TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
WTVD TELEVISION, LLC Doing Business As: WTVD TELEVISION, LLC	77 WEST 66TH STREET, 16TH FLR ATTN: JOHN W. ZUCKER, ESQ. NEW YORK, NY 10023 United States	+1 (212) 456-7387	john.w.zucker@abc.com	Limited Liability Company

Applicant

Address

Phone

Applicant Type

WTVD TELEVISION, LLC

Doing Business As: WTVD TELEVISION, LLC

77 WEST 66TH STREET, 16TH FLR

ATTN: JOHN W. ZUCKER, ESQ.

NEW YORK, NY 10023

United States

+1 (212) 456-7387

john.w.zucker@abc.com

Limited Liability Company

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
The Preparer is same as the reimbursement contact.

Broadcaster Information and Transition Plan

Question	Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information.	No
Briefly describe transition plan	Please see attachment for WTVD facilities and transition plan details.

Transmitters

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

Auxiliary Transmitter

Existing 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	PTCD40P4i
	Year	2010
	Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power Capacity	16 kW

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	VAXTE-24R37
	Transmitter Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power capacity	19.2 kW
	Justification for New Transmitter	The current channel 11 Auxiliary (Backup) transmitter cannot be re-channeled to meet new assignment on channel 9.

Auxiliary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	Yes
	Transformer (480V)	Yes
	Power	150 kVA
	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

Name	Description
HVAC Modifications	Modification of HVAC return ductwork
Electrical Installation	Electrical work related to replacement of old transmitter
Transmission line	Additional 3 inch unflanged transmission line required for transmitter installation.

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	PTCD40P4i
	Year	2010
	Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power Capacity	16 kW

Primary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Primary (Main)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Manufacturer
	Model	VAXTE-24R37
	Transmitter Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power capacity	19.2 kW
	Justification for New Transmitter	The current channel 11 Primary (Main) transmitter cannot be re-channeled to meet new assignment on channel 9

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	Yes
	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

Other Transmitter Cost Not Listed

Name	Description
HVAC modifications	Modification of HVAC return ductwork.
Electrical Installation	Electrical work related to replacement of old transmitters.

Antennas

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

Auxiliary Antenna

Existing 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 the existing antenna shared with another station or stations?	No
	Is the existing antenna directional?	No
	Is antenna in operating condition?	Yes
	Is antenna located on or in close proximity to an antenna farm?	Yes
Existing Antenna Manufacturer and Type	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Circular
	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:	45.0 kW
	Manufacturer
	Model	TLS-V8/VP-R S180
	Year	2010

Auxiliary Antenna

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?	No
	Will antenna be located on or in close proximity to an antenna farm?	Yes
New Antenna Manufacturer and Types	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Circular
	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:	45.0 kW
	Manufacturer
	Model	TLS-V8/VPR S180
	Year	2018
	Justification for New Antenna	The current channel 11 Auxiliary (Backup) antenna cannot be re-channeled to meet new assignment on channel 9.

Auxiliary Antenna

Other Antenna Costs

Section	Question	Response
Combiner for Shared Antenna	Do you need a Combiner for a Shared Antenna?	No
	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	4 1/16 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?	No
Sweep Test	Do you require the sweep testing of transmission line and antenna?	Yes

Auxiliary Antenna

Other Antenna Cost Not Listed

Information not provided.

Primary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Purchase New
	Antenna Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing antenna shared with another station or stations?	No
	Is the existing antenna directional?	No
	Is antenna in operating condition?	Yes
	Is antenna located on or in close proximity to an antenna farm?	Yes
Existing Antenna Manufacturer and Type	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Not in Stack
	Polarization	Circular
	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:	45.0 kW
	Manufacturer
	Model	THV-9A11/CP-R O4
	Year	2010

Primary Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Primary (Main)
	Description of Use	N/A
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	No
	Will antenna be located on or in close proximity to an antenna farm?	Yes
New Antenna Manufacturer and Types	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Not in Stack
	Polarization	Circular
	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:	45.0 kW
	Manufacturer
	Model	THV-9A9/CP-R O4
	Year	2018
	Justification for New Antenna	The current channel 11 Primary (Main)antenna cannot be re-channeled to meet new assignment on channel 9

Primary Antenna

Other Antenna Costs

Section	Question	Response
Combiner for Shared Antenna	Do you need a Combiner for a Shared Antenna?	No
	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?	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

Primary Antenna

Other Antenna Cost Not Listed

Name	Description
Mounting pole	New channel 9 Primary (Main) antenna requires a shorter mounting pole to maintain current antenna aperture and HAAT.

