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:
69292
Service:
DTV
Call Sign:
WUND-TV
Channel:
29 (UHF)
File Number:
0000025920
FRN:
0001910066
Date Submitted:
05/06/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

University of North Carolina

Doing Business As: University of North Carolina

Shelly Eubanks

PO Box 14900

Research Triangle Park, NC 27709

United States

+1 (919) 549-7000 fcc_notice@pbsnc.org Government Entity

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

Donald Smith

Director New Technologies and Compliance Planning

University of North Carolina Center for Public Television

Donald Smith

10 UNC-TV Drive

Research Triangle Park, NC 27709

United States

+1 (919) 549-7025 dsmith@pbsnc.org

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan The transition plan is to construct an interim facility at the existing site. The interim facility would be used when operation on the new channel begins. After that the necessary changes would be made to the primary transmission system.

Transmitters

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

Auxiliary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Auxiliary (Backup to Main)
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 DHD30P1
Year 2001
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 7.25 kW

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model ULXTE-20
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 12.9 kW
Justification for New Transmitter The transmitter manufacturer has indicated that components necessary to modify the transmitter for operation on its new channel are no longer available and it will not be able to provide re-channelization services for the transmitter. See attached letter

Auxiliary Transmitter

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Other Transmitter Costs

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

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

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 CD3300P3
Year 2001
Type Inductive Output Tube
IOT Power Type Three
Power Capacity 60 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 ULXTE-100
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 62.9 kW
Justification for New Transmitter The transmitter manufacturer has indicated that components necessary to modify the transmitter for operation on its new channel are no longer available and it will not be able to provide re-channelization services for the transmitter. See attached letter

Primary Transmitter

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Other Transmitter Costs

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

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Auxiliary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Auxiliary (Backup)
Description of Use Backup to main
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? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 741.0 kW
Manufacturer
Model TFU-30GTH-R O4
Year 2000

Auxiliary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Auxiliary (Backup)
Description of Use Interim Facility
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
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: 808.0 kW
Manufacturer
Model SAA30-O3-G200-ES5R-29
Year 2019
Justification for New Antenna The antenna is a single channel slotted pylon style antenna. It cannot operate on a channel other than what it was designed, channel 20. The only viable option is to replace the antenna.

Auxiliary Antenna

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Other Antenna Costs

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

Auxiliary Antenna

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Other Antenna Cost Not Listed

Information not provided.

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? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 543.0 kW
Manufacturer
Model ATW25HS3-ETO-20H
Year 2010

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? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 657.0 kW
Manufacturer
Model SAA30-O4G300-ET8R-29
Year 2019
Justification for New Antenna The antenna is a single channel slotted pylon style antenna. It cannot operate on a channel other than what it was designed, channel 20. The only viable option is to replace the antenna.

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? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 8 3/16 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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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? No

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change 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? 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? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1063239
Coordinates (NAD83) Latitude (NAD83) 35° 54' 01.0" N-
Longitude (NAD83) 076° 20' 44.0" W-
Overall Structure Height 1640.07 feet
Support Structure Height 1574.13 feet
Ground Elevation Above Mean Sea Level (AMSL) 5.91 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner UNIVERSITY OF NORTH CAROLINA
Date Constructed 10/21/2010

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
89274 WUND-FM FM

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.

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 120
Explanation Because the transmission site is owned by the State of North Carolina, it is subject to various state construction project rules. One rule is the hiring of a designer to create submittals for project review and approval by the state.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review 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 No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Additional Legal Expenses

Legal expenses for non-catalog advice and review, including transition status reports and other miscellaneous legal needs.

