TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
B&C COMMUNICATIONS, LLC Doing Business As: B&C COMMUNICATIONS, LLC	William Smith, Manager 155 MIDDLE PLANTATION LANE GULF BREEZE, FL 32561 United States	+1 (716) 310-3711	BILLSMEDIA@GMAIL.COM	Limited Liability Company

Applicant

Address

Phone

Applicant Type

B&C COMMUNICATIONS, LLC

Doing Business As: B&C COMMUNICATIONS, LLC

William Smith, Manager

155 MIDDLE PLANTATION LANE

GULF BREEZE, FL 32561

United States

+1 (716) 310-3711

BILLSMEDIA@GMAIL.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
Tony L. zumMallen President QCommunications, LLC	Tony zumMallen 705B SE Melody LN Lees Summit, MO 64063 United States	+1 (816) 729-1177	tony@qcomm.tv

Applicant

Address

Phone

Tony L. zumMallen

President

QCommunications, LLC

Tony zumMallen

705B SE Melody LN

Lees Summit, MO 64063

United States

+1 (816) 729-1177

tony@qcomm.tv

Broadcaster Information and Transition Plan

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

Transmitters

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

Primary Transmitter

Existing Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Purchase New
	Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is this transmitter currently shared with another station?	No
	Is this transmitter currently in operating condition?	Yes
Existing Transmitter Manufacturer and Type	Manufacturer
	Model	NV8604e
	Year	2008
	Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power Capacity	3.6 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	ULXTE-20
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	12.9 kW
	Justification for New Transmitter	3-9-2020-CH21- ERP of 620kW see attached- 3-9-power budget showing -TPO -11.82kW. The ULXTE-20- 12.9kW is the min available transmitter. OLD power budget for Ch. 31-was 84 kw ERP which required 7 kw.

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	Yes
	Switchgear (industrial 800 amp)	Yes
	Transformer (480V)	Yes
	Power	150 kVA
	Rigid Conduit and Wiring	Yes
	Size	2 inches
	Length	200.0 feet
	Other Electrical Service	No
	Description	N/A
HVAC Service	Does the replacement transmitter require HVAC Service?	Yes
	Type	Heating and Cooling
	Size	10 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

Other Transmitter Cost Not Listed

Name	Description
Transmitter Site Preparation	Site prep for installation of the main transmitter and RF components not part of Gates SOW.
Site Survey	Site Survey - required to perform the engineering and design of new equipment at new ch21 site
Electrical	Install 200 amp panel, conduit, surge protector, etc.

Antennas

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

Primary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Purchase New
	Antenna Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing antenna shared with another station or stations?	No
	Is the existing antenna directional?	Yes
	Is antenna in operating condition?	Yes
	Is antenna located on or in close proximity to an antenna farm?	No
Existing Antenna Manufacturer and Type	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Other
	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	Broadband Slot
	ERP:	33.5 kW
	Manufacturer
	Model	CS-2030-5771-14
	Year	2008

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?	Yes
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Types	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Broadband Slot
	Number of Stations Supported	1
	Number of Panels/Bays	24
	Lower Limit	512.00 MHz
	Upper Limit	518.00 MHz
	Design power capacity in use	90.0 %
	Other Antenna Type	N/A
	ERP:	620.0 kW
	Manufacturer
	Model	ALP24M3-HSBx-21
	Year	2020
	Justification for New Antenna	ch 21 requires new antenna model form ch 31 see the attached 3-9-WPAN_ERI-ALP24m3 -power budget file

Primary Antenna

Other Antenna Costs

Section	Question	Response
Combiner for Shared Antenna	Do you need a Combiner for a Shared Antenna?
	Type
	Number of channels supported	N/A
	Frequencies of channels supported	N/A
	Frequency	N/A
	Do you need a combiner output splitter/switcher for dual feed lines?	N/A
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	Yes
	Broadband or Single Channel?	Broadband
	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

Other Antenna Cost Not Listed

Name	Description
Sales Tax	Sales tax for Antenna and transmission line
Freight	Freight for antenna and transmission line
Move Antenna	Orient antenna to fit compass heading as required.

Transmission Line

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

Primary Transmission Line

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	Flexible Foam
	Diameter	1 5/8 inches
	Other Diameter	N/A
	Segment Length	N/A
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	790 feet per run

Primary Transmission Line

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	1270 feet per run
	Justification for New Transmission Line	ch21 requires new line at new site. see the attached power budget for line details. 3-9-WPAN_ERI-ALP24M3-HSBx-21_TPO20200226 and quote WPAN ERI 20200218-051RevA ALP24 wMACX675 Line Installed

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Name	Description
Vertical spring hanger	Vertical spring hangers that support transmission line.

