Go to the Federal Communications Commission homepage at www.fcc.gov

FCC Form 399: Reimbursement Request

Approved by OMB 3060-1178
Go to the Federal Communications Commission homepage at www.fcc.gov

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

Facility ID:
38336
Service:
DTV
Call Sign:
WLIW
Channel:
32 (UHF)
File Number:
0000025443
FRN:
0018265660
Date Submitted:
10/13/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WNET

Doing Business As: WNET

Robert A. Feinberg

825 EIGHTH AVENUE

ATTN: GENERAL COUNSEL

NEW YORK, NY 10019

United States

+1 (212) 560-6981 FEINBERG@WNET.ORG Not-for-Profit

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Frank Graybill

Senior Director Engineering

WNET

825 Eighth Avenue

New York, NY 10019

United States

+1 (212) 560-3506 graybill@thirteen.org

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan Relocate primary WLIW transmitter to WTC shared site in New York City. Retain Aux site in Plainview NY. Both Transmitters require replacement. WTC is a shared leased antenna. Plainview antenna requires replacement.

Question Response
Sharee Station Facility ID 9610
Call Sign WCBS-TV
Type Commercial
Licensee Name CBS BROADCASTING INC.
Status PROGRAM TEST AUTHORITY
DTS No
Community of License NEW YORK, NY
Pre-auction RF Channel 33
Post-auction RF Channel 36
Neilsen DMA New York
Network Affiliation
Question Response
Sharee Station Facility ID 73356
Call Sign WPXN-TV
Type Commercial
Licensee Name ION MEDIA LICENSE COMPANY, LLC
Status LICENSED
DTS No
Community of License NEW YORK, NY
Pre-auction RF Channel 31
Post-auction RF Channel 34
Neilsen DMA New York
Network Affiliation
Question Response
Sharee Station Facility ID 47535
Call Sign WNBC
Type Commercial
Licensee Name NBC TELEMUNDO LICENSE LLC
Status LICENSED
DTS No
Community of License NEW YORK, NY
Pre-auction RF Channel 35
Post-auction RF Channel 36
Neilsen DMA New York
Network Affiliation
Question Response
Sharee Station Facility ID 74197
Call Sign WWOR-TV
Type Commercial
Licensee Name FOX TELEVISION STATIONS, LLC
Status LICENSED
DTS No
Community of License SECAUCUS, NJ
Pre-auction RF Channel 25
Post-auction RF Channel 25
Neilsen DMA New York
Network Affiliation
Question Response
Sharee Station Facility ID 73333
Call Sign WNJU
Type Commercial
Licensee Name NBC TELEMUNDO LICENSE LLC
Status LICENSED
DTS No
Community of License LINDEN, NJ
Pre-auction RF Channel 35
Post-auction RF Channel 36
Neilsen DMA New York
Network Affiliation
Question Response
Sharee Station Facility ID 18795
Call Sign WNET
Type Noncommercial Educational
Licensee Name WNET
Status LICENSED
DTS No
Community of License NEWARK, NJ
Pre-auction RF Channel 13
Post-auction RF Channel 13
Neilsen DMA NEW YORK
Network Affiliation
Question Response
Sharee Station Facility ID 22206
Call Sign WNYW
Type Commercial
Licensee Name FOX TELEVISION STATIONS, LLC
Status LICENSED
DTS No
Community of License NEW YORK, NY
Pre-auction RF Channel 27
Post-auction RF Channel 27
Neilsen DMA New York
Network Affiliation

Transmitters

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

Auxiliary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Auxiliary Backup
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 Affinity
Year 2004
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1 kW

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model THU9-EVO
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 5 kW
Justification for New Transmitter Replacement of existing Aux transmitter (Thales Comark Affinity) which is no longer supported by manufacturer. To be installed as an Aux at Plainview Long Island.

Auxiliary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring 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

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Transmitter Installation

Removal of existing Transmitter and installation of new Transmitter. Including Electrical, Conduit and plumbing costs.