Tower Structural Analysis

Required by State Building Code

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning No
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application No
FCC Special Temporary Authority Application No
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? 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

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Other Expenses Not Listed

Name Description

Electrical Construction

Construction and modifications to the electrical infrastructure of the existing building as required to support the new transmitters

General Construction

General construction and administrative costs necessary for the installation of transmitters in an existing building

Network Switch

Cisco 52-port Gigabit Switch connects devices together on computer network by using packet switching to receive, process, and forward data to destination device

Antenna Main Other

Fine Matchers Elbows

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 $3,127,910.71 $2,025,259.40 N/A $1,832,727.66 N/A
Total for all systems $4,256,284.41 $3,349,562.77 N/A $3,023,671.81 N/A
Primary Transmitter ULXTE-100 $2,607,860.71 $1,553,300.80 $1,553,300.79
UHF - Liquid Cooled Solid State Transmitter 62.9 kW $783,060.71 $783,060.71 Remaining balance from other main transmitter expense line See Gates Quotes 75368, 79709, 87533 w/Invoices JW30004411, US0329378, US0339405 $783,060.70 Budget Revision
Transformer 3 phase/480v - 300 KVA $36,800.00 $5,744.00 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $5,744.00 N/A
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW $1,788,000.00 $764,496.09 ***System Notice: Estimate adjusted and locked because line has been superseded.***A quote from Comark for a replacement IOT transmitter is attached. That quote is substantially higher than the catalog pricing amount for the proposed solid state transmitter. The proposed transmitter should be eligible for full reimbursement. $764,496.09 N/A
Auxiliary Transmitter ULXTE-20 $520,050.00 $471,958.60 $279,426.87
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $494,500.00 $470,000.00 N/A $277,468.27 N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $1,958.60 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $1,958.60 N/A

Components

Actual Information Description File Name
UHF - Liquid Cooled Solid State Transmitter 62.9 kW

Component Description:
Main Transmitter See attach pg 1 for payment details.
Amount:
$644,355.24

Component Description:
Final Invoice Main Transmitter & Install See attach pg 1 for payment details attach pg 2 for invoice attach pg 3-6 for quote 87533
Amount:
$138,705.46
Transformer 3 phase/480v - 300 KVA

Component Description:
50% Transformer on Quote Line 16. Included with Transmitter on Invoice. Purchase Order for All 11 sites.
Amount:
$5,744.00
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW

Component Description:
Main Transmitter See attachment pg 1 for payment details.
Amount:
$644,355.24

Component Description:
50% Main Transmitter & Installation. Installation included w/Transmitter on Form 399. Transformer separate 399 Line item. Purchase Order for all 11 sites.
Amount:
$764,496.09
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW

Component Description:
See attach pg 1 for payment details See attach pg 2 for invoice See attach pg 3 for explanation of quotes See attach pg 4-22 for requested quotes
Amount:
$94,956.15

Component Description:
Aux Transmitter See attach pg 1-2 for UXLTE-20 Justification, Attach pg 3 for payment details Attach pg 4 for invoice Attach pg 5-8 for change order
Amount:
$94,956.15

Component Description:
Attach pg 1 - Invoice Attach pg 2 - Payment Details Attach pg 3-5 Quote 87534 Attach pg 6-13 ULXTE20 Quote 75370 Attach pg 14-20 ULXTE16 Quote 86881 Attach pg 21-38 Narrative Attach pg 39-42 Quote 79702
Amount:
$94,956.15

Component Description:
Final Aux Transmitter & Install See attach pg 1 for payment details See attach pg 3 for quote 87534
Amount:
$43,433.33

Component Description:
Aux Transmitter See attach pg 1 for payment details. See additl quote Q-86881 for ULXTE-16 on pages 7-13 of attachment as requested by reviewer.
Amount:
$94,956.15

Component Description:
See attach pg 1 for savings generated from purchase of upgrade as opposed to Baseline Attach pg 2 invoice Attach pg 3 payment details Attach pg 4-6 quote 87534 Attach pg 7-14 quote 75370 Attach pg 15-21 quote 86881 Attach pg 22-43 narrative
Amount:
$94,956.15

Component Description:
50% Aux Transmitter & Installation. Installation included w/Transmitter on Form 399. Purchase Order for all 11 sites.
Amount:
$139,078.79
Transformer 3 phase/480v - 150 KVA