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

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?	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	1054512
Coordinates (NAD83)	Latitude (NAD83)	30° 42' 21.0" N-
	Longitude (NAD83)	087° 24' 12.0" W-
	Overall Structure Height	1414.02 feet
	Support Structure Height	1328.72 feet
	Ground Elevation Above Mean Sea Level (AMSL)	134.51 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	B&C Communications, LLC
	Date Constructed	01/01/1997

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:	Serious Reinforcements needed

Primary Tower

Tower Rigging Costs

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

Primary Tower

Other Tower Expenses Not Listed

Name	Description
Additional Reinforcement Materials	Additional reinforcement materials and labor to install
Engineering Services - Land survey	3 separate visits to site to determine existing conditions, land survey, underground utilities, stake new tower centerline, new tower "as built" of base
Angle Brackets	Angle support brackets to reattach line to tower.
RF Installation	RF Installation
Tower Lighting	Tower Lighting due to height change. See letter attached to INV WPAN-37457F
Tag Path Clearing	Tag Path clearing - 500 to 600 feet to 50 feet tag path
Reinforcing Analysis and Design	Includes analysis and design of required tower reinforcements/modifications based on the previous ERI study

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	900
	Explanation	Scope and significance of project require outside management services to augment existing internal personnel to assist turnkey management of and ensure timely and safe execution of channel relocation.
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	4
	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	4
	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	Yes
	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	Yes
	Number of Days	10
	Justification	the new ch21 site requires additional field engineering prior to and during the repack system installation due to the unknown nature of the new sites existing building and other tenants facilities to ensure proper engineering and designs are imposed

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Name	Description
Consulting and Permit costs	Consulting Services for tower permitting for Repack.
General Consulting Engineering Services	Includes CP amendment, signal strength coverage map, change in tower height issues, general CP application
General Legal	General Legal services related to Repack activities
Geotechnical Survey and Report	Geotech survey, report, and associated borings.
Vendor travel expenses	Reimbursable Vendor Travel expenses for working in the field on behalf of the station for the Repack project
On-Site PM	On site project management services to coordinate Repack activities with all vendors

Other Expenses

Section	Question	Response
AM Pattern Disturbance	Is an Impact Study needed?	No
AM Pattern Disturbance	Is Remediation needed?	No
Facility Expenses	Name	N/A
	Other Distributed Transmission System Expenses Not listed	N/A
	Name	N/A
	Is Notification of a Medical Facility required as a result of DTV broadcasting?	Yes
Permit and Filing Costs	Local Zoning	No
	Non-zoning permits	No
	BLM or NFS Coordination	No
	FCC Construction Permit Minor Change	Yes
	FCC License to Cover Application	Yes
	FCC Special Temporary Authority Application	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?	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
Clear brush	Clear trees and brush to accommodate guy wire installation
Disconnect and decommission existing transmission and RF components	Disconnect transmitter and RF components from existing configuration to make way for new facilities.
Impedance Transformer	Additional parts - impedance transformer.
Portapotty	Portapotty for installation activities
Site Security	Site security to provide protection overnight for indoor and outdoor equipment during installation activities at an unmanned site.
Newspaper Legal Ads	Legal advertising for notice of channel change