Receiving Cost

Manpower, forklift rental to unload and receive equipment at site.

480V - 400V Step Down Transformer

480V - 400V 30 kVA Step down transformer for Transmitter Mains.

Mask Filter

Mask Filter for Channel 32

Commissioning and Proof

Commissioning and Proof of Aux Transmitter

Shipping costs

Shipping from Manufacturer to WLIW Plainview Long Island.

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model Ultimate
Year 2004
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power Capacity 5 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model THU9-EVO
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 19 kW
Justification for New Transmitter Existing Thales Comark Ultimate Transmitter is no longer supported by the manufacturer. See Attached. New TX to be installed at NYC World Trade Center. Quote Attached. Cost is prorated for 5kW of the 19kW purchase.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service 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

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Other Transmitter Cost Not Listed

Name Description

Transmitter Installation Engineering Design

Professional Engineering Design and Construction Filing

Shipping costs

Shipping cost from Manufacturer to Site. Including consolidation costs.

Fire Inspection

Fire inspection of Joints and Penetrations

Commissioning and Proof

Commissioning and Proof of primary Transmitter.

TAA Filing Fee

Port Authority Tenant Alteration Application Fee (Construction Permit)

RF Test Load

RF Test Load, including interconnect line.

RF Switching

RF Switching between two Antennas, Combiners & Load.

Transmitter Installation Change Order 1

Debris Removal

Hot Work Fire Guard

Hot Work Fire Guard

Transmitter Installtion Change Order 2

Additional Electric Outlets

Transmitter Installation

Union Contractor installation of combiner and transmitter components at the WTC. Includes all electrical, mechanical and RF installation.

400V Step Down Transformer

480V - 400V 90 kVA step down transformer for Transmitter Mains.

Antennas

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

Auxiliary Antenna

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Add Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Auxiliary (Backup)
Description of Use Auxiliary Backup
Ownership Owned
Owner N/A
Site N/A
Is this antenna currently shared with any other stations? No
Is this antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 98.0 kW
Manufacturer
Model TFU-10DSC-R P234 DC
Year 1999

Auxiliary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Auxiliary (Backup)
Description of Use Auxiliary Backup
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting 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: 114.0 kW
Manufacturer
Model TLP-12J-R
Year 2019
Justification for New Antenna Existing side mount antenna in use as a primary antenna is not Broadband and will not accommodate a change in channel from UHF 21 to 32.

Auxiliary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 6 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Auxiliary Antenna

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Other Antenna Cost Not Listed

Name Description

Freight

Shipping and handling Estimate.

Transformer 6-75 to 3-50

Transformer 6-75 to 3-50 CH 32 Jumper Input

Field Engineer Repack Sweep

Engineer on-site for one day, travel expenses and report.

Reducer 3-50 to 1-50

Reducer 3-50 to 1-50 Jumper Output

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Lease New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting 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: 89.9 kW
Manufacturer
Model TFU-26GTH-R P233
Year 2000

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Lease New
Is this a request for upgraded equipment? No
Ownership Leased
Owner Durst Broadcasting
Is antenna shared? Yes
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 Bottom
Polarization Circular
Type Broadband Panel
Number of Stations Supported 6
Number of Panels/Bays 96
Lower Limit 470.00 MHz
Upper Limit 700.00 MHz
Design power capacity in use 60.0 %
Other Antenna Type N/A
ERP: 2000.0 kW
Manufacturer
Model PEP96L
Year 2016
Justification for New Antenna New Building

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? Yes
Type Additional Module
Number of channels supported 1
Frequencies of channels supported RF channel
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? No
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power 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

Enter a list of RF channel numbers.

