TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
SACRAMENTO TELEVISION STATIONS, INC Doing Business As: SACRAMENTO TELEVISION STATIONS, INC	Daniel G. Ryson 2020 M. St., NW - Licensing DEPT WASHINGTON, DC 20036 United States	+1 (202) 457-4074	dryson@cbs.com	Corporation

Applicant

Address

Phone

Applicant Type

SACRAMENTO TELEVISION STATIONS, INC

Doing Business As: SACRAMENTO TELEVISION STATIONS, INC

Daniel G. Ryson

2020 M. St., NW - Licensing DEPT

WASHINGTON, DC 20036

United States

+1 (202) 457-4074

dryson@cbs.com

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
Daniel G Ryson Associate Director of Spectrum Management CBS	Daniel G. Ryson 1725 DeSales St. NW Suite 501 Washington, DC 20036 United States	+1 (202) 457-4074	dryson@cbs.com

Applicant

Address

Phone

Daniel G Ryson

Associate Director of Spectrum Management

CBS

Daniel G. Ryson

1725 DeSales St. NW

Suite 501

Washington, DC 20036

United States

+1 (202) 457-4074

dryson@cbs.com

Broadcaster Information and Transition Plan

Question	Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information.	Yes
Briefly describe transition plan	Facility utilizes broad band antennas and combiners One transmitter will be replaced. One combiner port will be replaced.

Transmitters

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

Auxiliary Transmitter

Add Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Retune Existing
	Use	Auxiliary (Backup)
	Ownership	Owned
	Owner	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	Thales
	Model	Affinity UD100000C
	Year	2002
	Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power capacity	1 kW

Auxiliary Transmitter

Retuning Transmitter Costs

Section	Question	Response
New IOT Tubes	Number of Tubes (including accessories) needed	N/A
New Mask Filter
	Power	1.5 kW
	Other Power	N/A
New Exciter	Is a new exciter needed?	No

Auxiliary Transmitter

Other Transmitter Costs

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

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Information not provided.

Auxiliary Transmitter

Add Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Purchase New
	Use	Auxiliary (Backup)
	Description of Use	Auxiliary
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is this transmitter currently shared with another station?	Yes
	Is this transmitter currently in operating condition?	Yes
Existing Transmitter Manufacturer and Type	Manufacturer
	Model	ULX17800AT
	Year	2009
	Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power Capacity	17.8 kW

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

Facility ID	Call Sign
56550	KOVR

Auxiliary Transmitter

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	ULXTE-30
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	19.2 kW
	Justification for New Transmitter	Please see Attachment 18.

Auxiliary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	No
	Transformer (480V)	No
	Power	N/A
	Rigid Conduit and Wiring	No
	Size	N/A
	Length	N/A
	Other Electrical Service	Yes
	Description	Install Pumps, Heat Exchanger, Transmitter. Requires 200 Amp Panel Board with breakers and concrete pad.
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

Other Transmitter Cost Not Listed

Name	Description
RF System	Please see Attachments 18, 28, 30, 35, 37, and 39.

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	DCX
	Year	2003
	Type	Inductive Output Tube
	IOT Power Type	Two
	Power Capacity	60 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?	Yes
	Manufacturer
	Model	ULXT80
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	68.5 kW
	Justification for New Transmitter	Manufacturer states that it will not attempt to retune any IOT transmitters. See Attachment 1

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	No
	Transformer (480V)	Yes
	Power	150 kVA
	Rigid Conduit and Wiring	Yes
	Size	3 inches
	Length	75.0 feet
	Other Electrical Service	Yes
	Description	Electrical service to new transmitter. Estimate at this point. Unable to reach site for estimate due to floods.
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
RF System - Mask Filters	Transmitter Quote Excludes RF System and Mask Filters. Please see Attachment 6.