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	$671,666.00	$619,522.60	N/A	$530,472.60	N/A
Total for all systems	$3,055,037.50	$3,613,093.77	N/A	$3,269,587.82	N/A
Primary Transmitter ULXTE-20	$671,666.00	$619,522.60		$530,472.60
Electrical	$13,616.00	$13,616.00	Per Gulf Coast Electrical Contractors: install 200 am commercial panel with all breakers required to feed new tx, pump module and heat exchanger. Install conduit, surge protector. Remove unused conduit/wiring. Replace disconnecting eq on HVAC	$13,616.00	N/A
Site Survey	$14,000.00	$14,000.00	Site survey and report are required to be performed before the new transmitter and components installation plan can be finalized.	$14,000.00	N/A
Transmitter Site Preparation	$5,700.00	$5,700.00	Site prep for installation of the main transmitter and RF components not part of Gates SOW.	N/A	N/A
2" Rigid Conduit and Wiring (Cost per foot)	$5,200.00	$5,200.00	N/A	N/A	N/A
Transformer 3 phase/480v - 150 KVA	$25,550.00	$25,550.00	N/A	N/A	N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW	$494,500.00	$475,131.60	N/A	$475,131.60	Same as estimated
10 Ton system	$60,500.00	$27,725.00	Purchase and installation of (2) 5-ton American St 20 SEER variable speed heat pum, air handlers, with associated duct runs, controllers, switches, permits per attached Climatech quote	$27,725.00	N/A
Service entrance 3 phase/800 amp/208 volt	$14,400.00	$14,400.00	N/A	N/A	N/A
Switchgear - industrial 800 amp	$38,200.00	$38,200.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Electrical	Component Description: Electrical work - Gulf Coast Electrical - INV 2020-154 Amount: $13,616.00
Site Survey	Component Description: Site Survey - QComm - QC21-807 Amount: $14,000.00
Transmitter Site Preparation	Information not provided.
2" Rigid Conduit and Wiring (Cost per foot)	Information not provided.
Transformer 3 phase/480v - 150 KVA	Information not provided.
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW	Component Description: Gates Air - 1st transmitter invoice # JW30004736-1 - Q-86562 Amount: $144,998.42 Component Description: Third and final invoice for transmitter. Includes sales tax & Freight. Gates INV US0339470 Amount: $176,398.57 Component Description: 2nd invoice for transmitter. GatesAir JW30004736-2 Amount: $144,998.42 Component Description: Freight for RF components - Gates INV US0339845 Amount: $340.69 Component Description: Final Tx invoice - Gates - US0339620 Amount: $8,395.50
10 Ton system	Component Description: HVAC system for WPAN - INV 3305 Amount: $27,725.00
Service entrance 3 phase/800 amp/208 volt	Information not provided.
Switchgear - industrial 800 amp	Information not provided.

Cost Information

Antennas

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$148,022.57	$147,692.57	N/A	$110,692.57	N/A
Total for all systems	$3,055,037.50	$3,613,093.77	N/A	$3,269,587.82	N/A
Primary Antenna ALP24M3-HSBx-21	$148,022.57	$147,692.57		$110,692.57
Move Antenna	$0.00	$0.00	6/2/21 Zeroed out. Submitted under another cost component. Mobilize, loosen antenna brackets & orient antenna to fit compass heading as required. Surveyor will ID exact direction antenna needs to be oriented.	$0.00	N/A
Freight	$5,593.46	$5,593.46	Freight for antenna and tx line per ERI invoice WPAN-56638	$5,593.46	N/A
Sales Tax	$27,870.50	$27,870.50	Sales tax for antenna and tx line - ERI Proposal 20200218-051 Rev C - Charged on INV WPAN-56638	$27,870.50	N/A
UHF - High Power, Side Mount, basic slot antenna, 24 bay,, 620 kW input, directional,, horizontally polarized	$70,978.61	$70,978.61	per attached proposal - 3-9- WPAN ERI 20200218-051RevA ALP24 wMACX675 Line Installed	$70,978.61	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$6,250.00	N/A
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)	$13,700.00	$13,700.00	N/A	N/A	N/A
Side mount brackets for high power antennas (if not included in antenna base cost)	$23,150.00	$23,150.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Move Antenna	Information not provided.
Freight	Component Description: Freight for antenna and tx line - ERI INV WPAN-56638 Amount: $5,593.46
Sales Tax	Component Description: Sales tax for antenna and transmission line - ERI - WPAN-56638 Amount: $27,870.50
UHF - High Power, Side Mount, basic slot antenna, 24 bay,, 620 kW input, directional,, horizontally polarized	Component Description: Antenna portion of invoice - WPAN - ERI - INV WPAN-64000A Amount: $35,489.30 Component Description: WPAN-ERI ANTENNA LINE 001 Amount: $35,489.31
Sweep test of existing antenna	Component Description: Remaining amount for sweep - ERI INV WPAN-56638 Amount: $625.00 Component Description: WPAN - ERI - Sweep - INV WPAN-64000A Amount: $2,500.00 Component Description: WPAN - SWEEP TEST LINE 028 - INV WPAN-64000 Amount: $3,125.00
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)	Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost)	Information not provided.