RF Channel Number
32

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Auxiliary Transmission Line

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Add Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Line to Auxilliary Antenna
Ownership Owned
Owner N/A
Site N/A
Is this transmission currently shared with any other stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 300 feet per run

Auxiliary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Auxiliary (Backup)
Description of Use Switch to Aux Antenna
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 19 3/4 inches
Other Segment Length N/A
Number of parallel runs 1
Length 300 feet per run
Justification for New Transmission Line Existing line is not compatible with new channel assignment of 32

Auxiliary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

TX to Switch Filter Assembly

Custom Line pieces to Interconnect the Transmitter to the Switch Filter Assembly

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 300 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 4 1/16 inches
Other Diameter N/A
Segment Length Other
Other Segment Length 10 feet
Number of parallel runs 2
Length 140 feet per run
Justification for New Transmission Line New transmission lines required to each of the Primary and Backup Combiner inputs.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Transmission line TX - Switch - Load interconnect.

Transmission line custom pieces to interconnect the TX with the Switch and load.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1007205
Coordinates (NAD83) Latitude (NAD83) 40° 47' 19.4" N-
Longitude (NAD83) 073° 27' 07.4" W-
Overall Structure Height 324.80 feet
Support Structure Height 266.73 feet
Ground Elevation Above Mean Sea Level (AMSL) 235.89 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner WNET
Date Constructed 03/30/2004


Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: Minor Reinforcements needed

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Geological Survey

Geological Survey required to determine ANSI EIA/TIA-222-G code requirements.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? No
Number of Hours N/A
Explanation N/A
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
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 Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review Yes
Environmental Assessment Yes
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Local Zoning Permit Expeditor

Prepare Local Zoning Permit and File with Local Town Agency.

Legal Fees

Consolidated Legal expenses related to 399 CORES Form 1876 and other FCC related items.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits 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)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? No
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

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Other Expenses Not Listed

Name Description

Internal Project Management

See attached.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,476,832.94 $811,032.94 N/A $810,422.94 N/A
Total for all systems $2,334,959.04 $1,737,715.63 N/A $1,557,697.10 N/A
Primary Transmitter THU9-EVO $1,142,871.00 $610,571.00 $610,571.00
400V Step Down Transformer $4,900.00 $4,900.00 (Cost in Rohde Proposal) $4,900.00 N/A
Transmitter Installation $247,720.00 $247,720.00 Cost includes installation of TX, Combiner RF Lines & Switches, RF Load and Electrical Service, $247,720.00 N/A
Transmitter Installtion Change Order 2 $3,700.00 $3,700.00 N/A $3,700.00 N/A
Hot Work Fire Guard $2,596.00 $2,596.00 N/A $2,596.00 N/A
Transmitter Installation Change Order 1 $2,334.00 $2,334.00 N/A $2,334.00 N/A
RF Switching $32,700.00 $32,700.00 Switching requires to switch between main and auxiliary antenna to allow for climbing and redundancy. (Cost in Rohde Proposal) $32,700.00 N/A
RF Test Load $17,000.00 $17,000.00 (Cost in Rohde Proposal) $17,000.00 N/A
TAA Filing Fee $7,000.00 $7,000.00 N/A $7,000.00 N/A
Commissioning and Proof $29,450.00 $29,450.00 (Cost in Rohde and SJ Ramer Proposals) $29,450.00 N/A
Fire Inspection $3,400.00 $3,400.00 Port Authority of NY & NJ Required Fire Inspection. $3,400.00 N/A
Transmitter Installation Engineering Design $88,947.25 $88,947.25 N/A $88,947.25 N/A
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW $684,000.00 $151,700.00 N/A $151,700.00 N/A
Shipping costs $19,123.75 $19,123.75 Includes shipping to consolidator Myat and shipping to WTC site. ((Cost in Rohde & Myat Proposals) $19,123.75 N/A
Auxiliary Transmitter THU9-EVO $333,961.94 $200,461.94 $199,851.94
Commissioning and Proof $13,500.00 $13,500.00 N/A $13,500.00 N/A
Shipping costs $5,000.00 $5,000.00 Shipping from manufacturer to WLIW Transmitter location $5,000.00 N/A
480V - 400V Step Down Transformer $2,700.00 $2,700.00 N/A $2,700.00 N/A
Mask Filter $4,800.00 $4,800.00 N/A $4,800.00 N/A
Receiving Cost $5,461.94 $5,461.94 N/A $5,461.94 N/A
Transmitter Installation $29,000.00 $29,000.00 N/A $28,390.00 N/A
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW $273,500.00 $140,000.00 N/A $140,000.00 N/A