Component Description:
50% Transformer on Quote Line 17. Included with Transmitter on Invoice. Purchase Order is for all 11 sites.
Amount:
$1,958.60

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 $506,220.00 $432,522.03 N/A $379,314.24 N/A
Total for all systems $4,256,284.41 $3,349,562.77 N/A $3,023,671.81 N/A
Primary Antenna SAA30-O4G300-ET8R-29 $311,480.00 $237,567.03 $223,067.03
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $214,112.03 See Narrative with Quote $214,112.03 N/A
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed) $15,250.00 $14,500.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $8,955.00 See RFS Invoice 27011674 with quote item 000020 $8,955.00 N/A
Auxiliary Antenna SAA30-O3-G200-ES5R-29 $194,740.00 $194,955.00 $156,247.21
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 N/A N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 N/A N/A N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $11,700.00 N/A N/A N/A
UHF - High Power, Side Mount, basic slot antenna, 808 kW input, elliptically or circularly polarized $147,300.00 $147,300.00 See narrative with quote See invoice 27011696 with quote for Fine Matchers & Elbows $147,292.21 Budget Revision
Sweep test of existing antenna $6,730.00 $8,955.00 See RFS Invoice 27011674 with quote item 000020 $8,955.00 N/A

Components

Actual Information Description File Name
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Final 50% Main Antenna Initial 50% paid invoice 27011328
Amount:
$107,056.01

Component Description:
50% Primary Antenna included in Inv & PO Line 3. Invoice & Purchase Order are for 10 sites.
Amount:
$107,056.02
Elbow complex, single channel, at antenna input, per 8 3/16. feedline (if needed) Information not provided.
Sweep test of existing antenna

Component Description:
Primary/Main Pre Sweep See attachmt pg 4 quote item 000020 17910/2 equal 8955.00 Remainder of invoice on separate 399 categories
Amount:
$8,955.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) Information not provided.
UHF - High Power, Side Mount, basic slot antenna, 808 kW input, elliptically or circularly polarized

Component Description:
50% Aux Antenna invoice line 10, initial 50% on invoice 27011328 Invoice Line 20 Fine Matchers & Invoice Line 30 Elbows on attached quote
Amount:
$77,972.71

Component Description:
50% Auxilliary Antenna included in Inv & PO Line 3. Invoice & Purchase Order are for 10 sites.
Amount:
$69,319.50
Sweep test of existing antenna

Component Description:
Aux Pre Sweep see attach pg 4 quote item 000020 17910/2 equal 8955.00 Remainder of invoice on separate 399 categories
Amount:
$8,955.00

Cost Information

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Transmission Line

Information not provided.

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 $210,500.00 $362,213.00 N/A $348,074.77 N/A
Total for all systems $4,256,284.41 $3,349,562.77 N/A $3,023,671.81 N/A
Primary Tower TOWER $210,500.00 $362,213.00 $348,074.77
Tall Tower (greater than 500') $210,500.00 $362,213.00 See narrative and attached quote See RFS Invoice 27011751 $348,074.77 N/A

Components

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

Component Description:
Install Plumb Tension Attach pg 1 - Invoice Attach pg 2-5 Quote 79575 Item 000020
Amount:
$78,888.00

Component Description:
50% Primary/Complex Tower Installation for Auxilliary Antenna included in Inv & PO Line 4. Invoice & Purchase Order are for 10 sites.
Amount:
$41,567.44

Component Description:
50% Tower Aux Install Initial 50% paid invoice 27011328 Remainder of invoice on separate 399 categories
Amount:
$41,567.44

Component Description:
Final 50% Main Install Initial 50% paid invoice 27011328
Amount:
$93,025.94

Component Description:
50% Primary/Complex Tower Installation for Primary Antenna included in Inv & PO Line 4. Invoice & Purchase Order are for 10 sites.
Amount:
$93,025.95

