TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
NBC TELEMUNDO LICENSE LLC	Angela Ball 300 NEW JERSEY AVE, N.W. WASHINGTON, DC 20001 United States	+1 (202) 524-6413	ANGELA.BALL@NBCUNI.COM	Limited Liability Company

Applicant

Address

Phone

Applicant Type

NBC TELEMUNDO LICENSE LLC

Angela Ball

300 NEW JERSEY AVE, N.W.

WASHINGTON, DC 20001

United States

+1 (202) 524-6413

ANGELA.BALL@NBCUNI.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
Angela Ball Assistant Secretary NBCUniversal, LLC	300 New Jersey Ave. NW Suite 700 Washington, DC 20001 United States	+1 (202) 524-6413	Angela.Ball@nbcuni.com

Applicant

Address

Phone

Angela Ball

Assistant Secretary

NBCUniversal, LLC

300 New Jersey Ave. NW

Suite 700

Washington, DC 20001

United States

+1 (202) 524-6413

Angela.Ball@nbcuni.com

Broadcaster Information and Transition Plan

Question	Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information.	Yes
Briefly describe transition plan	Install broadband interim antenna using existing transmitter to stay on air during transition and for repack channel if difficulty in completing new main antenna installation. Remove existing KSTS antenna. Install new transmitter & antenna for new channel

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	NV8610V
	Year	2010
	Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power Capacity	8 kW

Primary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Primary (Main)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Manufacturer
	Model	THU9-24
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	37 kW
	Justification for New Transmitter	We bought a THU9-24 as un upgrade that NBC will be paying for and will not be getting reimbursed for. See cover letter New Transmitter will be used so that the current transmitter can be used to keep KSTS on-air during the transition

Primary Transmitter

Other Transmitter Costs

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

Primary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Rohde and Schwarz THU9-24 Transmitter Installation and Commissioning	Transmitter Installation and Commissioning
Spinner RF Components for KSTS Transmitter Installation	Miscellaneous materials required for installation of transmitter

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?	Yes
Existing Antenna Manufacturer and Type	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Not in Stack
	Polarization	Elliptical
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels	N/A
	Design power capacity in use	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Other Antenna Type	N/A
	ERP:	257.0 kW
	Manufacturer
	Model	ATW26H5-ETC1L-48H
	Year	1999

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?	Yes
New Antenna Manufacturer and Types	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Top
	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:	250.0 kW
	Manufacturer
	Model	TFU-17ETT/VP-R C170
	Year	2020
	Justification for New Antenna	Current antenna will not work on new channel (ch 19)

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?	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?
Pattern Scatter Analysis	Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna?	No
Sweep Test	Do you require the sweep testing of transmission line and antenna?	No

Primary Antenna

Other Antenna Cost Not Listed

Name	Description
Antenna Installation	Labor for the installation of antenna, mount, and DACS

Interim Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Interim
	Description of Use	N/A
	Change Type	Purchase New
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	Yes
	Will antenna be located on or in close proximity to an antenna farm?	Yes
New Antenna Manufacturer and Type	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Broadband Slot
	Number of Stations Supported	2
	Number of Panels/Bays	16
	Lower Limit	470.00 MHz
	Upper Limit	698.00 MHz
	Design power capacity in use	100.0 %
	Other Antenna Type	N/A
	ERP:	200.0 kW
	Manufacturer
	Model	SBB-16C170
	Year	2020
	Justification for New Antenna	Interim antenna required to remain on air during transition.

Interim Antenna

Other Antenna Costs

Section	Question	Response
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	Yes
	Broadband or Single Channel?	B
	Feed Line Size	4 1/16 inches
Side Mount Brackets	Do you require the separate purchase of side mount brackets for an 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

Interim Antenna

Other Antenna Cost Not Listed

Information not provided.