Antennas

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

Primary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Retune Existing
	Antenna Use	Primary (Main)
	Description of Use	N/A
	Ownership	Leased
	Owner	American Tower
	Site	N/A
	Is the existing antenna shared with another station or stations?	Yes
	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	Bottom
	Polarization	Horizontal
	Type	Broadband Panel
	Number of Stations Supported	3
	Number of Panels	99
	Design power capacity in use	95.0 %
	Lower Limit	470.00 MHz
	Upper Limit	610.00 MHz
	Other Antenna Type	N/A
	ERP:	850.0 kW
	Manufacturer	Dielectric
	Model	TUG-05-16/80H-2-B
	Year	2010

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

Facility ID	Call Sign
10242	KQCA
33875	KCRA-TV

Primary Antenna

Adjustment to Existing Antenna

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

Primary Antenna

Other Antenna Costs

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

Enter a list of RF channel numbers.

RF Channel Number
25
23
24

Primary Antenna

Other Antenna Cost Not Listed

Information not provided.

Auxiliary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Retune Existing
	Antenna Use	Auxiliary (Backup)
	Description of Use	Auxiliary (Backup)
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing antenna shared with another station or stations?	Yes
	Is the existing antenna directional?	Yes
	Is antenna in operating condition?	Yes
	Is antenna located on or in close proximity to an antenna farm?	Yes
Existing Antenna Manufacturer and Type	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Not in Stack
	Polarization	Elliptical
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels	N/A
	Design power capacity in use	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Other Antenna Type	N/A
	ERP:	388.0 kW
	Manufacturer	Jampro
	Model	JSH-24/D21-D25 TEO
	Year	2009

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

Facility ID	Call Sign
51499	KMAX-TV
56550	KOVR

Auxiliary Antenna

Adjustment to Existing Antenna

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

Auxiliary Antenna

Other Antenna Costs

Section	Question	Response
Combiner for Shared Antenna	Do you need a Combiner for a Shared Antenna?	Yes
	Type	New
	Number of channels supported	2
	Frequencies of channels supported	RF channel
	Frequency	N/A

Enter a list of RF channel numbers.

RF Channel Number
25
21
24

Auxiliary Antenna

Other Antenna Cost Not Listed

Name	Description
Post Transition Mask and Combiner Module	Post Transition Mask Filter and Combiner Module.

Transmission Line

Section	Question	Response
Transmission Line Related Expenses	Do you have transmission line related expenses?	No

Tower Equipment And Rigging Costs

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

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	250
	Explanation	Station lacks internal resources.
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	No
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	No
	Quantity	N/A
	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	No
	For Auxiliary Facility	N/A
	For Main Facility	N/A
	Prepare and file Form FCC License to Cover Application	No
	For Auxiliary Facility	N/A
	For Main Facility	N/A
	Prepare request for Special Temporary Authority	No
	Quantity	N/A
	NEPA Section 106 environmental review	No
	Environmental Assessment	No
	ASR Modification	No
	FAA Consultation (including preparation of FAA Form 7460)	No
	Negotiation of Lease and other Matter for Shared Locations	No
	Prepare or Review FCC Form 399 for Reimbursement	No
	Address transition timing and coordination issues w/ other stations and wireless providers	No
RF Field Engineering Services	Comprehensive coverage verification via field study	No
	RF exposure measurements	Yes
	Additional Field Engineering Service	No
	Number of Days	N/A
	Justification	N/A

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

Section	Question	Response
AM Pattern Disturbance	Is an Impact Study needed?	No
AM Pattern Disturbance	Is Remediation needed?	No
Facility Expenses	Name	N/A
	Other Distributed Transmission System Expenses Not listed	N/A
	Name	N/A
	Is Notification of a Medical Facility required as a result of DTV broadcasting?	Yes
Permit and Filing Costs	Local Zoning	No
	Non-zoning permits	No
	BLM or NFS Coordination	No
	FCC Construction Permit Minor Change	Yes
	FCC License to Cover Application	Yes
	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?	No
	Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change?	Yes
	Does this relocation require MVPD Notification of a Channel Change?	Yes