Cost Information

Transmission Line

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$257,919.61	$200,879.61	N/A	$174,684.41	N/A
Total for all systems	$3,055,037.50	$3,613,093.77	N/A	$3,269,587.82	N/A
Primary Transmission Line	$257,919.61	$200,879.61		$174,684.41
Rigid Transmission Line - copper, 6 1/8"	$256,540.00	$199,500.00	per attacehd proposal - 3-9-WPAN ERI 20200218-051RevA ALP24 wMACX675 Line Installed plus estimated freight	$173,304.80	N/A
Vertical spring hanger	$1,379.61	$1,379.61	Vertical spring hangers to support the transmission line. Per actual costs - ERI invoice 56550	$1,379.61	N/A

Components

Actual Information Description	File Name
Rigid Transmission Line - copper, 6 1/8"	Component Description: Transmission line not needed - ERI - WPAN-56638 Amount: ($1,861.50) Component Description: WPAN - ERI - Transmission line & dryer - INV WPAN-64000A Amount: $87,583.15 Component Description: WPAN - TX LINE AND DRYER - LINES 002-026 INV WPAN-64000 Amount: $87,583.15
Vertical spring hanger	Component Description: Vertical Spring hangers for tx line - ERI - INV 56550 Amount: $1,379.61

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	$1,492,380.42	$2,174,118.99	N/A	$2,106,714.24	N/A
Total for all systems	$3,055,037.50	$3,613,093.77	N/A	$3,269,587.82	N/A
Primary Tower TOWER	$1,492,380.42	$2,174,118.99		$2,106,714.24
RF Installation	$1,868.59	$1,868.59	PER ERI Order 37457P - INV 56731	$1,868.59	N/A
Additional Reinforcement Materials	$10,486.80	$10,486.80	Additional reinforcement materials from ERI Order # 37457O - includes labor to install and FL sales tax	$10,486.80	N/A
Structural engineering tower load study for well documented tower	$12,600.00	$29,975.00	Two TAs needed to determine refurbished versus replaced. The 2nd TA was able to determine the tower can be refurbished if shortened and all tenents removed and with substantial reinforcements of tower and foundation work. see ERI 20200213-002	$29,975.00	N/A
Angle Brackets	$13,531.70	$13,531.70	Per ERI change order 37457D.1 attached to invoice WPAN-56218. Includes sales tax on INV WPAN-56218-1	$13,531.70	N/A
Reinforcing Analysis and Design	$5,250.00	$5,250.00	Per actual costs charged on ERI invoice #54843	$5,250.00	N/A
Tag Path Clearing	$18,705.00	$18,705.00	Tag Path Clearing: 500 - 600 feet to 50 feet tag path. PER ERI Inv 56573	$18,705.00	N/A
Engineering Services - Land survey	$29,280.00	$29,280.00	Per proposal from Electronics Research, Inc #20200103-684 for $29280.00.	N/A	N/A
Tower Lighting	$138,158.33	$138,158.33	Tower lighting - includes sales tax. Per ERI invoice WPAN-37457F and WPAN-56505 (freight)	$138,158.33	The total are actual costs and are the same as the estimated costs: $138,158.33
Tall Tower (greater than 500')	$210,500.00	$291,175.00	per ERI Proposal 20200218-05, line item 029 - TV Services. see attached	$253,050.25	N/A
Serious tower reinforcement/modifications	$1,052,000.00	$1,635,688.57	per ERI Proposal 20200213-002, line item 002 - TV Services. see attached WPAN-399-Tower mod summary-Final 3-9-2020 includes foundation repair Includes sales tax on INV WPAN-37457E	$1,635,688.57	N/A

Components

Actual Information Description	File Name
RF Installation	Component Description: RF Installation - ERI - INV 56731 Amount: $1,868.59
Additional Reinforcement Materials	Component Description: Additional reinforcement mat & labor - ERI - INV 56730 Amount: $10,486.80
Structural engineering tower load study for well documented tower	Component Description: 2nd invoice engineering tower climbing inspection - ERI WPAN-54187 Amount: $11,737.50 Component Description: 1st invoice engineering climbing inspection of tower - ERI INV WPAN-3000 Amount: $11,737.50 Component Description: Tower: Reinforcing analysis and design. ERI INV WPAN-37457C Amount: $3,250.00 Component Description: 2nd invoice Tower reinforcing analysis & design. ERI invoice WPAN-37457C-1 Amount: $3,250.00
Angle Brackets	Component Description: sales tax for angle brackets - ERI - INV WPAN-56218-1 Amount: $836.70 Component Description: Angle support brackets - ERI - INV WPAN-56218 Amount: $12,695.00
Reinforcing Analysis and Design	Component Description: ERI - reinforcing analysis and design - INV 54843 Amount: $5,250.00
Tag Path Clearing	Component Description: Tag path clearing - ERI INV 56573 Amount: $18,705.00
Engineering Services - Land survey	Information not provided.
Tower Lighting	Component Description: freight for tower lights - ERI - INV WPAN-56505 Amount: $1,462.23 Component Description: Tower light change due to height. WPAN - ERI - INV WPAN-37457F Amount: $136,696.10
Tall Tower (greater than 500')	Component Description: Weather days during antenna install - ERI - INV 56704 Amount: $7,800.00 Component Description: WPAN - ERI INSTALLATION OF LINE AND ANTENNA - LINE 029 - INV WPAN-64000 - ROUNDED DOWN 1 PENNY Amount: $145,587.49 Component Description: Installation of line & antenna - WPAN - ERI - INV WPAN-64000A Amount: $116,470.00 Component Description: Weather days - ERI - INV 56889 Amount: $11,050.00 Component Description: Weather day during antenna install - ERI - INV 56608 Amount: $2,600.00 Component Description: Antenna removal done by others - per CO 37457D - ERI - INV WPAN-56638 Amount: ($55,407.50) Component Description: Antenna move - ERI - INV 57172 Amount: $24,950.26
Serious tower reinforcement/modifications	Component Description: Weather Days - tower work - ERI INV 56335 Amount: $13,000.00 Component Description: Tower installation services - WPAN - INV 56457 Amount: $28,350.00 Component Description: Concrete testing at tower - ERI - INV 56872 Amount: $239.15 Component Description: tower work plus sales tax - ERI - INV WPAN-37457E Amount: $130,998.50 Component Description: WPAN Tower Work: ERI reinforcement, foundation, tv install - INV WPAN-54000A Amount: $681,534.60 Component Description: Freight for tower material - ERI - WPAN-56896 Amount: $5,436.82 Component Description: WPAN- ERI - TOWER REFURBISHMENT LINE 001,002,003 MATERIAL, FOUNDATION INV WPAN-54000 Amount: $776,129.50