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?	Yes

Primary Tower

Existing Tower

Section	Question	Response
Existing Tower Description	Type of change	Modify Existing
	Tower Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Is this tower consider Complex?
	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
Existing Tower Structure Registration	ASR Number	1010348
Coordinates (NAD83)	Latitude (NAD83)	35° 40' 06.0" N-
	Longitude (NAD83)	078° 31' 58.0" W-
	Overall Structure Height	1994.07 feet
	Support Structure Height	1885.80 feet
	Ground Elevation Above Mean Sea Level (AMSL)	318.89 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	WTVD Television, LLC
	Date Constructed	01/01/1978

Primary Tower

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

Tower Rigging Costs

Section	Question	Response
Tower Rigging Costs	Complex Tower	Other
Helicopter Services Required	Are helicopter services required?	Yes

Primary Tower

Other Tower Expenses Not Listed

Name	Description
Tower reinforcements	Reinforcements necessary to comply with ANSI/TIA-222-G standard
Top Beacon	Top beacon and cable, Quotation Q312202, dated March 12, 2020

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	No
	Number of Hours	N/A
	Explanation	N/A
Outside RF consulting Engineering Services	Perform engineering study for new channel assignment and antenna development	Yes
	Prepare engineering section of Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	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	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	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	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	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

Other Professional Services Expenses Not Listed

Name	Description
Structural Analysis	Structural analysis to comply with TIA/EIA-222-G and design of required reinforcement.
Structural project management	Structural Engineering services to manage tower reinforcements, antenna replacements and rigging plans.
Legal Advice re Reimbursement Process	Outside counsel advice re reimbursement and repacking procedures.

Other Expenses

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

Other Expenses

Other Expenses Not Listed

Name	Description
Equipment Delivery and Handling Charges	Complex site requires substantial handling equipment and charges.

Cost Information

Transmitters

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$1,195,918.50	$1,097,597.96	N/A	$1,039,883.16	N/A
Total for all systems	$3,151,318.03	$2,552,140.49	N/A	$2,311,914.75	N/A
Primary Transmitter VAXTE-24R37	$583,834.25	$545,743.21		$514,778.19
Switchgear - industrial 800 amp	$38,200.00	$2,401.86	N/A	$2,401.86	N/A
HVAC modifications	$3,500.00	$3,500.00	Modifications to HVAC return ductwork to accommodate new transmitter	$3,500.00	Sub total matches the estimated cost. Added updated file to the component needing more information and re-added the component with further information for the denied component.
Electrical Installation	$16,134.25	$16,134.25	N/A	$16,134.25	N/A
High VHF - Air Cooled Solid State Transmitter 16.6 . 20.7 kW	$526,000.00	$523,707.10	See attached quote from GatesAir, which includes costs of power transformer, mask filter, shipping, and installation.	$492,742.08	N/A
Auxiliary Transmitter VAXTE-24R37	$612,084.25	$551,854.75		$525,104.97
Transmission line	$2,700.00	$2,700.00	Insufficient transmission line was included in GatesAir quote to complete installation of auxiliary transmitter.	$2,656.76	N/A
Electrical Installation	$16,134.25	$16,134.25	N/A	$16,134.25	N/A
HVAC Modifications	$3,500.00	$3,500.00	Modifications to HVAC return ductwork to accommodate new transmitter	$3,500.00	Sub total matches the estimated cost. Added updated file to the component needing more information and re-added the component with further information for the denied component.
High VHF - Air Cooled Solid State Transmitter 16.6 . 20.7 kW	$526,000.00	$523,707.10	See attached quote from GatesAir, which includes costs of power transformer, mask filter, shipping, and installation	$497,000.56	N/A
Transformer 3 phase/480v - 150 KVA	$25,550.00	$3,411.54	75 KVA transformer for auxiliary transmitter power supply.	$3,411.54	N/A
Switchgear - industrial 800 amp	$38,200.00	$2,401.86	N/A	$2,401.86	N/A