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	Waveguide
	Diameter	N/A
	Other Diameter	N/A
	Segment Length	N/A
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	478 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 3/4 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	478 feet per run
	Justification for New Transmission Line	New transmission line required as existing wave guide cannot be re-used

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

New Transmission Line

Section	Question	Response
New Transmission Line Costs	Use	Interim
	Description of Use	N/A
	Change Type	Purchase New
	Type	Rigid
	Diameter	4 1/16 inches
	Segment Length	Broadband
	Other Segment Length
	Number of parallel runs	1
	Length	478 feet per run
	Justification for New Transmission Line	New transmission line required to support interim antenna

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

Existing Tower

Section	Question	Response
Existing Tower Description	Type of change	Modify Existing
	Tower Use	Primary (Main)
	Description of Use	N/A
	Ownership	Leased
	Is this tower consider Complex?	Candelabra
	Is this tower currently shared with any other stations?	Yes
	One or more FM, AM or TV radio broadcaster(s)	Yes
	Others Types of Users	No
	Is tower documented for structural analysis?	Unknown
	Is tower compliant with Rev G?	Unknown
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1044718
Coordinates (NAD83)	Latitude (NAD83)	37° 29' 57.0" N-
	Longitude (NAD83)	121° 52' 20.0" W-
	Overall Structure Height	442.91 feet
	Support Structure Height	392.06 feet
	Ground Elevation Above Mean Sea Level (AMSL)	2605.94 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	Univision Television Group, Inc.
	Date Constructed	02/25/1998

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
33778	KDTV-DT	DTV

Primary Tower

Tower Modification Costs

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

Primary Tower

Tower Rigging Costs

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

Primary Tower

Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	1040
	Explanation	Project oversight of transmitter install, electrical connectivity, tower work, and antenna installation. Additional time will be spent tracking financial and legal process and coordinating with other broadcasters
Outside RF consulting Engineering Services	Perform engineering study for new channel assignment and antenna development	No
	Prepare engineering section of Form FCC Construction Permit Application	No
	For Auxiliary Facility	N/A
	For Main Facility	N/A
	Prepare engineering section of Form FCC License to Cover Application	No
	For Auxiliary Facility	N/A
	For Main Facility	N/A
	Prepare request for Special Temporary Authority	No
	Quantity	N/A
	Do you have Distributed Transmission System engineering services?	N/A
	Critical Facility	N/A
	Terrain-Shielded Facility	N/A
Attorney and Other Outside Consulting Services	Prepare and file Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	Yes
	For Main Facility	Yes
	Prepare and file Form FCC License to Cover Application	Yes
	For Auxiliary Facility	Yes
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	No
	Quantity	N/A
	NEPA Section 106 environmental review	No
	Environmental Assessment	No
	ASR Modification	No
	FAA Consultation (including preparation of FAA Form 7460)	No
	Negotiation of Lease and other Matter for Shared Locations	No
	Prepare or Review FCC Form 399 for Reimbursement	Yes
	Address transition timing and coordination issues w/ other stations and wireless providers	No
RF Field Engineering Services	Comprehensive coverage verification via field study	Yes
	RF exposure measurements	Yes
	Additional Field Engineering Service	Yes
	Number of Days	20
	Justification	Ground Level RF Engineering

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Name	Description
Internal Reimbursement	Internal reimbursement for hours spent of FCC repack project work

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	Yes
	Non-zoning permits	Yes
	BLM or NFS Coordination	No
	FCC Construction Permit Minor Change	No
	FCC License to Cover Application	Yes
	FCC Special Temporary Authority Application	Yes
Other Miscellaneous Expenses	Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)?	Yes
	Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs?	Yes
	Does this relocation require Equipment Storage?	Yes
	Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change?	Yes
	Does this relocation require MVPD Notification of a Channel Change?	Yes

Other Expenses

Other Expenses Not Listed

Information not provided.

Cost Information

Transmitters

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$1,853,000.00	$669,997.58	N/A	$599,836.58	N/A
Total for all systems	$4,858,975.00	$2,312,285.58	N/A	$1,817,504.08	N/A
Primary Transmitter THU9-24	$1,853,000.00	$669,997.58		$599,836.58
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW	$1,473,000.00	$289,997.58	N/A	$289,997.58	N/A
Rohde and Schwarz THU9-24 Transmitter Installation and Commissioning	$120,000.00	$120,000.00	Rohde and Schwarz THU9-24 Transmitter Installation and Commissioning	$112,500.00	N/A
Other Electrical Service: Electrical connection to new equipment (proposal attached)	$60,000.00	$60,000.00	Electrical proposal attached	$0.00	N/A
Spinner RF Components for KSTS Transmitter Installation	$200,000.00	$200,000.00	N/A	$197,339.00	N/A

