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

FCC Form 399: Reimbursement Request

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

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

Facility ID:
9754
Service:
DTV
Call Sign:
KNCT
Channel:
17 (UHF)
File Number:
0000028595
FRN:
0018223693
Date Submitted:
03/08/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

Gray Television Licensee, LLC

Doing Business As: KNCT

4370 Peachtree Road, NE

Atlanta, GA 30319

United States

+1 (404) 504-9828 robert.folliard@gray.tv Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Samuel Hariton

Widelity Inc.

Samuel Hariton

4031 University Dr

Suite 100

Fairfax, VA 22030

United States

+1 (339) 222-8107 sam.hariton@widelity.com

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan Structural failed on existing tower. Move equipment to new location, new Ch 17 top mount antenna, with new transmission line in new tower. Use existing antenna, line and IOT transmitter to operate until channel transition.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model Visionary DT
Year 2003
Type Inductive Output Tube
IOT Power Type Single
Power Capacity 30 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model THU9-36evo
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 55.0 kW
Justification for New Transmitter IOT transmitter cannot be retuned for new channel. SS transmitter to be used for post-repack channel. See narrative. Transformer is 90 kVA - 150 is lowest option available on 399 form

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 15 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Transformer 3 phase - 480v - 90 KVA

Transformer option at 90 kVA is not available on form 399. Please see Rohde & Schwarz Transmitter Quote

Ice Break Structure

Parts and Labor for Ice Break Structure to protect exterior parts of the heat exchangers

Primary Transmitter - Heat Exchanger Stands

Primary Transmitter - Heat Exchanger Stands

Transmitter Bldg Roof

New roof on Moody location transmitter bldg due to forced repack relocation

Antennas

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

Primary Antenna

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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 Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 500.0 kW
Manufacturer
Model ATL20H3-HSO-38
Year 2003

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model TFU-28DSC-R C170
Year 2020
Justification for New Antenna Existing antenna is single channel 46, not tunable to Ch 17.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 6 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Bottom
Polarization Horizontal
Type Broadband Slot
Number of Stations Supported 2
Number of Panels/Bays 16
Lower Limit 470.00 MHz
Upper Limit 698.00 MHz
Design power capacity in use 30.0 %
Other Antenna Type N/A
ERP: 270.0 kW
Manufacturer
Model TFU-16WB-1-R C160
Year 2019
Justification for New Antenna INTERIM ANTENNA NO LONGER REQUIRED - CATEGORY CANNOT BE REMOVED FROM LMS

Interim Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for an antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? No

Interim Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 19 3/4 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1180 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1541 feet per run
Justification for New Transmission Line Building new tower. Existing transmission line needed to keep station on air while new antenna and line installed in new tower. See narrative.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Flexible Air
Diameter 5 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 1050 feet per run
Justification for New Transmission Line Line to feed interim antenna. See narrative.

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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Add Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1046229
Coordinates (NAD83) Latitude (NAD83) 31° 19' 19.2" N-
Longitude (NAD83) 097° 19' 03.0" W-
Overall Structure Height 1666.97 feet
Support Structure Height 1583.97 feet
Ground Elevation Above Mean Sea Level (AMSL) 853.01 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Gray Television Group, Inc.
Date Constructed 03/10/2010

FM, AM or TV radio broadcasters. Facility ID's, Call Signs and Services of other broadcast stations with whom the tower is shared

Facility ID Call Sign Service
35903 KWTX-TV DTV

Primary Tower

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Tower Modification Costs

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

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Foundation mapping and Geotechnical Services

Foundation mapping and Geotechnical Services for Load Analysis

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Move Equipment
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1058073
Coordinates (NAD83) Latitude (NAD83) 30° 59' 09.0" N-
Longitude (NAD83) 097° 37' 52.0" W-
Overall Structure Height 1140.73 feet
Support Structure Height 1095.79 feet
Ground Elevation Above Mean Sea Level (AMSL) 925.84 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner CENTRAL TEXAS COLLEGE
Date Constructed 01/01/1969


Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Construct New
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1058073
Coordinates (NAD83) Latitude (NAD83) 30° 59' 09.0" N-
Longitude (NAD83) 097° 37' 52.0" W-
Overall Structure Height 1140.73 feet
Support Structure Height 1095.79 feet
Ground Elevation Above Mean Sea Level (AMSL) 925.84 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner CENTRAL TEXAS COLLEGE
Date Constructed 01/01/1969

FM, AM or TV radio broadcasters. Facility ID's, Call Signs and Services of other broadcast stations with whom the tower is shared

Facility ID Call Sign Service
9977 KNCT-FM FM

Primary Tower

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Tower Construction Costs

Section Question Response
Construct New Tower Use Primary (Main)
Description of Use N/A
Is this a request for upgraded equipment? No
Height 1584.00 feet
Justification for New Tower Existing tower failed TIA 222-g standard, repairs too extensive and not feasible as per structural analysis conclusion. See narrative and analysis attachment. This is a direct replacement.

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Main antenna install

Main top antenna and transmission line installation.

Structural Study

Structural Engineering study (attached)

Removal of Tower

Remove existing tower and equipment upon completion of new tower.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 895
Explanation Extensive coordination over extended time period due to major construction of new tower and coordination with tenants on existing tower and moving to new tower negotiations. See narrative and quote1765.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Attorney Fees - Other Matters

Legal Services

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? Yes
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 Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

Preliminary Site Survey

Field Services and Site Survey performed by Marsand, Inc

Microwave Equipment

Microwave expenses to replicate the pre-repack coverage caused by the station's forced move. Please see KNCT Heartland Video System Quote WISQ53716-03.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $2,020,836.98 $1,564,103.17 N/A $1,404,112.52 N/A
Total for all systems $8,598,814.81 $4,270,545.62 N/A $3,470,177.15 N/A
Primary Transmitter THU9-36evo $2,020,836.98 $1,564,103.17 $1,404,112.52
Transformer 3 phase - 480v - 90 KVA $100,731.22 $100,731.22 Per Estimated Cost Justification KNCT-110-1st Primary Transmitter - Transformer 3 phase - 480v - 90 KVA v2 $100,494.81 N/A
15 Ton system $55,800.00 $66,180.44 Seeking full reimbursement for Lochridge-Priest Quote for HVAC work forced by the KNCT build out at the Moody Towers. $42,069.63 N/A
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW $1,788,000.00 $1,320,885.75 Please see Estimated Cost Justification KNCT-110-1st Primary Transmitter - UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW v2 $1,196,628.08 N/A
Primary Transmitter - Heat Exchanger Stands $3,600.00 $3,600.00 Please see Marsand quote 2028 $3,600.00 N/A
Ice Break Structure $61,320.00 $61,320.00 Please see Estimated Cost Justification KNCT-110-1st Primary Transmitter - Other Costs Not Listed - Ice Break Structure v0 $61,320.00 N/A
Transmitter Bldg Roof $11,385.76 $11,385.76 Justifying Quote and PO - KNCT Parsons Commercial Roofing, PO #001949 $0.00 N/A

Components

Actual Information Description File Name
Transformer 3 phase - 480v - 90 KVA

Component Description:
400AMP ATS, 3 pole, solid neutral, 480VAC, 3 Phase, NEMA 1 enclosure in-phase monitor
Amount:
$28,175.60

Component Description:
Installation of Electrical
Amount:
$6,550.00

Component Description:
KNCT-110-1st Primary Transmitter - Transformer 3 phase - 480v - 90 KVA
Amount:
$11,025.00

Component Description:
SP 200 120/208-3Y
Amount:
$1,009.87

Component Description:
KNCT-TV Ch17 Repack
Amount:
$2,076.10

Component Description:
KNCT-110-1st Primary Transmitter - Transformer 3 phase - 480v - 90 KVA
Amount:
$1,212.75

Component Description:
PV 400 277/480 3Y
Amount:
$4,232.57

Component Description:
"Phase I of KNCT-TV Ch. 17 transmitter repack at the Moody transmitter site Wire, service material Installation of gear"
Amount:
$19,485.00