Components

Actual Information Description	File Name
Switchgear - industrial 800 amp	Component Description: Switchgear for the Repack for WTVD TV, as agreed in Quote 1136 Amount: $2,401.86
HVAC modifications	Component Description: Inv # 36409 with Warren Hay for the 50/50 split of duct work removal and installation unknown at beginning of project with updated cover sheet. Amount: $1,500.00 Component Description: Invoice 35892 to be split 50/50 between the Primary and Auxiliary Transmitters. Amount: $2,000.00 Component Description: 50/50 split for each transmitter Amount: $2,000.00
Electrical Installation	Component Description: Main transmitter Electrical installation for the Repack for WTVD TV, as agreed in Quote 1136. Amount: $16,134.25
High VHF - Air Cooled Solid State Transmitter 16.6 . 20.7 kW	Component Description: Main TX Second Payment Invoice US0329473 Amount: $61,360.88 Component Description: Electrical for main transmitter, Second Payment Invoice US0329473 Amount: $226.62 Component Description: Freight for main transmitter, Second Payment Invoice US0329473 Amount: $1,185.00 Component Description: installation and proof for main transmitter, Second Payment Invoice US0329473 Amount: $3,485.13 Component Description: Amount reduced in change order Q-80769, mask filter system, main Tx Second Payment Invoice US0329473 Amount: $7,595.27 Component Description: 50/50 split cost for 4 GPS Antenna Kits. Two required for primary and auxiliary transmitter exciters. Amount: $911.10 Component Description: 70% down, install and proof for main transmitter Amount: $16,263.90 Component Description: Main Tx Final Payment Invoice US0339061, requested amount is reduced by two cents, see attachment Amount: $66,737.27 Component Description: 70% down, Freight for main transmitter Amount: $5,530.00 Component Description: 70% down mask filter system for main transmitter Amount: $42,038.55 Component Description: 70% down payment, transmitter VAXTE-24, main Amount: $286,350.79 Component Description: 70% down Electrical for main transmitter Amount: $1,057.57
Transmission line	Component Description: Additional Transmission line pieces were needed (plus expedited shipping due to timing of work, per Quote # 1931434). Cover sheet included Amount: $2,656.76 Component Description: Additional Transmission line pieces were needed (plus exp shipping due to timing of work, per Quote # 1931434 Amount: $2,656.76
Electrical Installation	Component Description: Aux transmitter Electrical installation for the Repack for WTVD TV, as agreed in Quote 1136 Amount: $16,134.25
HVAC Modifications	Component Description: Invoice 36409 to be split 50/50 between the Primary and Auxiliary Transmitters. Amount: $1,500.00 Component Description: Invoice 35892 to be split 50/50 between the Primary and Auxiliary Transmitters. Amount: $2,000.00 Component Description: 50/50 split cost for each transmitter Amount: $2,000.00
High VHF - Air Cooled Solid State Transmitter 16.6 . 20.7 kW	Component Description: installation and proof for Aux transmitter, Second Payment Invoice #US0329472 Amount: $3,485.13 Component Description: Amount reduced in change order Q-80771, mask filter system main TX Second Payment Invoice #US0329472 Amount: $8,231.81 Component Description: Freight for Aux transmitter, Second Payment Invoice #US0329472 Amount: $1,185.00 Component Description: Electrical for Aux transmitter, Second Payment Invoice #US0329472 Amount: $226.62 Component Description: (Amount includes change order Q-80891) Aux TX Second Payment Invoice #US0329472 Amount: $61,360.88 Component Description: 70% down payment, transmitter VAXTE-24, aux Amount: $286,350.79 Component Description: 70% down payment, install and proof for Aux transmitter Amount: $16,263.90 Component Description: 70% down, Freight for Aux transmitter Amount: $5,530.00 Component Description: 70% down Electrical for Aux transmitter Amount: $1,057.57 Component Description: 50/50 split cost for 4 GPS Antenna Kits. Two required for primary and auxiliary transmitter exciters. Amount: $911.10 Component Description: 70% down mask filter system for Aux transmitter Amount: $42,038.55 Component Description: Aux TX Final Payment invoice US0336990 (see attachment) Amount: $70,359.21
Transformer 3 phase/480v - 150 KVA	Component Description: Aux transmitter Electrical installation 480V transformer for the Repack for WTVD TV, as agreed in Quote 1136 Amount: $3,411.54
Switchgear - industrial 800 amp	Component Description: Aux transmitter Electrical installation Switchgear for the Repack for WTVD TV, as agreed in Quote 1136 Amount: $2,401.86