Components

Actual Information Description	File Name
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW	Component Description: Connection kit liquid cooling for external filter. REVISED Amount: $3,293.89 Component Description: Marked "yes" for upgraded equipment. Invoice should now contain all correct info with cover letter, PO, and quote. Amount: $286,703.69
Rohde and Schwarz THU9-24 Transmitter Installation and Commissioning	Component Description: Installation, Commissioning, setup and testing. Revised Amount: $97,200.00 Component Description: THU9 CH49 Retune. REVISED Amount: $4,500.00 Component Description: Installation, Commissioning, and R&S 8000 Retune & Commissioning Includes Combiner (mask filter) Retune and HX relocation. REVISED Amount: $10,800.00
Other Electrical Service: Electrical connection to new equipment (proposal attached)	Component Description: Removed all electrical conduit and disconnect from the other transmitter. Amount: $20,000.00 Component Description: KSTS work performed by the Five-O Electric, Vendor is not responding with our request for Resource, rate and work details. REVISED Amount: $31,302.04 Component Description: Receipts are not manageable. Vendor never respond our any request Amount: $623.02
Spinner RF Components for KSTS Transmitter Installation	Component Description: Spinner RF Components for KSTS Transmitter Installation Amount: $152,860.00 Component Description: Coaxial direct access unit 6 1 and Measuring adaptor for DAU 6 1/ Amount: $9,979.00 Component Description: TRANSMITTER SYSTEM - REMOVE, PREPARE AND REPLACE Amount: $34,500.00

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	$851,090.00	$796,513.00	N/A	$668,669.25	N/A
Total for all systems	$4,858,975.00	$2,312,285.58	N/A	$1,817,504.08	N/A
Interim Antenna SBB-16C170	$149,290.00	$170,765.00		$49,515.75
Side mount brackets for high power antennas (if not included in antenna base cost)	$23,150.00	$15,800.00	N/A	$6,210.00	N/A
Elbow complex, broadband, at antenna input, per 4 1/16. feedline (if needed)	$10,950.00	$8,065.00	N/A	$6,455.75	N/A
UHF - High Power, Side Mount, basic slot antenna, 16 bay,, 200 kW input, directional,, horizontally polarized	$103,200.00	$103,200.00	Side mount antenna to stay on air during transition and for use on new channel if main antenna installation is delayed.	$0.00	N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	$5,260.00	$15,000.00	Estimated cost is less than predetermined cost estimate	$8,150.00	N/A
Sweep test of existing antenna	$6,730.00	$28,700.00	Antenna sweep test and System installation	$28,700.00	N/A
Primary Antenna TFU-17ETT/VP-R C170	$701,800.00	$625,748.00		$619,153.50
Antenna Installation	$400,000.00	$400,000.00	N/A	$399,724.59	N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	$12,300.00	$10,298.00	N/A	$9,268.20	N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	$289,500.00	$215,450.00	Cost includes antenna, adapters, design, and sweep test from attached antenna proposal	$210,160.71	N/A