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 $93,275.00 $216,239.64 N/A $166,097.23 N/A
Total for all systems $4,256,284.41 $3,349,562.77 N/A $3,023,671.81 N/A
Outside Professional Services $93,275.00 $216,239.64 $166,097.23
Tower Structural Analysis $7,000.00 $7,000.00 N/A $2,500.00 N/A
Additional Legal Expenses $24,500.00 $24,500.00 Preliminary estimate for legal expenses for non-catalog advice and review including transition status reports and other miscellaneous legal needs. $10,089.31 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 N/A N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A $109.50 N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $4,000.00 N/A $109.50 N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $2,000.00 N/A $650.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $1,812.50 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $2,000.00 N/A $725.00 N/A
Project management of the transition $18,960.00 $140,989.64 See attachment "WUND Program Designer - Manager Narrative" for details on estimated cost Amendment #3 attached to Invoice 157570 Amendment #4 attached to Invoice 160595 Internal Labor 2,865.13 $140,854.77 N/A
Prepare and or review reimbursement form $2,630.00 $11,000.00 Estimated Internal Labor $6,140.65 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $227.50 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $2,878.50 N/A

Components

Actual Information Description File Name
Tower Structural Analysis

Component Description:
Outside Professional Services Tower Structural Analysis See attachment page 7 for schedule of services.
Amount:
$2,500.00
Additional Legal Expenses

Component Description:
Outside Professional Services Additional Legal Expenses Invoice applies to all 11 repack stations, amount requested reflects portion payable per Station: $245.00/11 as indicated on page 1 of Invoice
Amount:
$22.28

Component Description:
Outside Prof Svcs Addtl Legal See attach pg 1 fee analysis by 399 category
Amount:
$570.00

Component Description:
Outside Prof Svc Addtl Legal See attach pg 1 for fee analysis by 399 category
Amount:
$190.00

Component Description:
Outside Professional Services Additional Legal Expenses Legal services benefit entire FCC Repack project across all 11 Call Signs/Facility IDs, 2594.40/11 for 235.86 as outlined on page 1 of invoice.
Amount:
$235.86

Component Description:
Outside Prof Svcs Addtl Legal
Amount:
$266.00

Component Description:
Outside Professional Services Additional Legal Expenses Legal services benefit entire FCC Repack project across all 11 Call Signs/Facility IDs, 168.50/11 equal 15.32 as outlined on page 1 of invoice.
Amount:
$15.32

Component Description:
Outside Professional Services Additional Legal Expenses Legal services benefit entire FCC Repack project across all 11 Call Signs/Facility IDs, 3472.00/11 equal 315.64 as outlined on page 1 of invoice.
Amount:
$315.64

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$742.80

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$73.00

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$70.00

Component Description:
Outside Professional Services Additional Legal Expenses Legal services benefit entire FCC Repack project across all 11 Call Signs/Facility IDs, 368.00/11 equal 33.45 as outlined on page 1 of invoice.
Amount:
$33.45

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$33.70

Component Description:
Outside Prof Svcs Addtl Legal
Amount:
$623.50

Component Description:
Outside Professional Services Additional Legal Expenses Legal services benefit entire FCC Repack project across all 11 Call Signs/Facility IDs, 765.00/11 equal 69.54 as outlined on page 1 of invoice.
Amount:
$69.54

Component Description:
Outside Professional Services Additional Legal Expenses Legal services benefit entire FCC Repack project across all 11 Call Signs/Facility IDs, 350.00/11 equal 31.82 as outlined on page 1 of invoice.
Amount:
$31.82

Component Description:
Outside Professional Services Additional Legal Expenses 9/26/19 .10 ;.10x365 equal $36.50
Amount:
$36.50

Component Description:
Outside Professional Services Additional Legal Expenses Legal services benefit entire FCC Repack project across all 11 Call Signs/Facility IDs, 572.90/11 equal 52.08 as outlined on page 1 of invoice.
Amount:
$52.08