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	$595,297.00	$574,665.00	N/A	$543,649.85	N/A
Total for all systems	$3,151,318.03	$2,552,140.49	N/A	$2,311,914.75	N/A
Primary Antenna THV-9A9/CP-R O4	$450,529.00	$444,923.00		$426,117.50
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	$12,300.00	$7,024.00	This cost is included in the attached Dielectric Main antenna quote.	$5,926.50	N/A
High VHF - High Power Top Mount One Station elliptically or circularly polarized	$305,777.00	$305,777.00	See attached quote from Dielectric. This Primary (Main) top-mount channel 9 antenna is a direct replacement for our current channel 11 Primary (Main) antenna.	$299,540.50	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	This cost is included in the attached Dielectric Main antenna quote.	$6,400.00	N/A
Mounting pole	$125,722.00	$125,722.00	A shorter mounting pole for the new channel 9 Primary antenna is required to maintain current antenna aperture and HAAT. The cost for this mounting pole is included in the attached Dielectric Primary (Main) antenna quote.	$114,250.50	See Main Antenna Attachment for vendor letter and Cost Breakdown (3-08-2019)
Auxiliary Antenna TLS-V8/VPR S180	$144,768.00	$129,742.00		$117,532.35
Sweep test of existing antenna	$6,730.00	$6,400.00	This cost is included in the attached Dielectric Auxiliary (Backup) antenna quote.	$5,658.35	N/A
High VHF - High Power Side Mount One Station elliptically or circularly polarized	$105,318.00	$105,318.00	See attached quote from Dielectric. This Auxiliary (Backup) side-mount channel 9 antenna is a direct replacement for our current channel 11 Auxiliary (Backup) antenna.	$94,976.00	N/A
Side mount brackets for high power antennas (if not included in antenna base cost)	$23,150.00	$11,000.00	This cost is included in the attached Dielectric Auxiliary (Backup) antenna quote.	$10,313.00	N/A
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)	$9,570.00	$7,024.00	This cost is included in the attached Dielectric Auxiliary (Backup) antenna quote.	$6,585.00	N/A