Component Description:
KNCT-110-1st Primary Transmitter - Transformer 3 phase - 480v - 90 KVA
Amount:
$3,675.00

Component Description:
Installation of electric
Amount:
$23,052.92
15 Ton system

Component Description:
3 - 15 Ton Carrier RTUS and Duct
Amount:
$8,954.91

Component Description:
NO SA - HVAC, Truck Charge
Amount:
$161.30

Component Description:
(3) 15 TON CARRIER RTUS AND DUCT
Amount:
$26,864.72

Component Description:
Gravel for building drainage
Amount:
$300.00

Component Description:
Fabrication & Installation of the custom build cooling grill
Amount:
$5,950.00
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW

Component Description:
Credit Memo
Amount:
($433.00)

Component Description:
Credit Memo
Amount:
($47,430.82)

Component Description:
DRK19-44-36PROLRD - Middle Atlantic DRK Series Rack
Amount:
$5,046.47

Component Description:
Credit Memo
Amount:
($433.12)

Component Description:
Credit Memo
Amount:
($1,971.15)

Component Description:
Credit Memo
Amount:
($2,102.98)

Component Description:
Credit Memo
Amount:
($568.50)

Component Description:
Relocating a hose bib
Amount:
$659.24

Component Description:
JL074A-HP 3810M-48G-POE 1Slot
Amount:
$5,216.00

Component Description:
Smart-UPS ART 2200VA 120V - Rack/Tower
Amount:
$4,367.90

Component Description:
17" 3GHD & SD SDI Digital, Analog, HD HDMI/DVI (HDCP)
Amount:
$3,549.19

Component Description:
300KW Kohler Diesel Generator Set, one year system warranty
Amount:
$47,430.82

Component Description:
RG59/U Mini Precision 75 BrN
Amount:
$216.47

Component Description:
12G/6G/3G/HD/SD/MADI Distribution Amplifier 1 In / 10 Ou
Amount:
$2,102.98

Component Description:
Tax on order
Amount:
$86,681.52

Component Description:
High performance 3G reclocking DA w/rear module
Amount:
$3,077.88

Component Description:
Credit Memo
Amount:
($28,175.60)

Component Description:
DP 75% Downpayment
Amount:
$791,377.50

Component Description:
SNMP Manager for V5 ARC Plus Touch or ARC Plus SL
Amount:
$539.00

Component Description:
Middle Atlantic PD
Amount:
$1,971.15

Component Description:
Credit Memo
Amount:
($3,077.88)

Component Description:
APC S/UPS X 2000VA RACK/TOWER LCD 100-127V
Amount:
$4,270.35

Component Description:
DP 25% Down payment
Amount:
$263,792.50

Component Description:
12" MINI RG59, HD-BNC/F
Amount:
$433.12

Component Description:
Phase 1 of KNCT-TV Ch. 17 transmitter repack install at the Moody transmitter site.
Amount:
$10,361.07

Component Description:
Remote Support Task/Ticket: New switch and routers for Moody Transmitter
Amount:
$508.00

Component Description:
Phase 1 Moody Transmitter
Amount:
$23,052.92

Component Description:
Cobalt 9990 Decoder
Amount:
$3,549.35

Component Description:
Electrical Install for THU9-36Evo
Amount:
$62,400.00

Component Description:
Bittree Black 2X32 2RU Mini-Weco
Amount:
$1,534.12
Primary Transmitter - Heat Exchanger Stands

Component Description:
heat exchanger stand
Amount:
$3,600.00
Ice Break Structure

Component Description:
Spivey's Welding Service, Inc. is submitting this Invoice for the Engineering Consultant Ice Break Structure study for KNCT-TV Heat exchanges
Amount:
$1,000.00

Component Description:
Ice break and building work
Amount:
$3,000.00

Component Description:
Spivey's Welding Service, Inc. is submitting this Partial Invoice for the Ice Break and Building work for KNCT-TV ch 17 Repack to Moody Tower Site.
Amount:
$17,970.00

Component Description:
Work included: Removal of ventilator and temporary Cover of opening
Amount:
$39,350.00
Transmitter Bldg Roof