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$67.40

Component Description:
Outside Prof. Svs Additional Legal Expenses
Amount:
$36.50

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$67.40

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$105.00

Component Description:
Outside Professional Services Additional Legal Expenses Legal services benefit entire FCC Repack project across all 11 Call Signs/Facility IDs, 1617.10/11 for 147.01 as outlined on page 1 of invoice.
Amount:
$147.01

Component Description:
Outside Professional Services Additional Legal Expenses Legal services benefit entire FCC Repack project across all 11 Call Signs/Facility IDs, 402.00/11 equal 36.54 as outlined on page 1 of invoice.
Amount:
$36.54

Component Description:
Outside Prof Svcs Addtl Legal See attach pg 1 for fee analysis by 399 category
Amount:
$60.00

Component Description:
Outside Prof Svcs Addtl Legal Exp
Amount:
$546.00

Component Description:
Outside Professional Services Additional Legal Expenses Legal services benefit entire FCC Repack project across all 10 Call Signs/Facility IDs, 3378.88/10 for 337.89 as outlined on page 1 of invoice.
Amount:
$337.89

Component Description:
Outside Professional Services Additional Legal Expenses Legal services benefit entire FCC Repack project across all 11 Call Signs/Facility IDs, 323.00/11 equal 29.37 as outlined on page 1 of invoice.
Amount:
$29.37

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$182.50

Component Description:
Outside Professional Services Additional Legal Expense Legal services benefit entire FCC Repack project across all 11 Call Signs/Facility IDs, 2059.90/11 for 187.26 as outlined on page 1 of invoice.
Amount:
$187.26

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$182.50

Component Description:
Outside Prof Svcs Addtl Legal
Amount:
$38.00

Component Description:
Outside Professional Services Additional Legal Expenses Legal services benefit entire FCC Repack project across all 11 Call Signs/Facility IDs, 175.00/11 equal 15.91 as outlined on page 1 of invoice.
Amount:
$15.91

Component Description:
Outside Prof Svcs Addtl Legal See attach pg 1 for fee analysis by 399 category
Amount:
$328.50

Component Description:
Outside Prof Svcs Addtl Legal See attach pg 1 for fee analysis by 399 category
Amount:
$146.00

Component Description:
Outside Professional Services Additional Legal Expenses Invoice applies to all 11 repack stations, amount requested reflects portion payable per Station: $70.00/11 as indicated on page 1 of Invoice
Amount:
$6.36

Component Description:
Outside Prof Svcs Addtl Legal
Amount:
$76.00

Component Description:
Outside Prof Svc Additional Legal Fees
Amount:
$1,610.00

Component Description:
Outside Prof Svcs Addtl Legal
Amount:
$380.00

Component Description:
Outside Professional Services Additional Legal Expenses Legal services benefit entire FCC Repack project across all 11 Call Signs/Facility IDs, 67.40/11 equal 6.12 as outlined on page 1 of invoice.
Amount:
$6.12

Component Description:
Outside Professional Services Additional Legal Expenses Legal services benefit entire FCC Repack project across all 11 Call Signs/Facility IDs, 959.50/11 equal 87.23 as outlined on page 1 of invoice.
Amount:
$87.23

Component Description:
Outside Prof Svcs Addtl Legal 1/21/2021 SGH .1
Amount:
$45.50

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$35.00

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$146.00

Component Description:
Outside Prof Svcs Additional Legal
Amount:
$45.50

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$70.00

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$140.00

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$109.50

Component Description:
Outside Professional Services Additional Legal Expense
Amount:
$346.50

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$280.00

Component Description:
Outside Professional Services Additional Legal Expenses Legal services benefit entire FCC Repack project across all 11 Call Signs/Facility IDs, 315.00/11 equal 28.63 as outlined on page 1 of invoice.
Amount:
$28.63