Components

Actual Information Description	File Name
Side mount brackets for high power antennas (if not included in antenna base cost)	Component Description: Antenna Anchor Bolt Inspection Amount: $6,210.00
Elbow complex, broadband, at antenna input, per 4 1/16. feedline (if needed)	Component Description: Elbow 4-50 EIA 6.00-12.00 Cu Rei Amount: $2,975.00 Component Description: CA Sales Tax - Invoice 620009 Amount: $275.19 Component Description: CA Sales Tax - Invoice 592010 Amount: $230.56 Component Description: Elbow Amount: $2,975.00
UHF - High Power, Side Mount, basic slot antenna, 16 bay,, 200 kW input, directional,, horizontally polarized	Information not provided.
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	Component Description: RF exposure measurements at Mount Allison antenna farm, including new KSTS, Channel 19 main and auxiliary antennas: Amount: $8,150.00 Component Description: RF exposure measurements at Mount Allison antenna farm, including new KSTS, Channel 19 main and auxiliary antennas. Revised Amount: $8,150.00
Sweep test of existing antenna	Component Description: Antenna System Installation Assistance and Testing Amount: $1,000.00 Component Description: Service - sweep transmission line Amount: $2,200.00 Component Description: Temporary Bypass to Aux Antenna System and Aux Antenna Removal. REVISED Amount: $16,500.00 Component Description: Testing and measurement of channel 19 main antenna located at Mount Allison Amount: $54,200.00 Component Description: Antenna System Installation Assistance and Testing. REVISED Amount: $9,000.00
Antenna Installation	Component Description: progress payment for KSTS antenna install Amount: $148,000.00 Component Description: progress payment for KSTS antenna installation Amount: $88,800.00 Component Description: Payment for additional antenna installation costs Amount: $13,960.00 Component Description: ANTENNA BUILT TO C-70213-7, BY DRILLING ADDITIONAL HOLES AT TOP/SIDES OF FABRICATED POLE TO ALLOW FOR HELICOPTER LIFT/PICK Amount: $2,500.00 Component Description: progress payment for antenna installation Amount: $59,200.00 Component Description: Progress payment on KSTS antenna installation Amount: $29,000.00 Component Description: Permit fees for Antenna System Installation Amount: $4,584.59 Component Description: Progress payments for KSTS Antenna Install Amount: $29,000.00 Component Description: Permit fees for antenna installation Amount: $4,584.59 Component Description: Mt Allison broadband antenna system installation. REVISED Amount: $24,680.00
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	Component Description: please see line item 3 for the elbow complex. REVISED Amount: $4,634.10 Component Description: please see line item 3 from the attached package. REVISED Amount: $4,634.10 Component Description: This is the cover letter, invoice, and quote for the elbow for KSTS. Amount: $4,634.10
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	Component Description: please see line item 1 & 2 from the attached invoice for antenna Amount: $81,692.10 Component Description: CA Sales Tax -Invoice 648009 Amount: $1,478.25 Component Description: CA Sales Tax - Invoice 649013 Amount: $15,842.07 Component Description: This is the cover letter, invoice, and quote for the antenna for KSTS. REVISED Amount: $86,601.60 Component Description: Please 45% of the lie items 1 and 2 from the attached package. Amount: $86,601.60 Component Description: ANTENNA - UHF TOP MOUNT Amount: $26,024.94

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	$174,470.00	$202,310.00	N/A	$166,630.02	N/A
Total for all systems	$4,858,975.00	$2,312,285.58	N/A	$1,817,504.08	N/A
Interim Transmission Line	$77,914.00	$77,310.00		$58,091.04
Rigid Transmission Line - copper, 4 1/16" broadband	$77,914.00	$77,310.00	Price for SpectraLine as quoted by RFS	$58,091.04	N/A
Primary Transmission Line	$96,556.00	$125,000.00		$108,538.98
Rigid Transmission Line - copper, 6 1/8"	$96,556.00	$125,000.00	see attached antenna proposal	$108,538.98	N/A

Components

Actual Information Description	File Name
Rigid Transmission Line - copper, 4 1/16" broadband	Component Description: CA Sales Tax - Invoice 620006 Amount: $266.54 Component Description: Rigid transmission line Amount: $6,328.00 Component Description: RIGID TRANSMISSION LINE - COPPER Amount: $2,881.50 Component Description: Rigid transmission line Amount: $48,615.00
Rigid Transmission Line - copper, 6 1/8"	Component Description: please find cover letter for the line item 4,8, and 9 together for T/L expenses. REVISED Amount: $42,843.78 Component Description: CA Sales Tax _invoice 776006 Amount: $802.90 Component Description: adaptor 4 1/2" EIA male to 43 Amount: $980.00 Component Description: Rigid transmission line REVISED Amount: $8,680.00 Component Description: Cable kits consisting of fiber tool box, hybrid connector kids and 20 M cables Amount: $3,025.00 Component Description: CA Sales Tax- Invoice 804002 Amount: $279.81 Component Description: requested for the line item 4,8, and 9 from the attached package for the Rigid T/L expenses Amount: $42,843.78 Component Description: This is the cover letter, invoice, and quote for the rigid transmission line for WBTS. It covers multiple lines on the invoice that is attached see cover letter for explanation. Amount: $42,843.78 Component Description: CONNECTOR ADAPTER Amount: $175.00 Component Description: Inter series adapter 3 1/8" cl Amount: $7,723.35 Component Description: Inter-series adaptor 4 1/2"IEC Amount: $1,185.36 Component Description: CA Sales Tax _invoice 776006 Amount: $802.90