Cost Information

Outside Professional Services

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$387,188.52	$377,119.62	N/A	$282,353.62	N/A
Total for all systems	$3,055,037.50	$3,613,093.77	N/A	$3,269,587.82	N/A
Outside Professional Services	$387,188.52	$377,119.62		$282,353.62
On-Site PM	$25,000.00	$25,000.00	Per actual costs	$25,000.00	N/A
Vendor travel expenses	$14,000.00	$14,000.00	estimated vendor travel for the project	N/A	N/A
Geotechnical Survey and Report	$9,500.00	$9,500.00	Per ERI Proposals 2019717-126 and 20190913-739 attached to invoice 54838	$9,500.00	N/A
General Legal	$6,835.00	$6,835.00	General Legal services related to Repack	$6,835.00	Per actual invoice costs
General Consulting Engineering Services	$13,890.00	$13,890.00	Consulting Engineering - several issues, including tower height changes, CP application amendment, signal strength coverage, FAA consulting, CP extension, Tolling waiver, CP review. Lohnes and Culver invoices	$13,890.00	Per actual costs
Consulting and Permit costs	$12,743.52	$12,743.52	Consulting and permitting costs for WPAN tower site	$12,743.52	N/A
Comprehensive coverage verification via field study, if needed	$84,200.00	$43,732.00	Per QComm Quote 707CV/3001 attached to INV QC21-760.	$21,866.00	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	$210.00	N/A
ASR modification (prepare FCC Form 854)	$2,105.00	$2,105.00	N/A	$690.00	N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization	$14,720.00	$14,720.00	N/A	N/A	N/A
Attorney Fees - Negotiation of lease and other matters for shared locations	$4,210.00	$4,000.00	N/A	$1,140.00	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,250.00	N/A	$0.00	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$5,000.00	N/A	$4,860.00	N/A
Prepare request for Special Temporary Authorization	$8,200.00	$8,200.00	N/A	N/A	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	$0.00	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$2,975.00	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	$6,000.00	N/A
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	$3,100.00	Estimated Cost Justification WPAN-590-Prepare and_or Review Reimbursement Form v4	$3,100.00	Only asking for reimbursement of the $2500, but duplicate entry because adding required cover letter (can't delete or amend prior submission).
Additional Field Engineering Service, 10 Days	$22,500.00	$22,500.00	estimated amount for 10 days of field engineering	N/A	N/A
Project management of the transition	$142,200.00	$173,544.10	per actual invoices from QCommunications and Widelity.	$173,544.10	Actual costs.