Component Description:
Outside Prof Svcs Addtl Legal
Amount:
$38.00

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$146.00

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$70.00

Component Description:
Outside Professional Services Additional Legal Expenses
Amount:
$597.70
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
ASR modification (prepare FCC Form 854) Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Outside Prof Svcs STA See attach pg 1 for fee analysis by 399 category
Amount:
$36.50

Component Description:
Outside Professional Services STA 9/27/19 .2 x 365 equal $73.00
Amount:
$73.00
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application

Component Description:
Outside Prof Svcs CP AUX See attach pg 1 for fee analysis by 399 category
Amount:
$109.50
Prepare request for Special Temporary Authorization Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application

Component Description:
Outside Prof Services Engineering Svcs Aux CP
Amount:
$650.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Outside Professional Services Engineering Section FCC Form 2100 Construction Permit Application - Primary (Main)
Amount:
$1,812.50
Perform engineering study for new channel assignment and antenna development

Component Description:
Outside Professional Services Engineering Study New Channel Assignment Antenna Development
Amount:
$725.00
Project management of the transition

Component Description:
Outside Prof Svcs Proj Mgmt of Transition See attach pg. 2-5 for Contract/Invoice Summary. Amendment #3 on pg. 6. 12,800 divided by 11 equal 1,164.64 for 7 sites, 1,164.63 for 4 sites. PO/Contract for all eleven transmitter sites.
Amount:
$5,651.64

Component Description:
Outside Professional Services Project Management of Transition See attachment pg. 3-6 for Contract/Invoice Summary. PO/Contract for all eleven transmitter sites.
Amount:
$2,499.60

Component Description:
Outside Professional Svcs Proj Mgmt of Transition PO for eleven multiple sites See attach pg 2-7 for Contract/Invoice summary
Amount:
$4,356.00

Component Description:
Outside Professional Services Project Management of Transition See attachment pg 3-5 for Contract/Invoice Summary.
Amount:
$54,415.80

Component Description:
Outside Professional Services Project Management
Amount:
$9,022.50

Component Description:
Outside Prof Services Project Management Contract/Invoice summary for 11 sites see attach pgs 5-15
Amount:
$2,700.00

Component Description:
Outside Professional Svcs Proj Mgmt of Transition PO for eleven multiple sites See attach pg 2-7 for Contract/Invoice summary
Amount:
$4,356.00

Component Description:
Outside Proj Svcs Proj Mgmt of Transition PO for eleven multiple sites See attach pg 3-6 for Contract/Invoice summary
Amount:
$1,592.10

Component Description:
Project Mgmt Internal Labor July 2019-June 2020
Amount:
$2,865.13

Component Description:
Outside Professional Services Project Management See attachment pg. 3 & 4 for Project Summary
Amount:
$9,022.50

Component Description:
Outside Professional Services Project Management of Transition See attachment pg 3-5 for Contract/Invoice Summary.
Amount:
$12,671.60

Component Description:
Outside Professional Services Project Management of Transition See attachment pg. 3-6 for Contract/Invoice Summary. PO/Contract for all eleven transmitter sites.
Amount:
$4,088.44

Component Description:
Outside Prof Svcs Project Mgmt Attach pg 1-2 Invoice Attach pg 3-19 Contracts Attach pg 10-30 Project Summary
Amount:
$3,630.00

Component Description:
Outside Professional Services Project Management See attachment pg. 3 & 4 for Project Summary
Amount:
$6,703.50

Component Description:
Outside Professional Services Project Management of Transition See attachment pg 3-5 for Contract/Invoice Summary.
Amount:
$5,438.08

Component Description:
Outside Professional Services Project Management of Transition See attachment pg 3-5 for Contract/Invoice Summary.
Amount:
$4,550.14

Component Description:
Outside Professional Services Project Management of Transition See attachment pg 3-5 for Contract/Invoice Summary. PO/Contract for all eleven transmitter sites.
Amount:
$5,438.08