Actual Information Description

File Name

Rigid Transmission Line - copper, 4 1/16" broadband

Component Description:: CA Sales Tax - Invoice 620006
Amount:: $266.54

Component Description:: Rigid transmission line
Amount:: $6,328.00

Component Description:: RIGID TRANSMISSION LINE - COPPER
Amount:: $2,881.50

Component Description:: Rigid transmission line
Amount:: $48,615.00

Rigid Transmission Line - copper, 6 1/8"

Component Description:: please find cover letter for the line item 4,8, and 9 together for T/L expenses. REVISED
Amount:: $42,843.78

Component Description:: CA Sales Tax _invoice 776006
Amount:: $802.90

Component Description:: adaptor 4 1/2" EIA male to 43
Amount:: $980.00

Component Description:: Rigid transmission line REVISED
Amount:: $8,680.00

Component Description:: Cable kits consisting of fiber tool box, hybrid connector kids and 20 M cables
Amount:: $3,025.00

Component Description:: CA Sales Tax- Invoice 804002
Amount:: $279.81

Component Description:: requested for the line item 4,8, and 9 from the attached package for the Rigid T/L expenses
Amount:: $42,843.78

Component Description:: This is the cover letter, invoice, and quote for the rigid transmission line for WBTS. It covers multiple lines on the invoice that is attached see cover letter for explanation.
Amount:: $42,843.78

Component Description:: CONNECTOR ADAPTER
Amount:: $175.00

Component Description:: Inter series adapter 3 1/8" cl
Amount:: $7,723.35

Component Description:: Inter-series adaptor 4 1/2"IEC
Amount:: $1,185.36

Component Description:: CA Sales Tax _invoice 776006
Amount:: $802.90

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	$1,499,300.00	$175,000.00	N/A	$20,860.00	N/A
Total for all systems	$4,858,975.00	$2,312,285.58	N/A	$1,817,504.08	N/A
Primary Tower TOWER	$1,499,300.00	$175,000.00		$20,860.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	$421,000.00	$100,000.00	N/A	$0.00	N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	$26,300.00	$25,000.00	KSTS share of tower mapping	$20,860.00	N/A
Serious tower reinforcement/modifications	$1,052,000.00	$50,000.00	KSTS share of tower reinforcements	$0.00	N/A

Components

Actual Information Description	File Name
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	Component Description: Coordination for aerial lift site visit, and antenna delivery with West Coast Cranes Amount: $1,200.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	Component Description: Site Tower Analysis Rev "G" prepared for listed project Amount: $4,130.00 Component Description: Site Tower Appurtenance Mapping (Equipment Mapping) Amount: $12,000.00 Component Description: Tower mapping and structural analysis Amount: $450.00 Component Description: Tower mapping and SA work. Amount: $150.00 Component Description: Tower mapping and SA works Amount: $150.00 Component Description: Site Tower Analysis Rev "G" prepared for listed project Amount: $4,130.00
Serious tower reinforcement/modifications	Information not provided.

Cost Information

Outside Professional Services

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$304,035.00	$297,950.00	N/A	$252,989.80	N/A
Total for all systems	$4,858,975.00	$2,312,285.58	N/A	$1,817,504.08	N/A
Outside Professional Services	$304,035.00	$297,950.00		$252,989.80
Additional Field Engineering Service, 20 Days	$10,000.00	$10,000.00	N/A	$0.00	N/A
RF Exposure Measurements	$21,050.00	$10,000.00	N/A	$0.00	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,250.00	N/A	$0.00	N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application	$4,210.00	$5,000.00	KSTS permit/BL fees  Pulling permit/BL, coordinate inspections, and obtain final permit sign off	$0.00	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$1,500.00	N/A	$529.20	N/A
Prepare and or review reimbursement form	$2,630.00	$5,000.00	tba	$4,082.16	N/A
Internal Reimbursement	$10,000.00	$10,000.00	N/A	$0.00	N/A
Comprehensive coverage verification via field study, if needed	$84,200.00	$54,200.00	N/A	$54,200.00	N/A
Project management of the transition	$164,320.00	$200,000.00	Exceed predetermined cost	$194,178.44	N/A