Components

Actual Information Description	File Name
On-Site PM	Component Description: On-site PM - H. Joe Clary - INV WPAN-1 Amount: $25,000.00
Vendor travel expenses	Information not provided.
Geotechnical Survey and Report	Component Description: ERI prop 20190717-129 and 20190913-739. Geotech survey and associated borings. INV 54838 Amount: $9,500.00
General Legal	Component Description: General legal 10/3 thru 12/5/20 - Timmons - INV 2822 Amount: $300.00 Component Description: WPAN - Timmons - GEn Legal Aug - Oct 2020 - INV 2792 Amount: $390.00 Component Description: Medical notifications - legal - Timmons INV 2823 Amount: $90.00 Component Description: Gen Legal 1/1/19 - 3/16/19 - Timmons - INV 02543 Amount: $30.00 Component Description: Current amount due only. Legal Services - Jeffrey Timmons - INV 02763 Amount: $780.00 Component Description: Legal services 10/2/20 thru 10/15/20 - Timmons - INV 2810 Amount: $1,145.00 Component Description: Current amount due only. Legal Services - Jeffrey Timmons - INV 2741 Amount: $3,270.00 Component Description: Legal - medical notifications - Timmons - INV 2793 Amount: $830.00
General Consulting Engineering Services	Component Description: Various consulting engineering - Lohnes & Culver - INV 202010-1590-01-31570 Amount: $2,910.00 Component Description: FAA consulting, FAA notification - Lohnes & Culver - INV 202009-1590-01-31570 Amount: $2,190.00 Component Description: Consulting Engineering - Lohnes & Culver - INV 202012-1590-01-1 Amount: $780.00 Component Description: CP application amendment and signal strength coverage map - Lohnes & Culver INV 201904-1590-01-31570 Amount: $2,390.00 Component Description: Structural issues of tower; prepare eng statement for 399 - Lohnes & Culver - INV 202003-1590-01-31570 Amount: $4,870.00 Component Description: Lohnes - eng consultant - prepare final power budget - INV 202010-1590-02-31570 Amount: $750.00
Consulting and Permit costs	Component Description: Permitting and consulting services for WPAN Tower site - AFF - INV 2020243 Amount: $12,743.52
Comprehensive coverage verification via field study, if needed	Component Description: CV: 1/2 down - after mobilization - QComm - QC21-760 Amount: $21,866.00
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	Component Description: Legal invoice for Ch. 31 FAA filing work (replaces prior invoices submitted). Amount: $210.00
ASR modification (prepare FCC Form 854)	Component Description: Prepare 854-MD - Lohnes & Culver - INV 202009-1590-01-31570 Amount: $690.00
Attorney Fees - Prepare and File request for Special Temporary Authorization	Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations	Component Description: WPAN-550-Attorney - Negotiate Lease and Other Matters Amount: $210.00 Component Description: Calls with client and conference call with Widelity re: repack reimbursement issues Amount: $270.00 Component Description: Legal Services Amount: $660.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: Legal invoice for Ch. 31 construction permit application work (replaces prior invoices submitted). Amount: $4,860.00
Prepare request for Special Temporary Authorization	Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: FCC Form 2100 Construction Permit Application Amount: $1,735.00 Component Description: CP Application Modification Amount: $1,240.00
Perform engineering study for new channel assignment and antenna development	Component Description: New Channel Assignment & Antenna Development Amount: $2,400.00 Component Description: Alternate Channel Analysis Amount: $3,600.00
Address transition timing and coordination issues w/ other stations and wireless	Information not provided.
Prepare and or review reimbursement form	Component Description: Legal invoice for cost estimates/reimbursements work. Request reimburse $2500 approved in allotment, vendor wrote off/credit for $1250 per retainer; adds cover letter to previously submission. Amount: $2,500.00 Component Description: Legal Services Amount: $90.00 Component Description: Legal Services Amount: $30.00 Component Description: Legal Services Amount: $180.00 Component Description: Upload invoice to Widelity site Amount: $60.00 Component Description: Legal Services Amount: $150.00 Component Description: Legal Services Amount: $120.00 Component Description: Legal invoice for cost estimates/reimbursements work. Request reimburse $2500 approved in allotment, vendor wrote off/credit for $1250 per retainer. Amount: $2,500.00
Additional Field Engineering Service, 10 Days	Information not provided.
Project management of the transition	Component Description: October 2020 Paperwork PM - QComm - INV QC20-504 Amount: $3,768.30 Component Description: Tech & field Proj mgmt Dec 2019 Amount: $4,345.00 Component Description: June 2019 PM Hours Amount: $318.75 Component Description: Feb 2019 PM Hours Amount: $183.75 Component Description: May 2019 PM Hours Amount: $1,775.40 Component Description: Technical and field PM Aug 2019 QC20-370 Amount: $7,094.20 Component Description: March 2021 PM Hours - QComm - QC21-813 Amount: $2,828.20 Component Description: April 2018 PM Hours Amount: $1,674.85 Component Description: Project Management - paperwork July 2020 - INV QC20-432 Amount: $742.60 Component Description: June 2021 399 PM - QComm - QC21-914 Amount: $1,856.50 Component Description: June 2018 PM Hours Amount: $1,413.80 Component Description: Jan 2022 Tech PM - QComm - INV 220033 Amount: $616.00 Component Description: PM - August 2021 - QComm - INV 230031 Amount: $600.60 Component Description: April 2019 PM Hours Amount: $921.25 Component Description: July 2019 PM Hours Amount: $670.00 Component Description: Widelity - Nov 2019 PM Amount: $173.75 Component Description: Dec 2021 Tech PM - QComm - INV 2022009 Amount: $770.00 Component Description: Feb 2021 PM Hours - QComm - QC21-769 Amount: $963.80 Component Description: Dec 2020 399 PM Hours - QC21-712 Amount: $481.90 Component Description: March 2019 PM Hours Amount: $255.00 Component Description: August 2019 PM Amount: $151.25 Component Description: Widelity April project management - INV B&C-WPAN-037. NOTE: INVOICE NUMBER IS B&C-WPAN-037. "And" was substituted for "&" in the invoice number. Amount: $2,233.35 Component Description: July 2021 399 PM - QComm - INV 230013 Amount: $292.30 Component Description: May 2020 PM Hours - QComm - INV QC20-330 Amount: $450.30 Component Description: Tech and field PM March 2020 - Amount: $17,143.00 Component Description: March 2020 PM - Widelity - B&C-WPAN-036 Amount: $28.75 Component Description: Tech and field PM April 2020 Amount: $10,175.20 Component Description: Nov 2020 399 PM hours - QComm - QC20-611 Amount: $1,406.20 Component Description: Oct 2019 PM - Widelity Amount: $656.25 Component Description: Tech & field proj mgmt July 2020 Amount: $10,886.20 Component Description: Field and Tech Proj mgmt - June 2020 Amount: $14,046.20 Component Description: Nov 2021 PM - QComm - INV 230098 Amount: $316.00 Component Description: Provide Project Management to station for repack - QComm INV QC20-272 Amount: $1,698.50 Component Description: Technical and field proj mgmt Oct 2019 Amount: $1,027.00 Component Description: Tech and Field proj mgmt September 2019 Amount: $6,399.00 Component Description: 8-3-20 QComm - PM hours for June 2020 - QC20-354 Amount: $466.10 Component Description: Technical and Field project management - July 2019 - Amount: $2,196.20 Component Description: January 399 Paperwork PM hours - QComm - INV 21-728 Amount: $1,817.00 Component Description: 399 "paperwork" processing - PM - August 2020 - QC20-483 Amount: $2,575.40 Component Description: February 2020 PM - Widelity - B&C-WPAN-035 Amount: $540.00 Component Description: Technical and field proj mgmt - May 2020 Amount: $14,172.60 Component Description: Technical and field proj mgmt - Nov 2019 Amount: $2,133.00 Component Description: 399 processing PM - QC20-484 Amount: $1,508.90 Component Description: April 2021 Tech & 399 PM - QComm - INV QC21-889 Amount: $3,449.60 Component Description: May 2021 399 PM - QComm - INV QC21-887 Amount: $347.60 Component Description: July 2021 Tech & Field PM - QComm - INV 120002 Amount: $616.00 Component Description: Tech and Field Proj mgmt Jan 2020 Amount: $24,000.20 Component Description: Sept 2019 PM Amount: $526.25 Component Description: Widelity - Dec 2019 PM Amount: $273.75 Component Description: June 2021 Field & Tech PM - QComm - INV 120001 Amount: $924.00 Component Description: Field and Tech proj mgmt - Feb 2020 Amount: $18,154.20 Component Description: May 2018 PM Hours Amount: $1,480.15