Components

Actual Information Description File Name
400V Step Down Transformer

Component Description:
Step Down Transformer - Prorated and Partial of Total Invoice
Amount:
$1,225.00

Component Description:
Step Down Transformer - Prorated and Partial of Total Invoice
Amount:
$3,675.00
Transmitter Installation

Component Description:
Primary Transmitter Installation (3 of 3)
Amount:
$99,088.00

Component Description:
Primary Transmitter Installation (1 of 3)
Amount:
$74,316.00

Component Description:
Primary Transmitter Installation (2 of 3)
Amount:
$74,316.00
Transmitter Installtion Change Order 2

Component Description:
Installation of additional circuits
Amount:
$3,700.00
Hot Work Fire Guard

Component Description:
Hot work Fire Guard
Amount:
$2,596.00
Transmitter Installation Change Order 1

Component Description:
Debris removal
Amount:
$2,334.00
RF Switching

Component Description:
RF Output Switching (Partial of Total Invoice)
Amount:
$24,525.00

Component Description:
RF Output Switching (Partial of Total Invoice)
Amount:
$8,175.00
RF Test Load

Component Description:
RF Test Load - Prorated (Partial of Total Invoice)
Amount:
$12,750.00

Component Description:
RF Test Load - Prorated (Partial of Total Invoice)
Amount:
$4,250.00
TAA Filing Fee

Component Description:
TAA Fee
Amount:
$7,000.00
Commissioning and Proof

Component Description:
Proof Performance
Amount:
$5,200.00

Component Description:
Commissioning and Proof - Prorated (Partial of Total Invoice)
Amount:
$10,125.00

Component Description:
Commissioning and Proof - Prorated (Partial of Total Invoice)
Amount:
$3,375.00

Component Description:
Transmitter - Commissioning and Proof - SJ Ramer
Amount:
$10,750.00
Fire Inspection

Component Description:
Primary Transmitter Fire Inspection
Amount:
$3,400.00
Transmitter Installation Engineering Design

Component Description:
Transmitter Installation Engineering Design (1 of 3)
Amount:
$70,751.70

Component Description:
Transmitter Installation Engineering Design (2 of 3)
Amount:
$9,300.00

Component Description:
Transmitter Installation Engineering Design (3 of 3)
Amount:
$8,895.55
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW

Component Description:
THU9-EVO Transmitter Prorated for Transmitter Upgrade (Partial of total Invoice). Submitting reimbursement for a 5kW however we are purchasing a 19kW.
Amount:
$113,775.00

Component Description:
THU9-EVO Transmitter Prorated for Transmitter Upgrade (Partial of total Invoice). Submitting reimbursement for a 5kW however we are purchasing a 19kW.
Amount:
$37,925.00

Component Description:
THU9-EVO Transmitter Prorated for Transmitter Upgrade (Partial of total Invoice). Submitting reimbursement for a 5kW however we are purchasing a 19kW.
Amount:
$113,775.00

Component Description:
THU9-EVO Transmitter Prorated for Transmitter Upgrade (Partial of total Invoice). Submitting for a 5kW however we are purchasing a 19kW.
Amount:
$37,925.00

Component Description:
THU9-EVO Transmitter Prorated for Transmitter Upgrade (Partial of total Invoice). Submitting for a 5kW however we are purchasing a 19kW.
Amount:
$113,775.00
Shipping costs

Component Description:
Shipping and Consolidation (and needs to be combined with other invoices from Myat and the Rhode and Schwarz invoice)
Amount:
$2,808.75

Component Description:
Shipping and Consolidation (and needs to be combined with other invoices from Myat and the Rhode and Schwarz invoice)
Amount:
$6,685.00