Component Description:
Balance due per proposal
Amount:
$5,692.88

Component Description:
Material draw per proposal
Amount:
$5,692.88

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $268,087.00 $266,027.00 N/A $235,392.15 N/A
Total for all systems $8,598,814.81 $4,270,545.62 N/A $3,470,177.15 N/A
Interim Antenna TFU-16WB-1-R C160 $0.00 $0.00 $0.00
UHF - High Power, Side Mount, basic slot antenna, 16 bay,, 270 kW input, directional,, horizontally polarized $0.00 $0.00 Interim antenna no longer required for transition - category cannot be removed due to LMS bug. $0.00 N/A
Primary Antenna TFU-28DSC-R C170 $268,087.00 $266,027.00 $235,392.15
Sweep test of existing antenna $6,730.00 $6,400.00 Please see DTVPros Quote JEHQ1537 $6,400.00 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $21,750.00 Per DTVPros Quote JEHQ1537 $21,750.00 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $11,970.00 Please see DTVPros Quote JEHQ1537 $11,970.00 N/A
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, directional,, elliptically or circularly polarized $225,907.00 $225,907.00 Budget justification: KNCT-210-Primary Antenna - UHF High Power Side Mount, E-POL Verified Budget Increase Justification v0; increase request uploaded with Inv#271-3 Rev 4.2.20 $195,272.15 N/A

Components

Actual Information Description File Name
UHF - High Power, Side Mount, basic slot antenna, 16 bay,, 270 kW input, directional,, horizontally polarized Information not provided.
Sweep test of existing antenna

Component Description:
KNCT-210-Primary Antenna - Sweep Test
Amount:
$1,280.00

Component Description:
KNCT-210-KNCT-210-Primary Antenna - Sweep Test
Amount:
$1,600.00

Component Description:
KNCT-210-KNCT-210-Primary Antenna - Sweep Test
Amount:
$1,600.00

Component Description:
KNCT Primary Antenna Sweep Test
Amount:
$1,920.00
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
KNCT-210-Primary Antenna - Custom Side Mount Brackets
Amount:
$4,350.00

Component Description:
KNCT-210-Primary Antenna - Custom Side Mount Brackets
Amount:
$5,437.50

Component Description:
KNCT Primary Antenna- Custom Side Mount Brackets
Amount:
$6,525.00

Component Description:
KNCT-210-Primary Antenna - Custom Side Mount Brackets
Amount:
$5,437.50
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
KNCT-210-Primary Antenna - Elbow Complex, 6 1/8"
Amount:
$2,394.00

Component Description:
KNCT Primary Antenna Elbow Complex
Amount:
$3,591.00

Component Description:
KNCT-210-Primary Antenna - Elbow Complex, 6 1/8"
Amount:
$2,992.50

Component Description:
KNCT-210-Primary Antenna - Elbow Complex, 6 1/8"
Amount:
$2,992.50
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, directional,, elliptically or circularly polarized

Component Description:
UHF - HIGH POWER SIDE MOUNT (200-1000 KW) TV ANT TFU 28 DSC-R C170 CH 17
Amount:
$45,563.25

Component Description:
UHF High Power Side Mount (200-1000KW) TV Ant
Amount:
$54,675.90

Component Description:
KNCT-210-Primary Antenna - UHF High Power Side Mount, H-POL
Amount:
$49,469.75

Component Description:
UHF - HIGH POWER SIDE MOUNT (200-1000 KW)
Amount:
$45,563.25

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $421,532.00 $270,439.84 N/A $270,439.72 N/A
Total for all systems $8,598,814.81 $4,270,545.62 N/A $3,470,177.15 N/A
Interim Transmission Line $110,250.00 $0.00 $0.00
Flexible Air Transmission Line - dielectric, 5" $110,250.00 $0.00 Interim transmission line no longer required for transition. Category cannot be removed due to LMS bug. $0.00 N/A
Primary Transmission Line $311,282.00 $270,439.84 $270,439.72
Rigid Transmission Line - copper, 6 1/8" $311,282.00 $270,439.84 see Estimated Cost Justification KNCT-310-Primary Transmission Line - Rigid Copper, 6 1_8 v0 $270,439.72 N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 5" Information not provided.
Rigid Transmission Line - copper, 6 1/8"

