents submitted reflect costs actually incurred. 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 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.	Elizabeth Ryder General Counsel 10/08/2021

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).

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 certifies that the statements in this form and attached documentation are true, complete, and correct.
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 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) .
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 certifies that the cost information/documents submitted reflect costs actually incurred.
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 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.

Elizabeth Ryder

General Counsel

10/08/2021

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.	Elizabeth Ryder General Counsel 10/08/2021

Section

Question

Response

Submission of Final Allocation or Accounting Information Statements

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.

Elizabeth Ryder

General Counsel

10/08/2021

(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

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Interim Antenna

New Antenna Costs

Interim Antenna

Other Antenna Costs

Interim Antenna

Other Antenna Cost Not Listed

Transmission Line

Interim Transmission Line

New Transmission Line

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Tower Equipment And Rigging Costs

Primary Tower

Existing Tower

Primary Tower

Tower Modification Costs

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

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

Components

Cost Information

Outside Professional Services

Components