Components

Actual Information Description	File Name
Additional Field Engineering Service, 20 Days	Information not provided.
RF Exposure Measurements	Component Description: RF exposure measurement at Mt. Allison antenna Amount: $8,150.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Information not provided.
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application	Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: Preparation of minor change application Amount: $226.80 Component Description: See line 1 of invoice, less 10% vendor discount. Amount: $302.40
Prepare and or review reimbursement form	Component Description: Legal charges for stations KSTS Amount: $285.60 Component Description: Legal charges for stations KSTS Amount: $1,055.70 Component Description: Legal charges for stations KSTS Amount: $43.65 Component Description: Legal charges for stations KSTS Amount: $405.00 Component Description: Legal charges for stations KSTS Amount: $180.00 Component Description: Review of Form 399 Amount: $43.65 Component Description: Review of Form 399 Amount: $43.65 Component Description: Legal charges for stations KSTS Amount: $91.80 Component Description: Legal charges for stations KSTS Revised Amount: $397.80 Component Description: See lines 2-4 of invoice, less 10% vendor discount. Amount: $310.86 Component Description: Legal charges for stations KSTS Amount: $540.00 Component Description: Legal charges for stations KSTS Amount: $45.00 Component Description: AUX Antenna CP related cost not reimbursable Amount: N/A Component Description: Legal charges for stations KSTS Amount: $45.00 Component Description: Legal charges for stations KSTS Amount: $43.65 Component Description: Legal charges for stations KSTS Amount: $550.80
Internal Reimbursement	Component Description: NBC internal reimbursement invoice for hours spent on KSTS repack project by resource Pat Stahl including expenses Amount: $4,568.82
Comprehensive coverage verification via field study, if needed	Component Description: Comprehensive field test Amount: $54,200.00
Project management of the transition	Component Description: 9/1/2019 - 9/26/2019 Anthony Flores WZTD-LD Permitting - Antenna Change-out Building Submittal/Approval/Clearance Amount: $3,000.00 Component Description: Project Management Service - 8/1/2019 - 8/23/2019 Anthony Flores WZTD-LD Permitting - Electrical Permit submittal/Approval Amount: $666.91 Component Description: AFF Consulting - July 2019 invoice for Project Management work at KSTS Amount: $150.00 Component Description: Invoice of $1200 for 8 hours of Project Management work carried out by Point B Amount: $1,200.00 Component Description: November 2018 Project Management Amount: $3,940.00 Component Description: AFF Consulting - October 2019 invoice for Project Management work at KSTS Amount: $1,800.00 Component Description: KSTS -SJ/SF-Repack Finance Resource- Project Management Services- 64987 Amount: $3,634.00 Component Description: Point B - October 2019 invoice for Project Management work at KSTS Amount: $5,846.00 Component Description: August 2018 Project Management Amount: $6,266.72 Component Description: Project Management Amount: $1,740.00 Component Description: October 2018 Project Management Amount: $150.00 Component Description: Project management: Permitting research and conference calls. Amount: $95.00 Component Description: AFF Consulting - November 2019 invoice for Project Management work at KSTS Amount: $1,800.00 Component Description: AFF Consulting - December 2019 invoice for Project Management work at KSTS Amount: $900.00 Component Description: Re-analysis and modification drawings. REVISED Amount: $750.00 Component Description: Engagement Leader-Project Management Services- 64987 Amount: $3,476.00 Component Description: KSTS -SJ/SF-Repack Finance Resource- Project Management Services- 64987 Amount: $3,318.00 Component Description: KSTS -SJ/SF-Repack Finance Resource-Project Management Services- 64987 Amount: $9,164.00 Component Description: July 2018 Project Management Amount: $4,518.26 Component Description: AFF Consulting - August 2019 invoice for Project Management work at KSTS Amount: $2,250.00 Component Description: Engagement Leader-Project Management Services- 64987 Amount: $2,686.00 Component Description: KSTS -SJ/SF-Engagement Leader-Project Management Services- 64987 Amount: $158.00 Component Description: AFF Consulting - May 2019 invoice for Project Management work at KSTS Amount: $750.00 Component Description: KSTS - Point B invoice June 2020 Amount: $5,925.00 Component Description: KSTS - Point B invoice August 2020 Amount: $2,923.00 Component Description: KSTS -SJ/SF-Engagement Leader-Project Management Services- 64987 REVISED Amount: $711.00 Component Description: KSTS - Point B invoice July 2020 Amount: $711.00 Component Description: Transmission line replacement of existing collocation broadcast facility Amount: $6,990.14 Component Description: June 2018 Project Management Amount: $300.00 Component Description: Project Management Services Amount: $2,145.00 Component Description: Repack Finance Resource- Project Management Services- 64987 Amount: $1,264.00 Component Description: AFF Consulting - June 2019 invoice for Project Management work at KSTS Amount: $600.00 Component Description: September 2018 Project Management Amount: $1,650.00 Component Description: Engagement Leader-Project Management Services- 64987 REVISED Amount: $4,503.00 Component Description: Project Management Services Amount: $975.00 Component Description: Repack Finance Resource- Project Management Services- 64987 Amount: $1,264.00 Component Description: Project Management Services Amount: $348.95 Component Description: Project Management Services - Coordination with WIS Tower and Erickson for aerial lift solution Amount: $1,500.00 Component Description: September 2018 Project Management Amount: $300.00 Component Description: Invoice of $1386 for 9 hours of project management work carried out by Point B. Amount: $1,386.00 Component Description: Project Management Services Amount: $1,365.00 Component Description: Invoice of $9548 for 62 hours of project management work carried out by Point B Amount: $9,548.00 Component Description: Project Management Services -1/1/2020-1/31/2020 Anthony Flores KSTS - Coordination with WIS Tower and Erickson for aerial lift solution Amount: $1,500.00 Component Description: October 2018 Project Management Amount: $3,612.40 Component Description: Point B - January 2020 invoice for Project Management work at KSTS Amount: $17,775.00 Component Description: Project Management Services - site visit from 2/1/2020-2/29/2020 Anthony Flores KSTS Amount: $1,200.00 Component Description: Coordination for aerial lift & site visit, and antenna delivery with West Coast Cranes Amount: $3,000.00 Component Description: Engagement Leader-Project Management Services- 64987 REVISED Amount: $17,008.00 Component Description: Project Management Services Amount: $975.00 Component Description: Project Management service 02/02/2020 - 02/29/2020. Revised Amount: $17,008.00 Component Description: Project management cost split 50/50 between KNTV and KSTS Amount: $162.45 Component Description: Project Management Amount: $150.00 Component Description: Point B - December 2019 invoice for Project Management work at KSTS Amount: $9,617.52 Component Description: Project management services for the station KSTS Amount: $1,386.00 Component Description: Repack Finance Resource- Project Management Services- 64987 Amount: $1,264.00 Component Description: KSTS - Point B invoice February 2020 Amount: $17,008.00 Component Description: Engagement Leader-Project Management Services- 64987 Amount: $158.00 Component Description: 9/1/2019-9/30/2019 Anthony Flores KSTS - Coordination with WIS Tower Contractor for Aux antenna installation Amount: $1,200.00 Component Description: KSTS - Point B invoice May 2020 Amount: $9,761.00 Component Description: Project Mangement Services Amount: $450.00 Component Description: Project management services for KSTS Amount: $1,200.00 Component Description: June 2018 Project Management Amount: $2,225.00 Component Description: Point B - August 2019 invoice for Project Management work at KSTS Amount: $9,548.00 Component Description: Project Management Invoice Amount: $750.00 Component Description: Coordination for Tower Mapping Amount: $600.00 Component Description: KSTS - Point B invoice April 2020 Amount: $18,576.00 Component Description: 7/1/2018-7/31/2018 KSTS - Anthony Flores coordination for site visit and planning meeting scheduled for August. Amount: $450.00 Component Description: Point B - September 2019 invoice for Project Management work at KSTS Amount: $5,056.00 Component Description: Invoice of $1200 for 8 hours of Project Management work carried out by Point B Amount: $1,200.00 Component Description: Project management services - Structural Analysis coordination; Recurring project planning and status update meetings Amount: $1,386.00 Component Description: KSTS - Point B invoice March 2020 Amount: $17,396.00 Component Description: Permitting Research and conference call with Univision (Tower Owner) Amount: $261.25 Component Description: August 2018 Project Management Amount: $2,250.00 Component Description: Project management services for KSTS Revised Amount: $7,979.00 Component Description: Project management cost split 50/50 between KNTV and KSTS Amount: $346.75 Component Description: Point B - November 2019 invoice for Project Management work at KSTS Amount: $8,047.00 Component Description: Repack Finance Resource- project Management services. REVISED Amount: $6,952.00 Component Description: Repack Finance Resource- Project Management Services- 64987 Amount: $632.00 Component Description: Project Management Amount: $1,500.00 Component Description: Consulting- Project management services Amount: $1,200.00