Component Description:
Shipping - Prorated (Partial of Total Invoice) and needs to be combined with other invoices from Myat and Rohde & Schwarz
Amount:
$2,000.00

Component Description:
Shipping - Prorated (Partial of Total Invoice) and needs to be combined with other invoices from Myat and Rohde & Schwarz
Amount:
$6,000.00

Component Description:
Shipping and Consolidation (and needs to be combined with other invoices from Myat and the Rhode and Schwarz invoice)
Amount:
$1,630.00
Commissioning and Proof

Component Description:
Rohde and Schwarz Plainview Transmitter Commissioning and Proof (Portion of $41,500)
Amount:
$13,500.00
Shipping costs

Component Description:
Rohde and Schwarz Plainview Shipping Cost (Portion of $41,500)
Amount:
$5,000.00
480V - 400V Step Down Transformer

Component Description:
Rohde and Schwarz Plainview Transmitter -Step Down Transformer (Portion of $41,500)
Amount:
$2,700.00
Mask Filter

Component Description:
Rohde and Schwarz - Plainview Transmitter - Mask Filter (Portion of $41,500)
Amount:
$4,800.00
Receiving Cost

Component Description:
Aux Transmitter receiving cost
Amount:
$5,461.94
Transmitter Installation

Component Description:
WLIW Plainview Transmitter Install Payment #3
Amount:
$2,840.00

Component Description:
WLIW Plainview Transmitter Install Payment #1
Amount:
$14,500.00

Component Description:
WLIW Plainview Transmitter Install Payment #2
Amount:
$11,050.00
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW

Component Description:
Rohde & Schwarz Plainview Transmitter (Portion of $41,500)
Amount:
$15,500.00

Component Description:
Rohde & Schwarz Plainview Transmitter
Amount:
$124,500.00

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $240,307.00 $282,595.59 N/A $274,065.09 N/A
Total for all systems $2,334,959.04 $1,737,715.63 N/A $1,557,697.10 N/A
Primary Antenna PEP96L $90,930.00 $222,035.59 $218,535.59
Sweep test of existing antenna $6,730.00 $4,500.00 N/A $1,000.00 N/A
UHF - High Power Top Mount Six Station broadband panel antenna elliptically or circularly polarized $0.00 $0.00 Antenna is leased and shared with 6+ stations. $0.00 N/A
Adding a module to existing combiner (without antenna) $84,200.00 $217,535.59 Adding a main and backup input module to existing combiner. Includes installation supervision and commissioning. Also includes "Air Freight" vs. "Sea Freight" from Australia $217,535.59 Shipped from Australia "Air Freight " vs "Sea Freight" which was on the original quote.
Auxiliary Antenna TLP-12J-R $149,377.00 $60,560.00 $55,529.50
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $7,650.00 N/A $7,650.00 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $6,700.00 N/A $6,700.00 N/A
Sweep test of existing antenna $6,730.00 $2,900.00 Please see the Attached Advent invoice for a line sweep which has already been performed. $2,869.50 N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized $89,400.00 $25,773.00 See attached Dielectric proposal. $25,773.00 N/A
Transformer 6-75 to 3-50 $2,484.00 $2,484.00 N/A $2,484.00 N/A
Freight $2,760.00 $2,760.00 N/A $2,760.00 N/A
Reducer 3-50 to 1-50 $893.00 $893.00 N/A $893.00 N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 N/A N/A N/A
Field Engineer Repack Sweep $6,400.00 $6,400.00 N/A $6,400.00 N/A

Components

Actual Information Description File Name
Sweep test of existing antenna

Component Description:
Sweep Test
Amount:
$1,000.00
UHF - High Power Top Mount Six Station broadband panel antenna elliptically or circularly polarized Information not provided.
Adding a module to existing combiner (without antenna)

Component Description:
Partial of Combiner Modules - We acknowledge that we are submitting for less than the invoice amount. The amount requested differs from the invoice amount due to the tax. WNET/WLIW is tax exempt. Form attached.
Amount:
$28,680.00