Component Description:
Outside Professional Services Project Management of Transition See attachment pg 3-6 for Contract/Invoice Summary. PO/Contract for all eleven transmitter sites.
Amount:
$10,876.16
Prepare and or review reimbursement form

Component Description:
Outside Prof Svcs Prepare Review Reimbursement Request Jan-August 2021
Amount:
$775.89

Component Description:
Outside Prof Svcs Review Prepare Reimbursement Request Sept 2021
Amount:
$93.66

Component Description:
Internal Labor Jan-Aug 2021
Amount:
$775.89

Component Description:
Outside Prof Svcs Prepare Review Reimbursement Request January-December 2020
Amount:
$1,884.41

Component Description:
Internal Labor Mar-Dec 2019
Amount:
$1,756.45

Component Description:
Outside Professional Services Prepare Reimbursement Wages & Employer Portion Social Security for Temp Employee. Tasks applicable to all 11 repack sites, amount requested reflects portion payable per site.
Amount:
$102.76

Component Description:
Outside Prof Svcs Prepare Review Reimbursement Request March-December 2019
Amount:
$1,756.45

Component Description:
Prepare Reimbursement Request Oct-Dec 2021
Amount:
$458.59

Component Description:
Prepare Reimbursement Request Jan-Feb 2022
Amount:
$100.11

Component Description:
Internal Labor Jan-Dec 2020
Amount:
$1,884.41

Component Description:
Prepare Reimbursement Request October 2017-January 2018
Amount:
$456.90

Component Description:
Prepare Reimbursement Feb 2018-June 2018
Amount:
$511.88
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Outside Prof Svcs Legal Lic to Cover
Amount:
$45.50

Component Description:
Outside Prof Svc Legal Lic to Cover 1/26/2021 SGH .4
Amount:
$182.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Outside Prof Svcs CP See attach pg 1 for fee analysis by 399 category
Amount:
$338.50

Component Description:
Outside Prof Svcs CP See attach pg 1 for fee analysis by 399 category
Amount:
$912.00

Component Description:
Outside Prof Svcs CP See attach pg 1 for fee analysis by 399 category
Amount:
$146.00

Component Description:
Outside Pro Svcs CP See attach pg 1 fee analysis by 399 category
Amount:
$1,292.00

Component Description:
Outside Prof Svcs CP See attach pg 1 for fee analysis by 399 category
Amount:
$190.00

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $318,378.70 $313,328.70 N/A $297,457.91 N/A
Total for all systems $4,256,284.41 $3,349,562.77 N/A $3,023,671.81 N/A
Other Expenses $318,378.70 $313,328.70 $297,457.91
Antenna Main Other $9,747.00 $9,747.00 See RFS Invoice 27011752 $9,746.10 N/A
Network Switch $1,048.00 $1,048.00 See attachment - WUND Network Switch Justification $1,047.97 N/A
General Construction $56,400.00 $56,400.00 See the attached document WUND GC budget for additional information See PO Summary (attach pg 106) with Riley invoice 75-08 $56,318.71 N/A
Electrical Construction $153,600.00 $153,600.00 See the attached document WUND GC Budget for additional information. See PO Summary (attach pg 106) with Riley Invoice 75-08 $153,597.79 N/A
MVPD Notification of Channel Change $5,500.00 $5,500.00 Preliminary cost estimate for service $463.64 N/A
Equipment Delivery and Handling Charges $6,000.00 $6,000.00 Preliminary estimates N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $72,533.70 $72,533.70 Invoiced amount based on competitive bid award $72,533.70 N/A
DTV Medical Facility Notification $11,550.00 $6,500.00 Preliminary cost estimate for service $3,750.00 N/A
Develop and air announcement of upcoming channel change $2,000.00 $2,000.00 Preliminary estimate N/A N/A

Components

Actual Information Description File Name
Antenna Main Other

Component Description:
Fine Matchers & Elbows See quote attach pg 3 items 000040 & 000050
Amount:
$9,746.10
Network Switch