Component Description:
UHF - High Power side mount
Amount:
$83,952.02

Component Description:
KNCT Primary Transmission Line
Amount:
$69,792.66

Component Description:
Hanger Kit for EW 63 - package of 10
Amount:
$374.00

Component Description:
KNCT-310-Primary Transmission Line - Rigid Copper, 6 1/8"
Amount:
$58,160.52

Component Description:
KNCT-310-Primary Transmission Line - Rigid Copper, 6 1/8"
Amount:
$58,160.52

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $5,475,745.00 $1,709,081.78 N/A $1,281,321.78 N/A
Total for all systems $8,598,814.81 $4,270,545.62 N/A $3,470,177.15 N/A
Primary Tower TOWER $1,312,905.00 $1,265,356.78 $1,037,596.78
Tall Tower (greater than 500') $210,500.00 $304,515.81 Estimated Cost Justification KNCT-480-New Tower - Tall Tower v0 $304,515.81 Cost Estimate increased per actual invoices
Foundation mapping and Geotechnical Services $24,105.00 $24,105.00 N/A $24,105.00 N/A
Serious tower reinforcement/modifications $1,052,000.00 $910,735.97 Estimated Cost Justification KNCT-480-Serious Tower Reinforcement/Modification v0 $708,975.97 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $26,000.00 N/A $0.00 N/A
Primary Tower TOWER $3,110,840.00 $241,965.00 $41,965.00
Tall Tower (greater than 500') $210,500.00 $200,000.00 removal of Gray equipment from pre-repack tower location $0.00 N/A
Structural Study $17,860.00 $17,860.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***Tower Consultants, Inc. Proposal #TCI-18-191 $17,860.00 N/A
New tower between 1000' and 1500' without elevator, presumptive soil conditions $2,882,480.00 $24,105.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***Quote Attached $24,105.00 N/A
Primary Tower TOWER $0.00 $0.00 $0.00
Primary Tower $1,052,000.00 $201,760.00 $201,760.00
Serious tower reinforcement/modifications $1,052,000.00 $201,760.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***TCI proposals TCI-19-053, TCI-19-060 and Marsand invoice 6734 $201,760.00 N/A

Components

Actual Information Description File Name
Tall Tower (greater than 500')

Component Description:
Tower Drop Plates
Amount:
$5,400.00

Component Description:
Total Cost of P.O.#002121
Amount:
$210.00

Component Description:
Existing Tower, Tall Tower, greater than 500'
Amount:
$75,720.00

Component Description:
KNCT-480-New Tower - Tall Tower
Amount:
$51,010.81

Component Description:
Total Cost of P.O.# 002121
Amount:
$750.00

Component Description:
Rigging, Existing Tower, Tall Tower
Amount:
$126,200.00

Component Description:
KNCT-480-New Tower - Tall Tower
Amount:
$45,225.00
Foundation mapping and Geotechnical Services

Component Description:
Existing Tower, Foundation mapping and Geotechnical Services
Amount:
$24,105.00
Serious tower reinforcement/modifications

Component Description:
Tower Mods
Amount:
$53,815.00

Component Description:
Completion: Section 1 and 2 - Tower Modifications
Amount:
$117,762.57

Component Description:
Existing Tower, Serious Tower Reinforcement/Modifications
Amount:
$174,786.00

Component Description:
Weather days invoice
Amount:
$34,425.00

Component Description:
Change order #1- Builders Risk Policy required by Gray Media
Amount:
$4,375.00

Component Description:
Existing Tower, Serious Tower Reinforcement/Modifications
Amount:
$291,310.00

Component Description:
Tower work per TCI quote 1764
Amount:
$32,502.40
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study Information not provided.
Tall Tower (greater than 500') Information not provided.
Structural Study