Other Expenses

Other Expenses Not Listed

Name	Description
Sales Tax	Sales Tax

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	$3,188,132.65	$1,911,060.80	N/A	$1,861,966.04	N/A
Total for all systems	$3,590,105.08	$2,193,175.73	N/A	$2,022,968.47	N/A
Primary Transmitter ULXT80	$2,350,556.34	$1,635,050.76		$1,588,756.00
UHF - Liquid Cooled Solid State Transmitter 68.5 - 75 kW	$1,999,000.00	$1,284,969.42	Existing transmitter cannot be returned. See Attachments 1 and 2. Amount shown is total of Items A, B, and D from Attachment 2 plus 8% sales tax and minus $201,258.00 discount.	$1,284,969.42	N/A
Transformer 3 phase/480v - 150 KVA	$25,550.00	$24,300.00	N/A	N/A	N/A
3" Rigid Conduit and Wiring (Cost per foot)	$3,900.00	$3,675.00	N/A	N/A	N/A
RF System - Mask Filters	$307,106.34	$307,106.34	Original transmitter order (Attachment 2) excluded mask filters and RF System. Please see Attachment 6A.	$303,786.58	N/A
Other Electrical Service: Electrical service to new transmitter. Estimate at this point. Unable to reach site for estimate due to floods.	$15,000.00	$15,000.00	No quotation available yet since site has been inaccessible due to flooding since December.	N/A	N/A
Auxiliary Transmitter ULXTE-30	$729,346.31	$273,210.04		$273,210.04
RF System	$34,104.31	$34,104.31	Includes transmitter room transmission line, coaxial switches, installation, etc. Please see Statement in Attachment 29.	$34,104.31	N/A
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW	$684,000.00	$227,863.73	Please see quotes in Attachments 18, 24, and 41. See also Statement in Attachment 19.	$227,863.73	The sub total equals the Estimated Cost.
Other Electrical Service: Install Pumps, Heat Exchanger, Transmitter. Requires 200 Amp Panel Board with breakers and concrete pad.	$11,242.00	$11,242.00	Please see Attachment 26 and the Statement in Attachment 27.	$11,242.00	N/A
Auxiliary Transmitter Affinity UD100000C	$108,230.00	$2,800.00		$0.00
1.5 kW mask filter	$3,030.00	$2,800.00	N/A	N/A	N/A
UHF and VHF - minor banding issues	$105,200.00	$0.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
UHF - Liquid Cooled Solid State Transmitter 68.5 - 75 kW	Component Description: Approximately 1/3 Progress Payment. Amount: $431,718.62 Component Description: Final Transmitter Payment. Note: The Surge Suppressor shown on the original transmitter quote (Attachment 2 Item C) was omitted. Includes $201,258 discount. Amount: $421,532.18 Component Description: Approximately 1/3 Down Payment. Amount: $431,718.62
Transformer 3 phase/480v - 150 KVA	Information not provided.
3" Rigid Conduit and Wiring (Cost per foot)	Information not provided.
RF System - Mask Filters	Component Description: Please see Attachment 6A. Amount: $102,368.78 Component Description: RF System Final Payment. Sales tax and freight shown separately. Please see Attachment 14A. Amount: $52,822.39 Component Description: RF System Third Payment. Sales Tax shown separately. Please see Attachment 13A. Amount: $42,307.31 Component Description: RF System Down Payment. Please see Attachment 12. Amount: $106,288.10
Other Electrical Service: Electrical service to new transmitter. Estimate at this point. Unable to reach site for estimate due to floods.	Information not provided.
RF System	Component Description: Aux Transmitter RF System. Please see Statement in Attachment 36. Amount: $32,765.81 Component Description: Transmitter room transmission line cut line segments. Please see Statement in Attachment 29. Amount: $1,338.50
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW	Component Description: Aux Transmitter Installation. Please see Statement in Attachment 25. Amount: $17,868.34 Component Description: Aux Transmitter Heat Exchanger and Pump, Invoiced separately. Please see Statement in Attachment 22. Amount: $6,238.40 Component Description: Final Payment on Aux Transmitter. Please see Statement in Attachment 21. Amount: $63,760.07 Component Description: Progress Payment on Aux Transmitter. Please see Statement in Attachment 20. Amount: $69,998.46 Component Description: Transmitter 1/3 Down Payment. Please see Statement in Attachment 19. Amount: $69,998.46
Other Electrical Service: Install Pumps, Heat Exchanger, Transmitter. Requires 200 Amp Panel Board with breakers and concrete pad.	Component Description: Aux Transmitter Electrical Installation. Please see Statement in Attachment 27. Amount: $11,242.00
1.5 kW mask filter	Information not provided.
UHF and VHF - minor banding issues	Information not provided.