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	$177,080.00	$170,515.00	N/A	$108,518.43	N/A
Total for all systems	$4,858,975.00	$2,312,285.58	N/A	$1,817,504.08	N/A
Other Expenses	$177,080.00	$170,515.00		$108,518.43
Equipment Delivery and Handling Charges	$70,000.00	$70,000.00	N/A	$64,537.95	N/A
MVPD Notification of Channel Change	$12,000.00	$12,000.00	N/A	$0.00	N/A
Develop and air announcement of upcoming channel change	$20,000.00	$20,000.00	N/A	$0.00	N/A
Equipment Storage	$40,000.00	$40,000.00	N/A	$39,361.88	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$20,000.00	$20,000.00	N/A	N/A	N/A
Non-zoning permits	$1,500.00	$1,500.00	N/A	$368.60	N/A
Local Zoning	$1,500.00	$1,500.00	N/A	N/A	N/A
FCC Filing Fees - Special Temporary Authorization request	$195.00	$190.00	N/A	N/A	N/A
FCC Filing Fees - Form 2100 license to cover application	$335.00	$325.00	N/A	N/A	N/A
DTV Medical Facility Notification	$11,550.00	$5,000.00	N/A	$4,250.00	N/A

Components

Actual Information Description	File Name
Equipment Delivery and Handling Charges	Component Description: Please find cover letter- only shipping cost is requested for the payment in the section. Amount: $22,378.95 Component Description: Equipment & Delivery charges for stations KSTS. REVISED Amount: $6,800.00 Component Description: Equipment & Delivery charges for stations KSTS. Station ID use instead Vendor EIN, REVISED Amount: $200.20 Component Description: Equipment & Delivery charges for stations KSTS. Station EIN used REVISED Amount: $6,800.00 Component Description: Equipment & Delivery charges for stations KSTS. Station EIN used REVISED Amount: $6,800.00 Component Description: Freight and shipping - PAF Van Delivery. REVISED Amount: $4,860.00 Component Description: CA Sales Tax- Invoice 801002 Amount: $776.54 Component Description: N/A Amount: N/A Component Description: Freight and shipping costs - L8,9,25 FedEx Express First Overnight Amount: $9,122.26 Component Description: Equipment & Delivery charges for stations KSTS Amount: $6,800.00 Component Description: Freight and shipping charges - FedEx Express First Overnight. REVISED Amount: $9,122.26 Component Description: Delivery antenna with West Coast cranes Amount: $3,000.00
MVPD Notification of Channel Change	Information not provided.
Develop and air announcement of upcoming channel change	Component Description: AIR DRYER Amount: $8,402.00 Component Description: AIR DRYER Amount: $8,402.00
Equipment Storage	Component Description: PAF van storage for three months costs. REVISED Amount: $2,020.00 Component Description: Only storage expenses are requested for the reimbursement. please see line item 2 and 4. REVISED Amount: $8,395.00 Component Description: 8 Months Storage of Transmitter and Third Party Equipment Amount: $28,946.88
Disposal Costs (for equipment and other waste, net of any salvage value)	Information not provided.
Non-zoning permits	Component Description: Permitting Research Amount: $118.75 Component Description: Permitting research Amount: $249.85
Local Zoning	Information not provided.
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 notification mailing Amount: $4,250.00 Component Description: Medical Notification Mailing Complete per FCC Repack Amount: $4,250.00

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$4,858,975.00	$2,312,285.58	$1,817,504.08

Reimbursement Status

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

Certification

Section	Question	Response
Submission of Estimated Expenses Statements	WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD). The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Angela Ball Assistant Secretary 08/02/2022

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.

Angela Ball

Assistant Secretary

08/02/2022

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.	Angela Ball Assistant Secretary 08/02/2022

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.

Angela Ball

Assistant Secretary

08/02/2022

Certification

Section	Question	Response
Submission of Final Allocation or Accounting Information Statements	WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Angela Ball Assistant Secretary 08/02/2022

Section

Question

Response

Submission of Final Allocation or Accounting Information Statements

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

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

Angela Ball

Assistant Secretary

08/02/2022

(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

Interim Antenna

New Antenna Costs

Interim Antenna

Other Antenna Costs

Interim 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

Interim Transmission Line

New Transmission Line

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Tower Equipment And Rigging Costs

Primary Tower

Existing Tower

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

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