Component Description:
Structural Analysis for KNCT Tower
Amount:
$8,000.00

Component Description:
Side Mount Antenna analysis
Amount:
$4,930.00

Component Description:
Services rendered by Tower Consultants, Inc.
Amount:
$4,930.00
New tower between 1000' and 1500' without elevator, presumptive soil conditions

Component Description:
50% Down Payment - Services rendered by Tower Consultants, Inc. in connection with Foundation Mapping and Geotechnical Investigation Services
Amount:
$24,105.00
Serious tower reinforcement/modifications

Component Description:
Serious Tower Mods
Amount:
$75,660.00

Component Description:
This category has been superseded, please delete this invoice
Amount:
N/A

Component Description:
This category has been superseded, please delete this invoice
Amount:
N/A

Component Description:
This invoice has been moved, the category has been superseded.
Amount:
N/A

Component Description:
Serious Tower Mods
Amount:
$126,100.00

Component Description:
This category has been superseded, please delete this invoice
Amount:
N/A

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $199,182.67 $268,517.67 N/A $171,611.67 N/A
Total for all systems $8,598,814.81 $4,270,545.62 N/A $3,470,177.15 N/A
Outside Professional Services $199,182.67 $268,517.67 $171,611.67
Attorney Fees - Other Matters $1,802.67 $1,802.67 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $1,802.67 see submitted invoices
RF Exposure Measurements $21,050.00 $20,000.00 N/A $0.00 N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A $0.00 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A $296.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $62.25 N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A $600.00 N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A $0.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $850.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $1,575.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $14,640.00 Estimated Cost Justification KNCT-530-RF Eng - Engineering Study for New Channel Assignment V0 $14,640.00 See KNCT Chesapeake 4864
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A $0.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $1,299.00 N/A
Project management of the transition $141,410.00 $206,325.00 Project management will be extensive due to complexity of new tower project, tenants and coordinating with nearby tower tenants. See Quote 1765 and Widelity Strategic Support Quote. $150,486.75 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $0.00 N/A

Components

Actual Information Description File Name
Attorney Fees - Other Matters

Component Description:
KNCT-550-Attorney - Other Matters - $222.00
Amount:
$222.00

Component Description:
Total Professional Services
Amount:
$814.00

Component Description:
For Professional Services Rendered
Amount:
$433.67

Component Description:
Legal services
Amount:
$333.00
RF Exposure Measurements Information not provided.
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Total Professional Services
Amount:
$296.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
KNCT-550-Attorney - License to Cover Application (Main)
Amount:
$62.25
Prepare request for Special Temporary Authorization

Component Description:
Prepare Request for Special Temporary Authorization Prepare Engineering Statement to support interim facilities
Amount:
$600.00

Component Description:
Prepare Request for Special Temporary Authorization Prepare Engineering Statement to support interim facilities
Amount:
$600.00
ASR modification (prepare FCC Form 854)

Component Description:
FCC Antenna Structure Registration modification Prepare FCC Form 854
Amount:
$1,200.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Prepare engineering section of FCC form 2100 Construction Permit (CP) Application
Amount:
$1,125.00

Component Description:
Prepare engineering section of FCC form 2100 Construction Permit (CP) Application
Amount:
$1,125.00

Component Description:
Consulting Engineer
Amount:
$600.00

Component Description:
KNCT-530-RF Eng - License to Cover Application (Main)
Amount:
$250.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepare Engineering section
Amount:
$1,125.00

Component Description:
Provide derivations of required Transmitter Power Output regarding "90 day" replication CP facility
Amount:
$450.00

Component Description:
Prepare engineering section of FCC For,m 2100 License to Cover Application
Amount:
$1,200.00
Perform engineering study for new channel assignment and antenna development

Component Description:
KNCT-530-RF Eng - Engineering Study for New Channel Assignment
Amount:
$1,750.00

Component Description:
Prepare engineer section of FCC Form 2100 License to cover application.
Amount:
$1,200.00

Component Description:
Consulting engineer: recent commencement on repack Ch-17
Amount:
$300.00

Component Description:
"Regarding prospective relocation of KNCT's repack Ch-17 to Moody tower, review tower structural analysis report"
Amount:
$8,565.00