Components

Actual Information Description	File Name
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	Component Description: "prior to ship" invoice, line 4 Amount: $4,280.25 Component Description: 25% down payment, line 4 of invoice Amount: $1,646.25 Component Description: "prior to ship" invoice, line 4 Amount: $4,280.25
High VHF - High Power Top Mount One Station elliptically or circularly polarized	Component Description: "prior to ship" invoice, line 7 Amount: $1,117.03 Component Description: "prior to ship" invoice, line 1 Amount: $176,735.65 Component Description: "prior to ship" invoice, line 5 Amount: $1,208.02 Component Description: "prior to ship" invoice, line 8 Amount: $1,376.38 Component Description: Dielectric payment 3 for main antenna, see attachment Amount: $40,382.04 Component Description: "prior to ship" invoice, line 6 Amount: $864.50 Component Description: 25% down payment, line 5 of Invoice Amount: $464.62 Component Description: 25% down payment, line 7 of Invoice Amount: $429.63 Component Description: Main Antenna, Invoice 843010, see attachment Amount: $430.50 Component Description: 25% down payment, line 6 of Invoice Amount: $332.50 Component Description: "prior to ship" invoice, line 3 Amount: $5,557.50 Component Description: 25% down payment, line 3 on invoice Amount: $2,137.50 Component Description: 25% down payment, line 8 of Invoice Amount: $529.38 Component Description: 25% down payment, Main Antenna, line 1 Amount: $67,975.25
Sweep test of existing antenna	Component Description: "prior to ship" invoice, line 9 Amount: $4,160.00 Component Description: final payment for sweep test Amount: $640.00 Component Description: 25% down payment, line 9 of Invoice Amount: $1,600.00
Mounting pole	Component Description: "prior to ship" invoice, line 2 Amount: $82,514.25 Component Description: 25% down payment Amount: $31,736.25
Sweep test of existing antenna	Component Description: "prior to ship" invoice, line 7 Amount: $2,560.00 Component Description: 25% down payment, line 7 of Aux Ant Invoice Amount: $1,600.00 Component Description: Correct reimbursement amount is $2240.00 for invoice 675009rev (6400-1498.35). The $4901.65 credit issued under Invoice # 517014 was split into the final payment, ($1498.35 amount includes adjustment made to invoice 517014, see attachment Amount: $1,498.35
High VHF - High Power Side Mount One Station elliptically or circularly polarized	Component Description: "prior to ship" invoice, line 6 Amount: $712.04 Component Description: final payment Aux Antenna invoice 517014 (lines 1,4, & 5) Amount: $31,576.33 Component Description: 25% down payment, line 5 of Aux Ant Invoice Amount: $217.00 Component Description: 25% down payment, line 6 of Aux Ant Invoice Amount: $445.03 Component Description: "prior to ship" invoice, line 5 Amount: $347.20 Component Description: "prior to ship" invoice, line 1 Amount: $35,028.00 Component Description: freight, aux antenna invoice 608035 Amount: $4,016.25 Component Description: 25% down payment, line 4 of Aux Ant Invoice Amount: $285.25 Component Description: 25% down payment, line 1 of Aux Ant Invoice Amount: $21,892.50 Component Description: "prior to ship" invoice, line 4 Amount: $456.40
Side mount brackets for high power antennas (if not included in antenna base cost)	Component Description: final payment,Aux Ant invoice 517014, line 3 Amount: $3,609.55 Component Description: "prior to ship" invoice, line 3 Amount: $4,125.20 Component Description: 25% down payment, line 3 of Aux Ant Invoice Amount: $2,578.25
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)	Component Description: final payment,Aux Ant invoice 517014, line 2 Amount: $2,304.75 Component Description: "prior to ship" invoice, line 2 Amount: $2,634.00 Component Description: 25% down payment, line 2 of Aux Ant Invoice Amount: $1,646.25

Cost Information

Transmission Line

Information not provided.

Cost Information

Tower Equipment and Rigging Costs

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$1,143,528.00	$671,354.00	N/A	$640,077.00	N/A
Total for all systems	$3,151,318.03	$2,552,140.49	N/A	$2,311,914.75	N/A
Primary Tower TOWER	$1,143,528.00	$671,354.00		$640,077.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	$421,000.00	$65,000.00	*System Notice: Estimate adjusted and locked because line has been superseded.*See attached quotes from Coast to Coast Tower Service which includes replacements of Primary and Auxiliary (Backup) antennas.	$65,000.00	N/A
Top Beacon	$3,415.00	$3,415.00	Basis of cost estimate – Parts Quotation Q312202, dated March 12, 2020	$3,415.00	N/A
Tower Helicopter Lift	$488,863.00	$488,863.00	On 6/15/2020, CTC revised CTC Proposal #12081901T and replaced it with Proposal #06152001T, which sets forth a total cost of $468,113. On 6/24, a fee of $60,750 set forth in 1-E of CTC proposal #06242001T, was added, total cost is ($528,863-$40,000)	$488,863.00	WTVD Television has updated the Schedule 399 cost estimate to reflect revised contract for HTS air crane install dated 06-24-2020 CTC Proposal: #06242001T. See attachment
Minor tower reinforcement/modifications	$158,000.00	$47,726.00	Remaining Balance owed to CTC under CTC Proposal #06221704T - $47,726	$47,726.00	N/A
Tower reinforcements	$59,650.00	$59,650.00	Tower reinforcements are necessary to comply with TIA/EIA-222-G standards with the new antenna loads.	$30,173.00	See attachment for Tower Mod payment, $30,173.00 total amount,The $28,550 quote dated 07-03-2017 will not be used.
Structural engineering tower load study for well documented tower	$12,600.00	$6,700.00	ORIGINAL ENGINEERING STUDY THAT WAS DONE TO DETERMINE REQUIREMENTS, BUT THIS WAS REIMBURSED IN A PREVIOUS FILING (TURRIS - $6,700). NOTHING ELSE ON REINFORCEMENT.	$4,900.00	N/A