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	$97,860.38	$93,760.38	N/A	$64,670.38	N/A
Total for all systems	$3,055,037.50	$3,613,093.77	N/A	$3,269,587.82	N/A
Other Expenses	$97,860.38	$93,760.38		$64,670.38
Newspaper Legal Ads	$209.88	$209.88	Newspaper legal ad regarding channel change and resume broadcast date. NW Daily News - 34426797	$209.88	N/A
Site Security	$21,600.00	$21,600.00	Overnight site security to protect indoor and outdoor equipment during installation activities at an unmanned site.	$21,600.00	N/A
Portapotty	$1,750.00	$1,750.00	Actual costs per XTreme Plumbing & Septic Invoices	$1,750.00	N/A
Impedance Transformer	$1,538.77	$1,538.77	Impedance transformer per ERI invoice 56408 - additional parts.	$1,538.77	N/A
Disconnect and decommission existing transmission and RF components	$14,000.00	$14,000.00	estimated amount to disconnect and decommission tx and rf components	N/A	N/A
Clear brush	$9,650.00	$9,650.00	Clear trees and brush from guy paths per ERI invoice 56411	$9,650.00	N/A
MVPD Notification of Channel Change	$1,000.00	$1,000.00	Prepare and send notices to MVPDs.	$0.00	N/A
Develop and air announcement of upcoming channel change	$250.00	$250.00	Voice talent to tape announcement.	$0.00	N/A
Equipment Delivery and Handling Charges	$8,500.00	$8,500.00	N/A	N/A	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$26,171.73	$26,171.73	Per actual costs	$26,171.73	Actual costs the same as estimated
FCC Filing Fees - Special Temporary Authorization request	$195.00	$195.00	N/A	N/A	N/A
FCC Filing Fees - Form 2100 license to cover application	$335.00	$325.00	N/A	$0.00	N/A
DTV Medical Facility Notification	$11,550.00	$7,500.00	N/A	$3,750.00	N/A
FCC Filing Fees - Form 2100 minor change CP application	$1,110.00	$1,070.00	N/A	$0.00	N/A