Component Description:
Partial of Combiner Modules Invoice with invoice difference explanation
Amount:
$188,855.59
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
This is the 10% portion payment (Total 3 payments for this vendor)
Amount:
$765.00

Component Description:
This is the first 45% portion payment (Total 3 payments for this vendor)
Amount:
$3,442.50

Component Description:
This is the second 45% portion payment (Total 3 payments for this vendor)
Amount:
$3,442.50
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
This is the 10% portion payment (Total 3 payments for this vendor)
Amount:
$670.00

Component Description:
This is the first 45% portion payment (Total 3 payments for this vendor)
Amount:
$3,015.00

Component Description:
This is the second 45% portion payment (Total 3 payments for this vendor)
Amount:
$3,015.00
Sweep test of existing antenna

Component Description:
Sweep of Auxiliary Antenna line. Main line and Antenna will not be installed at this site. (50% of invoice amount)
Amount:
$2,869.50
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized

Component Description:
This is the 10% portion payment (Total 3 payments for this vendor)
Amount:
$2,577.30

Component Description:
This is the first 45% portion payment (Total 3 payments for this vendor)
Amount:
$11,597.85

Component Description:
This is the second 45% portion payment (Total 3 payments for this vendor)
Amount:
$11,597.85
Transformer 6-75 to 3-50

Component Description:
This is the 10% portion payment (Total 3 payments for this vendor)
Amount:
$248.40

Component Description:
This is the first 45% portion payment (Total 3 payments for this vendor)
Amount:
$1,117.80

Component Description:
This is the second 45% portion payment (Total 3 payments for this vendor)
Amount:
$1,117.80
Freight

Component Description:
This is the 10% portion payment (Total 3 payments for this vendor)
Amount:
$276.00

Component Description:
This is the first 45% portion payment (Total 3 payments for this vendor)
Amount:
$1,242.00

Component Description:
This is the second 45% portion payment (Total 3 payments for this vendor)
Amount:
$1,242.00
Reducer 3-50 to 1-50

Component Description:
This is the 10% portion payment (Total 3 payments for this vendor)
Amount:
$89.30

Component Description:
This is the first 45% portion payment (Total 3 payments for this vendor)
Amount:
$401.85

Component Description:
This is the second 45% portion payment (Total 3 payments for this vendor)
Amount:
$401.85
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Field Engineer Repack Sweep

Component Description:
This is the 10% portion payment (Total 3 payments for this vendor)
Amount:
$640.00

Component Description:
This is the first 45% portion payment (Total 3 payments for this vendor)
Amount:
$2,880.00

Component Description:
This is the second 45% portion payment (Total 3 payments for this vendor)
Amount:
$2,880.00

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $113,172.10 $113,174.10 N/A $113,174.00 N/A
Total for all systems $2,334,959.04 $1,737,715.63 N/A $1,557,697.10 N/A
Primary Transmission Line $45,209.23 $51,374.23 $51,374.23
Transmission line TX - Switch - Load interconnect. $5,449.23 $5,449.23 Misc. Line lengths & matchers between TX and Switch Assembly and load. $5,449.23 N/A
Rigid Transmission Line - copper, 4 1/16" $39,760.00 $45,925.00 Transmission line from output of switch assembly fine matcher to Combiner Inputs. $45,925.00 N/A
Auxiliary Transmission Line $67,962.87 $61,799.87 $61,799.77
TX to Switch Filter Assembly $7,362.87 $7,362.87 New Transmission line required to connect the Transmitter to the Switch and filter assembly. $7,362.77 N/A
Rigid Transmission Line - copper, 6 1/8" $60,600.00 $54,437.00 Cost includes shipping. $54,437.00 The estimated cost will be adjusted to add in the .10 cent difference.

Components

Actual Information Description File Name
Transmission line TX - Switch - Load interconnect.