Components

Actual Information Description	File Name
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	Component Description: Deposit for tower modifications and antenna replacements Amount: $65,000.00
Top Beacon	Component Description: Skytec Inc. for $3,415, includes shipping for (2) 60 lb. and 26 lb. boxes Amount: $3,415.00
Tower Helicopter Lift	Component Description: Progress Payment for the Repack for WTVD TV, as agreed in CTC proposal #06242001T & WTVD PO #4506101697 and WTVD PO #4506220994. Amount: $200,000.00 Component Description: Deposit for the addition of the Helicopter lift to install the main antenna for the Repack for WTVD TV, as agreed in CTC proposal 12081901T. Amount: $114,106.00 Component Description: (Line 1) Progress Payment for the Repack for WTVD TV, as agreed in CTC proposal #06242001T & WTVD PO #4506220994. Amount: $49,007.00 Component Description: Line 2, Mobilization Fee for HTS Airlift, as agreed in, section 1-E of CTC proposal #06242001T, Coast to Coast was not able to complete the WTVD TV Repack project in conjunction with another airlift, this resulted in an additional $60,750 Amount: $60,750.00 Component Description: Progress Payment for the Repack for WTVD TV, as agreed in CTC proposal #06242001T & WTVD PO #4506220994. Amount: $65,000.00
Minor tower reinforcement/modifications	Component Description: Balance owed to CTC under CTC Proposal #06221704T - $47,726 Amount: $47,726.00
Tower reinforcements	Component Description: deposit payment for tower mod, see attached. Amount: $10,560.00 Component Description: remaining balance for tower mod payment, see attached. Amount: $19,613.00
Structural engineering tower load study for well documented tower	Component Description: Construction Drawings Amount: $4,900.00

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	$175,711.17	$173,927.17	N/A	$55,919.13	N/A
Total for all systems	$3,151,318.03	$2,552,140.49	N/A	$2,311,914.75	N/A
Outside Professional Services	$175,711.17	$173,927.17		$55,919.13
Legal Advice re Reimbursement Process	$20,086.17	$20,086.17	Legal services relating to research and advice regarding reimbursable legal expenses and required backup support. See two attached quotes from Akin Gump.	$20,086.17	N/A
Structural project management	$28,550.00	$28,550.00	See attached quote from Turris Engineering to provide rigging plan and engineering services for antenna replacements and structural modifications.	N/A	N/A
Structural Analysis	$10,000.00	$10,000.00	Structural analysis required to comply with current tower standards. See attached quote from Turris Engineering.	$6,700.00	N/A
Comprehensive coverage verification via field study, if needed	$84,200.00	$79,955.00	Attached quote includes services for field strength study to verify antenna and coverage performance.	$0.00	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,250.00	N/A	$1,572.01	N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application	$4,210.00	$4,511.00	cost of additional legal services/fees for Aux Antenna	$4,510.52	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$5,000.00	N/A	$4,048.90	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	$1,200.00	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	$480.00	N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application	$2,105.00	$3,000.00	Additional permit had to be received to allow WTVD to transition to Channel 9 early to coincide with the change over with other stations in our market to avoid viewer confusion and inconvenience and avoid a 2nd set of viewer announcements	$2,902.50	Additional permit needed to move WTVD to Channel 9 early to coincide with the change over with other stations in our market to avoid viewer confusion and inconvenience and avoid a 2nd set of viewer announcements
Perform engineering study for new channel assignment and antenna development	$7,360.00	$9,575.00	Additional engineering study had to be performed to determine if WTVD could transition to Channel 9 early to coincide with the change over with other stations in our market to avoid viewer confusion and inconvenience and avoid a 2nd set of viewer announce	$9,573.75	Additional engineering study had to be performed to determine if WTVD could transition to Channel 9 early to coincide with the change over with other stations in our market to avoid viewer confusion and inconvenience and avoid a 2nd set of viewer announce
Prepare and or review reimbursement form	$2,630.00	$2,500.00	N/A	$2,002.78	N/A
Address transition timing and coordination issues w/ other stations and wireless	$2,630.00	$2,500.00	N/A	$525.00	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$2,317.50	N/A