Component Description:
Perform engineering study for new channel assignment and antenna development from Ch 46 to Ch17
Amount:
$2,250.00

Component Description:
Various discussions with FCC and KNCT staff regarding land mobile Interference
Amount:
$1,400.00

Component Description:
Re: establishment of a microwave link from Killeen office to KNCT tower, develop path profile, provide plot and remarks.
Amount:
$300.00

Component Description:
Perform Engineering study for new channel and antenna development from Ch 46 to Ch 17
Amount:
$2,250.00

Component Description:
Consulting Engineer
Amount:
$75.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
Prepare and review reimbursement for Schedule 399. Generate scope of work needed to result in approved plans
Amount:
$1,250.00

Component Description:
Prepare and/or review reimbursement for Schedule 399. Generate scope of work needed to result in approved plans.
Amount:
$1,299.00
Project management of the transition

Component Description:
Project Management
Amount:
$6,975.15

Component Description:
Project Management
Amount:
$348.75

Component Description:
Project Management
Amount:
$155.00

Component Description:
Project Management
Amount:
$505.00

Component Description:
Project Management provide coordination plan address transition timing and coordination issues with other stations and wireless
Amount:
$1,250.00

Component Description:
Project Management
Amount:
$350.00

Component Description:
Project Management
Amount:
$8,920.75

Component Description:
Project Management
Amount:
$5,840.65

Component Description:
Project Management
Amount:
$3,298.15

Component Description:
Project Management
Amount:
$310.00

Component Description:
Project Management
Amount:
$14,054.65

Component Description:
Project Management
Amount:
$7,165.00

Component Description:
Site survey document existing layout identify needs for changes in hvac electrical and building modifications in preparation for rep
Amount:
$3,250.00

Component Description:
Project management
Amount:
$731.35

Component Description:
Project Management
Amount:
$229.20

Component Description:
Pedrform engineer study for new channel assignment and antenna development from Ch 46 to Ch 17
Amount:
$2,250.00

Component Description:
Project Management
Amount:
$4,283.35

Component Description:
Project Management
Amount:
$5,344.55

Component Description:
Project Management
Amount:
$3,135.35

Component Description:
Project Management
Amount:
$699.95

Component Description:
Project Management
Amount:
$1,200.00

Component Description:
Project Management
Amount:
$663.15

Component Description:
Project management
Amount:
$4,676.80

Component Description:
Perform engineering study for new channel assignment and antenna development from Ch 46 to Ch 17
Amount:
$2,250.00

Component Description:
Project Management
Amount:
$77.50

Component Description:
Project Management
Amount:
$9,002.20

Component Description:
Project Management
Amount:
$4,662.25

Component Description:
Project Management
Amount:
$12,127.55

Component Description:
Project Management
Amount:
$6,835.70

Component Description:
Project Management
Amount:
$77.50

Component Description:
Project Management
Amount:
$6,497.45

Component Description:
Project Management
Amount:
$4,012.95

Component Description:
Project Management
Amount:
$5,418.55

Component Description:
Site survey document existing layout identify needs for changes in HVAC,electrical and building modifications in preparation for repack transmitter
Amount:
$3,250.00

Component Description:
Project Management Per Invoice
Amount:
$10,275.00

Component Description:
Project Management
Amount:
$9,445.75

Component Description:
Prepare engineering section of FCC Form 2100 Construction Permit Application
Amount:
$1,125.00