Component Description:
One of two vendor payments for the total of this line item.
Amount:
$4,060.00

Component Description:
One of two vendor payments for the total of this line item.
Amount:
$1,389.23
Rigid Transmission Line - copper, 4 1/16"

Component Description:
Rigid Transmission Line
Amount:
$31,130.00

Component Description:
Rigid Transmission Line
Amount:
$14,795.00
TX to Switch Filter Assembly

Component Description:
TX to Switch Filter Assembly
Amount:
$6,368.82

Component Description:
Tx to Switch Filter Assembly - Myat
Amount:
$993.95
Rigid Transmission Line - copper, 6 1/8"

Component Description:
This is the 10% portion payment (Total 3 payments for this vendor)
Amount:
$5,320.80

Component Description:
This is the first 45% portion payment (Total 3 payments for this vendor)
Amount:
$23,943.65

Component Description:
This is the second 45% portion payment (Total 3 payments for this vendor)
Amount:
$23,943.65

Component Description:
Rigid Transmission Line-Revised attachment with explanation for expedited shipping
Amount:
$1,228.90

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $265,377.00 $318,478.00 N/A $318,478.00 N/A
Total for all systems $2,334,959.04 $1,737,715.63 N/A $1,557,697.10 N/A
Primary Tower GTOWER $265,377.00 $318,478.00 $318,478.00
Minor tower reinforcement/modifications $158,000.00 $152,386.00 Please See attached proposal. $152,386.00 N/A
Short Tower (less than 500') $84,200.00 $146,565.00 Rigging and installation cost for the Auxiliary antenna in Plainview. $146,565.00 N/A
Geological Survey $10,577.00 $10,577.00 See Attached Invoice. $10,577.00 N/A
Structural engineering tower load study for well documented tower $12,600.00 $8,950.00 See Attached Invoices. $8,950.00 N/A

Components

Actual Information Description File Name
Minor tower reinforcement/modifications

Component Description:
Tower Restructure Payment 2.
Amount:
$38,000.00

Component Description:
Tower Restructure Payment 1.
Amount:
$101,651.00

Component Description:
Tower Restructure Payment 3 Final.
Amount:
$12,735.00
Short Tower (less than 500')

Component Description:
Short Tower - US Tower Invoice
Amount:
$132,200.00

Component Description:
Short Tower
Amount:
$14,365.00
Geological Survey

Component Description:
Supervision, Labor and equipment to perform a geological survey for the foundations.
Amount:
$10,577.00
Structural engineering tower load study for well documented tower

Component Description:
Structural Eng Tower Load Study
Amount:
$795.00

Component Description:
Tower Restructure Engineering Analysis
Amount:
$8,155.00

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $167,235.00 $146,700.00 N/A $34,086.07 N/A
Total for all systems $2,334,959.04 $1,737,715.63 N/A $1,557,697.10 N/A
Outside Professional Services $167,235.00 $146,700.00 $34,086.07
Local Zoning Permit Expeditor $1,600.00 $1,600.00 N/A $1,600.00 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $1,500.00 N/A $1,375.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $2,100.00 Cost as billed from Engineering Consultant $2,100.00 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $3,000.00 ????? $3,000.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A N/A 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
Legal Fees $26,000.00 $26,000.00 Consolidation of all various FCC related legal expenses. $25,411.07 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $10,000.00 N/A N/A N/A
NEPA Section 106 environmental review, if needed $6,310.00 $6,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $0.00 Moved to "Legal Fees" category N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $0.00 Moved to "Legal Fees" category N/A N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $0.00 Moved to "Legal Fees" category N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $0.00 Moved to "Legal Fees" category N/A N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A $600.00 N/A

Components

Actual Information Description File Name
Local Zoning Permit Expeditor

Component Description:
Local Zoning Permit
Amount:
$1,600.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application

Component Description:
RF Consulting Engineering Fees-Aux Antenna
Amount:
$250.00

Component Description:
Aux Antenna
Amount:
$1,125.00

Component Description:
RF Consult Eng Fees for FCC Form Prep
Amount:
$1,125.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Main Antenna
Amount:
$2,100.00

Component Description:
Prepare Eng Section of FCC Form
Amount:
$2,100.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application