Components

Actual Information Description	File Name
Legal Advice re Reimbursement Process	Component Description: Legal Advice re: Reimbursement process Amount: $1,122.23 Component Description: See Invoice for 399 line items (net of fee adjustment) Amount: $5,542.13 Component Description: Legal Advice re: Reimbursement process Amount: $314.73 Component Description: Legal fees Amount: $9,131.63 Component Description: Legal Advice re: Reimbursement process Amount: $1,797.83 Component Description: Legal Advice re: Reimbursement process Amount: $663.76 Component Description: See Invoice for 399 line items (net of fee adjustment) Amount: $1,513.86
Structural project management	Information not provided.
Structural Analysis	Component Description: Structural analysis and report for WTVD 2000' transmission tower Amount: $6,700.00
Comprehensive coverage verification via field study, if needed	Component Description: Engineering Feasibilty study Amount: N/A Component Description: Engineering fees for waiver to phase 5 Amount: N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Component Description: Legal fees to cover main application to FCC Amount: $1,572.01
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application	Component Description: Legal fees for Aux Application Amount: $530.15 Component Description: Attorney fees for Aux Amount: $2,516.94 Component Description: Legal fees of Aux finalization Amount: $1,463.43
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: See Invoice 1727603 (2100) line items (net of fee adjustment) Amount: $491.44 Component Description: See Invoice 1723104 (2100) line items (net of fee adjustment) Amount: $3,557.46
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application	Component Description: Engineering fees for application for license of Aux Amount: $960.00 Component Description: Engineering fees for additional work of Aux license fee Amount: $240.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Component Description: Engineering fees for application for license to cover main antenna Amount: $480.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application	Component Description: Prep of application for Aux Construction permit to replace antenna for post repack channel 9. Transition to Aux and replace main antenna after Amount: $2,902.50
Perform engineering study for new channel assignment and antenna development	Component Description: Preparation of waiver to change to Phase 5, Interference studies and report Amount: $5,760.00 Component Description: Study to determine the feasibility of WTVD transitioning to Channel 9 early using the Aux construction permit facility with a Special Temporary Authority. Amount: $960.00 Component Description: See Invoice # Item 1 Amount: $2,853.75
Prepare and or review reimbursement form	Component Description: Legal fees for FCC 399 Reimbursement Amount: $1,178.10 Component Description: Legal fees for FCC 399 reimbursement Amount: $530.15 Component Description: Legal review of FCC 399 Reimbursements of final invoices Amount: $58.91 Component Description: Legal review of FCC 399 Reimbursements Amount: $117.81 Component Description: Legal review of FCC 399 Reimbursements Amount: $117.81
Address transition timing and coordination issues w/ other stations and wireless	Component Description: Engineering study re: transition plan and interim facilities Amount: $525.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: See Invoice # Item 2 Amount: $2,317.50

Cost Information

Other Expenses

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$40,863.36	$34,596.36	N/A	$32,385.61	N/A
Total for all systems	$3,151,318.03	$2,552,140.49	N/A	$2,311,914.75	N/A
Other Expenses	$40,863.36	$34,596.36		$32,385.61
DTV Medical Facility Notification	$11,550.00	$4,868.00	N/A	$4,868.00	N/A
FCC Filing Fees - Form 2100 license to cover application	$335.00	$750.00	WTVD will be required to file license applications for both the Primary and Auxiliary facilities.	$0.00	N/A
Equipment Delivery and Handling Charges	$4,903.69	$4,903.69	Payments to Herc Rentals required for transmitter unloading and installation.	$4,903.69	Estimated cost matches the sub-total provided of all invoices requesting reimbursement on.
Develop and air announcement of upcoming channel change	$4,000.00	$4,000.00	N/A	$2,539.25	N/A
MVPD Notification of Channel Change	$5,354.00	$5,354.00	FCC Waiver to move from phase 9 to 10, due to Covid-19, scheduling conflicts with linked stations in phase 9, WTVD notified MVPD's of its transition to phase 10. Thus requiring a second set of notices and additional expenses incurred.	$5,354.00	N/A
Equipment Delivery and Handling Charges	$14,720.67	$14,720.67	Additional freight and storage costs for Main antenna billed at time of shipment.	$14,720.67	N/A