Component Description:
Other Expenses Network Switch 11 Switches for total of 11,527.67 equals 1,047.97 per transmitter site.
Amount:
$1,047.97
General Construction

Component Description:
General Contract See attach pg 1 for payment details Invoice attach pg 2-18 Change orders attach pg 19-105 PO Summary attach pg 106
Amount:
$1,598.20

Component Description:
General Contract See attach pg 1 for payment details. Invoice attach pg 2-10 Change orders attach pg 11-28 PO Summary attach pg 29
Amount:
$1,414.04

Component Description:
Other Expenses General Contract See attachment pg 1 for payment details by contract/site including payment responsibility. PO for 6 sites.
Amount:
$6,970.67

Component Description:
General Contract See attach pg 1 for payment details by FACId/Call. See attach last page for Purchase Order Summary for multiple sites.
Amount:
$3,746.89

Component Description:
General Contract See attach pg 1 for payment details. Invoice attach pg 2-10 Change orders attach pg 11-33 PO Summary attach pg 34
Amount:
$5,278.00

Component Description:
General Contract See attach pg 1 for payment details by FACId/Call. See attach last page for Purchase Order Summary for multiple sites.
Amount:
$34,853.36

Component Description:
General Contract See attach pg 1 for payment details. Invoice attach pg 2-14 PO Summary attach pg 15, Recon pg 16.
Amount:
$1,708.17

Component Description:
General Contract See attach pg 1 for payment details by FACId/Call. See attach last page for Purchase Order Summary for multiple sites.
Amount:
$749.38
Electrical Construction

Component Description:
Electrical Contract See attach pg 1 for payment details. Invoice attach pg 2-10 Change orders attach pg 11-28 PO Summary attach pg 29
Amount:
$1,290.73

Component Description:
Electrical Contract See attach pg 1 for payment details. Invoice attach pg 2-10 Change orders attach pg 11-33 PO Summary attach pg 34
Amount:
$2,391.09

Component Description:
Electrical Contract See attach pg 1 for payment details by FACId/Call. See attach last page for Purchase Order Summary for multiple sites.
Amount:
$11,797.27

Component Description:
Electrical Contract See attach pg 1 for payment details by FACId/Call. See attach last page for Purchase Order Summary for multiple sites.
Amount:
$11,239.37

Component Description:
Electrical Contract See attach pg 1 for payment details Invoice attach pg 2-18 Change orders attach pg 19-105 PO Summary attach pg 106
Amount:
$17,476.97

Component Description:
Electrical Contract See attach pg 1 for payment details. Invoice attach pg 2-14 PO Summary attach pg 15, Recon pg 16.
Amount:
$4,617.36

Component Description:
Electrical Contract See attach pg 1 for payment details by FACId/Call. See attach last page for Purchase Order Summary for multiple sites.
Amount:
$104,785.00
MVPD Notification of Channel Change

Component Description:
MVPD Notify See attach pg. 12-13 $5,100 for 11 sites equal 463.64 each
Amount:
$463.64
Equipment Delivery and Handling Charges Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Final Main Transmitter Disposal See attach pg 1 for payment details
Amount:
$22,484.25

Component Description:
50% Main Transmitter Removal. Purchase Order is for all 11 sites.
Amount:
$22,484.25

Component Description:
50 % Aux Transmitter Removal. Purchase Order is for all 11 sites.
Amount:
$13,782.60

Component Description:
Final Aux Transmitter Disposal See attach pg 1 for payment details
Amount:
$13,782.60
DTV Medical Facility Notification

Component Description:
Other Expenses Med Notify See attachment pg. 11 for schedule of services PO for 11 sites
Amount:
$3,750.00
Develop and air announcement of upcoming channel change Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $4,256,284.41 $3,349,562.77 $3,023,671.81

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.

Shelly L Eubanks

Director of Finance and Administration


05/06/2022

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.

Shelly L Eubanks

Director of Finance and Administration


05/06/2022

Attachments

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