Component Description:
RF Consulting Engineer
Amount:
$625.00

Component Description:
RF Consult Eng Fees - Aux Antenna
Amount:
$2,375.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
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.
Legal Fees

Component Description:
FCC related Legal fees
Amount:
$984.37

Component Description:
FCC related Legal fees
Amount:
$2,848.50

Component Description:
FCC related Legal fees
Amount:
$156.25

Component Description:
FCC related Legal fees
Amount:
$493.87

Component Description:
FCC related Legal fees
Amount:
$428.62

Component Description:
FCC related Legal fees-revised
Amount:
$2,525.63

Component Description:
FCC related Legal Fees
Amount:
$1,343.25

Component Description:
FCC related Legal Fees
Amount:
$411.75

Component Description:
FCC related Legal Fees
Amount:
$1,063.12

Component Description:
FCC related Legal Fees
Amount:
$823.50

Component Description:
FCC related Legal fees
Amount:
$5,435.49

Component Description:
FCC related Legal fees
Amount:
$1,592.98

Component Description:
FCC related Legal Fees
Amount:
$1,235.25

Component Description:
FCC related Legal Fees
Amount:
$2,855.25

Component Description:
FCC related Legal fees-revised
Amount:
$272.50

Component Description:
FCC related Legal Fees
Amount:
$877.50

Component Description:
FCC related Legal fees (Revised to reflect the removal of hours not reimbursable)
Amount:
$1,212.62

Component Description:
FCC related Legal fees-Revised
Amount:
$305.00

Component Description:
FCC related Legal fees
Amount:
$545.62
Comprehensive coverage verification via field study, if needed Information not provided.
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet Information not provided.
NEPA Section 106 environmental review, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization

Component Description:
Prepare request for special temporary authorization
Amount:
$600.00

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $72,035.00 $65,735.00 N/A $7,471.00 N/A
Total for all systems $2,334,959.04 $1,737,715.63 N/A $1,557,697.10 N/A
Other Expenses $72,035.00 $65,735.00 $7,471.00
Internal Project Management $32,000.00 $32,000.00 See attached Exhibit. N/A N/A
Develop and air announcement of upcoming channel change $4,985.00 $4,985.00 Please see attached Estimate Detail. N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $12,000.00 $12,000.00 Disposal of existing transmitters and installation debris for both main and aux. N/A N/A
MVPD Notification of Channel Change $1,500.00 $1,500.00 N/A N/A N/A
Local Zoning $10,000.00 $10,000.00 N/A $2,221.00 N/A
DTV Medical Facility Notification $11,550.00 $5,250.00 N/A $5,250.00 N/A

Components

Actual Information Description File Name
Internal Project Management Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
MVPD Notification of Channel Change Information not provided.
Local Zoning

Component Description:
Moved to Professional Services as directed by Repack Administrator
Amount:
N/A

Component Description:
Town of Oyster Bay Construction Permit Application Payment #1 (Copy of Cancelled Check included per FCC request)
Amount:
$100.00

Component Description:
Town of Oyster Bay Permit Application Fee. Payment 2 Final and cancelled check as requested
Amount:
$2,121.00
DTV Medical Facility Notification

Component Description:
DTV Medical Facility Notification
Amount:
$5,250.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,334,959.04 $1,737,715.63 $1,557,697.10

Reimbursement Status

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

Certification

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Section Question Response
Submission of Estimated Expenses Statements

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

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

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

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

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

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

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

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

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

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

Frank Graybill

Senior Director of Engineering


10/13/2021

Certification

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Section Question Response
Submission of Actual Cost Documentation Statements

WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733).

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

  2. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct.

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

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

  5. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) .

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

  7. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.

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

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

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

Frank Graybill

Senior Director of Engineering


10/13/2021

Certification

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Section Question Response
Submission of Final Allocation or Accounting Information Statements

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

  1. The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

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

  3. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.

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

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

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

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

Frank Graybill

Senior Director of Engineering


10/13/2021

Attachments

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