Components

Actual Information Description	File Name
DTV Medical Facility Notification	Component Description: Required Notification to medical facilities Amount: $4,868.00
FCC Filing Fees - Form 2100 license to cover application	Information not provided.
Equipment Delivery and Handling Charges	Component Description: Herc Rentals Inv # 31275280-001 for Fork Lift rental fees Amount: $781.22 Component Description: Herc Rentals Inv# 30900377-001 for Fork Lift Rental Fees Amount: $752.11 Component Description: Herc Rentals Inv # 30998761-001 for Fork Lift rental fees Amount: $632.62 Component Description: Herc Rentals invoice # 31279362-001 for Fork Lift Rental Amount: $1,891.50 Component Description: invoice 31275280-001, Fork lift rental fees Amount: $781.22 Component Description: invoice 30900377-001, Fork lift rental fees Amount: $752.11 Component Description: invoice 30931718-001, Fork lift rental fees Amount: $846.24 Component Description: invoice 31279362-001, Fork lift rental fees Amount: $1,891.50 Component Description: invoice 30998761-001, Fork lift rental fees Amount: $632.62
Develop and air announcement of upcoming channel change	Component Description: Tv rescan call center payment for Invoice 12537191 Amount: $525.00 Component Description: Tv rescan call center payment for Invoice 12523938 Amount: $365.75 Component Description: Tv rescan call center payment for Invoice 12528132 Amount: $525.00 Component Description: Tv rescan call center payment for Invoice 12510936 Amount: $525.00 Component Description: Tv rescan call center payment for Invoice 12519138 Amount: $525.00 Component Description: Tv rescan call center payment for Invoice 12514827 Amount: $73.50
MVPD Notification of Channel Change	Component Description: Second set of notices required for transition from phase 9 to phase 10 Amount: $2,677.00 Component Description: Notice to MVPDs Amount: $2,677.00
Equipment Delivery and Handling Charges	Component Description: Dielectric Inv 837016 for Van storage and freight delivery on main antenna with cover sheet and backup Amount: $4,545.00 Component Description: invoice 848003, freight fees with Fed Express NDA early morning for delivery of stored equipment needed for installation Amount: $774.43 Component Description: Dielectric invoice # 853006 for Flatbed freight and delivery of main antenna Amount: $9,401.24 Component Description: invoice 837016, Van storage & freight fees Amount: $4,545.00 Component Description: invoice 853006, flatbed delivery & storage fees Amount: $9,401.24 Component Description: invoice 848003, freight fees with Fed Express NDA early morning Amount: $774.43

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$3,151,318.03	$2,552,140.49	$2,311,914.75

Reimbursement Status

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

Certification

Section	Question	Response
Submission of Estimated Expenses Statements	WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD). The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	John W Zucker Assistant Secretary 03/17/2022

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.

John W Zucker

Assistant Secretary

03/17/2022

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.	John W Zucker Assistant Secretary 03/17/2022

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.

John W Zucker

Assistant Secretary

03/17/2022

Certification

Section	Question	Response
Submission of Final Allocation or Accounting Information Statements	WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	John W Zucker Assistant Secretary 03/17/2022

Section

Question

Response

Submission of Final Allocation or Accounting Information Statements

The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.
The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

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

John W Zucker

Assistant Secretary

03/17/2022

(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

Existing Transmitter Information

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

Auxiliary Antenna

Existing Antenna Information

Auxiliary Antenna

New Antenna Costs

Auxiliary Antenna

Other Antenna Costs

Auxiliary Antenna

Other Antenna Cost Not Listed

Primary Antenna

Existing Antenna Information

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Transmission Line

Tower Equipment And Rigging Costs

Primary Tower

Existing Tower

Primary Tower

Tower Modification Costs

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Cost Information

Tower Equipment and Rigging Costs

Components