Components

Actual Information Description	File Name
Newspaper Legal Ads	Component Description: Newspaper Ad - NW FL Daily News - 34426797 Amount: $209.88
Site Security	Component Description: Revised date - Security services for 8/11/20 through 8/17/20. Amount: $3,780.00 Component Description: Site security from 8/4/20 to 8/10/20. Amount: $3,780.00 Component Description: Week #6 - final site security invoice- Severance - INV 1295 Amount: $2,700.00 Component Description: 10/7/20 Revised - Site security week 4 - Severance - INV 1290 Amount: $3,780.00 Component Description: Revised 10/7/20 Site Security - week 5 - Severance INV 1293 Amount: $3,780.00 Component Description: Security services for 8/18/20 through 8/24/20. Amount: $3,780.00
Portapotty	Component Description: Portapotty services Oct 5 - Nov 4, 2020 Amount: $400.00 Component Description: Portapotty for one month with 2 cleanings/week. INV 1032150767743 Amount: $150.00 Component Description: Portapotty for September 2020 Amount: $150.00 Component Description: Portapotty 9/7/20 thru 10/6/20 - Xtreme INV I2051 Amount: $325.00 Component Description: portapotty services 12-5-20 thru 1-4-2021 - Xtreme - INV I2348 Amount: $325.00 Component Description: portapotty services Nov 5 - Dec 4, 2020 - Xtreme - INV I1585 Amount: $400.00
Impedance Transformer	Component Description: Impedance transformer - ERI - INV 56408 Amount: $1,538.77
Disconnect and decommission existing transmission and RF components	Information not provided.
Clear brush	Component Description: Clear trees & brush from guy paths - ERI - INV 56411 Amount: $9,650.00
MVPD Notification of Channel Change	Information not provided.
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Delivery and Handling Charges	Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value)	Component Description: Clean up of old guy wire and tower sections - Joe Clary - INV WPAN Amount: $21,700.00 Component Description: Dumpster Fees - ERI - INV 56636 Amount: $1,201.47 Component Description: Dumpster fees - ERI - INV 56709 Amount: $2,074.11 Component Description: Dumpster - ERI - INV 56354 Amount: $980.15 Component Description: Dumpster rental - ERI - INV 57069 Amount: $216.00
FCC Filing Fees - Special Temporary Authorization request	Information not provided.
FCC Filing Fees - Form 2100 license to cover application	Information not provided.
DTV Medical Facility Notification	Component Description: Medical Notifications - WPAN - RF Notifications - INV 1488 Amount: $3,750.00
FCC Filing Fees - Form 2100 minor change CP application	Information not provided.

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$3,055,037.50	$3,613,093.77	$3,269,587.82

Reimbursement Status

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

Certification

Section	Question	Response
Submission of Estimated Expenses Statements	WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD). The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	William Smith Manager 03/21/2022

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.

William Smith

Manager

03/21/2022

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.	William Smith Manager 03/21/2022

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.

William Smith

Manager

03/21/2022

(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

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Antennas

Primary Antenna

Existing Antenna Information

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Transmission Line

Primary Transmission Line

Existing Transmission Line

Primary Transmission Line

New Transmission Line

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Tower Equipment And Rigging Costs

Primary Tower

Add Tower

Primary Tower

Tower Modification Costs

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Components

Cost Information

Tower Equipment and Rigging Costs

Components

Cost Information

Outside Professional Services

Components