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	$236,630.00	$178,945.00	N/A	$92,545.00	N/A
Total for all systems	$3,590,105.08	$2,193,175.73	N/A	$2,022,968.47	N/A
Primary Antenna TUG-05-16/80H-2-B	$90,930.00	$86,400.00		$0.00
Adding a module to existing combiner (without antenna)	$84,200.00	$80,000.00	N/A	N/A	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	N/A	N/A
Auxiliary Antenna JSH-24/D21-D25 TEO	$145,700.00	$92,545.00		$92,545.00
Post Transition Mask and Combiner Module	$61,500.00	$61,500.00	Post transition combiner module (see quote in Attachment 30) and installation (see quote in Attachment 39).	$61,500.00	N/A
New combiner, cost per channel (without antenna)	$84,200.00	$31,045.00	Pre-Transition Aux Site Combiner (see quote in Attachment 30) and installation (see quote in Attachment 37).	$31,045.00	N/A

Components

Actual Information Description	File Name
Adding a module to existing combiner (without antenna)	Information not provided.
Sweep test of existing antenna	Information not provided.
Post Transition Mask and Combiner Module	Component Description: Post transition aux mask filter and combiner installation. Please see statement in Attachment 40. Amount: $12,500.00 Component Description: Post transition aux mask filter and combiner module final payment. Please see Statement in Attachment 33. Amount: $24,500.00 Component Description: Post transition aux mask filter and combiner module down payment. Please see Statement in Attachment 32. Amount: $24,500.00
New combiner, cost per channel (without antenna)	Component Description: Pre-transition combiner installation. Please see Statement in Attachment 38. Amount: $16,200.00 Component Description: Pre-transition Aux Combiner. Please see Statement in Attachment 34. Amount: $14,845.00

Cost Information

Transmission Line

Information not provided.

Cost Information

Tower Equipment and Rigging Costs

Information not provided.