Component Description:
Project Management
Amount:
$738.80

Component Description:
Project Management
Amount:
$1,201.25

Component Description:
Project Management
Amount:
$5,348.65

Component Description:
Project Management
Amount:
$813.75

Component Description:
Project Management
Amount:
$310.00

Component Description:
Project Management
Amount:
$11,444.65

Component Description:
Project Management
Amount:
$3,585.45
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $213,431.16 $192,376.16 N/A $107,299.31 N/A
Total for all systems $8,598,814.81 $4,270,545.62 N/A $3,470,177.15 N/A
Other Expenses $213,431.16 $192,376.16 $107,299.31
Equipment Delivery and Handling Charges $38,684.00 $38,684.00 See attached Quote 1767 $1,715.00 N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $740.00 see Estimated Cost Justification KNCT-610-FCC Filing - STA v1 $740.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 Please see attached justification for the FCC License to Cover Application Fees $335.00 N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $3,300.00 N/A
AM Pattern Disturbance -- Remedy $21,050.00 $0.00 N/A N/A N/A
Microwave Equipment $91,876.45 $91,876.45 Microwave expenses to replicate the pre-repack coverage caused by the station’s forced move. Please see KNCT Heartland Video System Quote WISQ53716-03. $88,034.18 N/A
Preliminary Site Survey $11,000.00 $11,000.00 Please see attached Marsand Site Survey Justification Document $5,499.00 N/A
MVPD Notification of Channel Change $5,000.00 $5,000.00 N/A $2,000.00 N/A
Develop and air announcement of upcoming channel change $5,000.00 $5,000.00 N/A N/A N/A
Equipment Storage $3,740.71 $3,740.71 Per Estimated Cost Justification KNCT-610-Equipment Storage v6 $3,740.71 Invoices
Disposal Costs (for equipment and other waste, net of any salvage value) $25,000.00 $25,000.00 Disposal of pre-auction transmitter equipment $1,935.42 N/A

Components

Actual Information Description File Name
Equipment Delivery and Handling Charges

Component Description:
10,000 lb. Telehandler Forklift Regular Hours - RK
Amount:
$1,715.00
FCC Filing Fees - Special Temporary Authorization request

Component Description:
KNCT-610-FCC Filing - STA
Amount:
$340.00

Component Description:
Joan Stewart - Filing Fees
Amount:
$200.00

Component Description:
KNCT-610-FCC Filing - STA
Amount:
$200.00
FCC Filing Fees - Form 2100 license to cover application

Component Description:
Total Professional Services
Amount:
$335.00
DTV Medical Facility Notification

Component Description:
Medical Notification
Amount:
$3,300.00
AM Pattern Disturbance -- Remedy Information not provided.
Microwave Equipment

Component Description:
phoeniX G2 IDU
Amount:
$88,034.18
Preliminary Site Survey

Component Description:
Site Survey
Amount:
$5,499.00
MVPD Notification of Channel Change

Component Description:
Prepare KNCT MVPD Notifications for repack
Amount:
$2,000.00
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage

Component Description:
40' HC Container monthly rent
Amount:
$357.23

Component Description:
40' HC Container monthly rental
Amount:
$535.84

Component Description:
40' HC Container monthly rental
Amount:
$358.05

Component Description:
40' HC Container monthly rental
Amount:
$870.00

Component Description:
40' HC N Container
Amount:
$503.36

Component Description:
40' HC Container monthly rental
Amount:
$330.00

Component Description:
Taxes Due on Inv. #1716
Amount:
$71.77

Component Description:
Taxes due on invoice #1722
Amount:
$27.23

Component Description:
40' HC Container monthly rental
Amount:
$357.23

Component Description:
40' HC Container monthly rental
Amount:
$330.00
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Container @ Tower Rd Moody TX
Amount:
$1,029.28

Component Description:
Pickup roll off & empty - 8/12
Amount:
$324.10

Component Description:
ROLL OFF DELIVERY CHARGE - 5/23
Amount:
$582.04

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $8,598,814.81 $4,270,545.62 $3,470,177.15

Reimbursement Status

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

Certification

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Section Question Response
Submission of Estimated Expenses Statements

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

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

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

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

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

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

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

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

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

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

Robert Folliard , III .

Assistant Secretary


03/08/2022

Certification

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Section Question Response
Submission of Actual Cost Documentation Statements

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

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

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

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

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

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

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

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

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

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

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

Robert Folliard , III .

Assistant Secretary


03/08/2022

Certification

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Section Question Response
Submission of Final Allocation or Accounting Information Statements

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

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

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

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

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

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

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

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

Robert Folliard , III .

Assistant Secretary


03/08/2022

Attachments

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