Cost Information

Outside Professional Services

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$74,750.00	$18,887.50	N/A	$4,175.00	N/A
Total for all systems	$3,590,105.08	$2,193,175.73	N/A	$2,022,968.47	N/A
Outside Professional Services	$74,750.00	$18,887.50		$4,175.00
Perform engineering study for new channel assignment and antenna development	$7,360.00	$1,387.50	Based on actual cost. Please see Attachment 15 and first item in Attachment 16.	$1,387.50	N/A
RF Exposure Measurements	$21,050.00	$5,000.00	N/A	N/A	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	N/A	N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application	$2,105.00	$2,000.00	N/A	N/A	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$2,787.50	N/A
Project management of the transition	$39,500.00	$6,000.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Perform engineering study for new channel assignment and antenna development	Component Description: Studies regarding antenna options following new channel assignment. Amount: $937.50 Component Description: Engineering study and discussions regarding new channel assignment. Amount: $450.00
RF Exposure Measurements	Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application	Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: Prepare second CP application filed during "priority" window. Required as a consequence of population loss due to new channel assignment. Amount: $1,375.00 Component Description: Prepare initial Construction Permit application. Amount: $1,412.50
Project management of the transition	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	$90,592.43	$84,282.43	N/A	$64,282.43	N/A
Total for all systems	$3,590,105.08	$2,193,175.73	N/A	$2,022,968.47	N/A
Other Expenses	$90,592.43	$84,282.43		$64,282.43
Equipment Delivery and Handling Charges	$12,958.38	$12,958.38	Based on actual freight costs. Please see Attachments 14, 23, and 36.	$12,958.38	N/A
Sales Tax	$44,639.05	$44,639.05	State Sales Tax - Based on actual costs. Please see Attachments 13A, 14A, 21, 22, 29, 32, 33, 34, and 36.	$44,639.05	N/A
MVPD Notification of Channel Change	$0.00	$0.00	N/A	N/A	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$20,000.00	$20,000.00	Still waiting on quote. Main transmitter dismantle and remove.	N/A	N/A
FCC Filing Fees - Form 2100 license to cover application	$335.00	$715.00	License Applications for Main and Aux antennas ($315 + $380)	$715.00	N/A
FCC Filing Fees - Form 2100 minor change CP application	$1,110.00	$2,220.00	Construction Permit applications for Main and Aux antennas ($1,110 + $1,110).	$2,220.00	N/A
DTV Medical Facility Notification	$11,550.00	$3,750.00	N/A	$3,750.00	N/A
Develop and air announcement of upcoming channel change	$0.00	$0.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Equipment Delivery and Handling Charges	Component Description: Shipping for RF System. Please see Statement in Attachment 36. Amount: $488.06 Component Description: Freight for Aux Transmitter. Please see Statement in Attachment 23. Amount: $2,900.00 Component Description: Freight for transmitter RF System. Please see Attachment 14A. Amount: $9,570.32
Sales Tax	Component Description: State Sales Tax on additional RF System hardware. Please see Attachment 14A. Amount: $552.67 Component Description: State Sales Tax on RF System. Please see Attachment 13A. Amount: $19,575.52 Component Description: Shipping on RF System. Please see Statement in Attachment 36. Amount: $2,539.35 Component Description: Sales Tax on Pre-Transition Combiner. Please see Statement in Attachment 34. Amount: $1,298.94 Component Description: Sales Tax on Combiner Final Payment. Please see Statement in Attachment 33. Amount: $2,143.75 Component Description: Sales Tax on Combiner Down Payment. Please see Statement in Attachment 32. Amount: $2,143.75 Component Description: Sales tax on cut line sections. Please see Statement in Attachment 29. Amount: $110.43 Component Description: Sales Tax on Heat Exchanger and Pump. Please see Statement in Attachment 22. Amount: $483.47 Component Description: Sales tax on Aux Transmitter. Please see Statement in Attachment 21. Amount: $15,791.17
MVPD Notification of Channel Change	Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value)	Information not provided.
FCC Filing Fees - Form 2100 license to cover application	Component Description: Please see Attachment 9 Amount: $380.00 Component Description: Please see Attachment 10. Amount: $335.00
FCC Filing Fees - Form 2100 minor change CP application	Component Description: Please see explanation for unorthodox Invoice Number in Attachment 8. Amount: $1,110.00 Component Description: Please see Attachment 7. Amount: $1,110.00
DTV Medical Facility Notification	Component Description: Please see Attachment 11. Amount: $3,750.00
Develop and air announcement of upcoming channel change	Information not provided.

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$3,590,105.08	$2,193,175.73	$2,022,968.47

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.	No
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator.	No

Certification

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.	Martha E Heller VP, Government Relations and Regulatory 02/23/2022

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.

Martha E Heller

VP, Government Relations and Regulatory

02/23/2022

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.	Martha E Heller VP, Government Relations and Regulatory 02/23/2022

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.

Martha E Heller

VP, Government Relations and Regulatory

02/23/2022

(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

Auxiliary Transmitter

Add Transmitter Information

Auxiliary Transmitter

Retuning Transmitter Costs

Auxiliary Transmitter

Other Transmitter Costs

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Auxiliary Transmitter

Add Transmitter Information

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

Auxiliary Transmitter

New Transmitter Costs

Auxiliary Transmitter

Other Transmitter Costs

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Antennas

Primary Antenna

Existing Antenna Information

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

Primary Antenna

Adjustment to Existing Antenna

Primary Antenna

Other Antenna Costs

Enter a list of RF channel numbers.

Primary Antenna

Other Antenna Cost Not Listed

Auxiliary Antenna

Existing Antenna Information

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

Auxiliary Antenna

Adjustment to Existing Antenna

Auxiliary Antenna

Other Antenna Costs

Enter a list of RF channel numbers.

Auxiliary Antenna

Other Antenna Cost Not Listed

Transmission Line

Tower Equipment And Rigging Costs

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Cost Information

Tower Equipment and Rigging Costs

Cost Information

Outside Professional Services

Components

Cost Information

Other Expenses

Components

Cost Information