TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
TELEMUNDO LAS VEGAS LICENSE LLC	Angela Ball C/O NBCUNIVERSAL 300 NEW JERSEY AVENUE, NW WASHINGTON, DC 20001 United States	+1 (202) 524-6413	ANGELA.BALL@NBCUNI.COM	Limited Liability Company

Applicant

Address

Phone

Applicant Type

TELEMUNDO LAS VEGAS LICENSE LLC

Angela Ball

C/O NBCUNIVERSAL

300 NEW JERSEY AVENUE, NW

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.	No
Briefly describe transition plan	Install antenna for new channel on new tower while using existing main antenna on pre-auction channel with auxiliary transmitter. Replace mask filter and retune existing main transmitter for new channel. Modify aux for use on new channel after cut-over.

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	Retune Existing
	Use	Primary (Main)
	Ownership	Owned
	Owner	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	Rohde & Schwarz
	Model	THU-9/24
	Year	2013
	Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	24 kW

Primary Transmitter

Retuning Transmitter Costs

Section	Question	Response
New IOT Tubes	Number of Tubes (including accessories) needed	N/A
New Mask Filter
	Power	30 kW
	Other Power	N/A
New Exciter	Is a new exciter needed?	No

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	Transformer - 45 KVA K13 480/400Y-230
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
Transmitter Installation	Transmitter Installation; cabinet R&S, coax, SW, Electrical & Load including covert and add switched

Auxiliary Transmitter

Existing Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Purchase New
	Use	Auxiliary (Backup)
	Description of Use	Backup
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is this transmitter currently shared with another station?	No
	Is this transmitter currently in operating condition?	Yes
Existing Transmitter Manufacturer and Type	Manufacturer
	Model	TDU2-5K00LV
	Year	2006
	Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power Capacity	5 kW

Auxiliary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Auxiliary (Backup)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Manufacturer
	Model	THU9-5 (Non-EVO)
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	5.8 kW
	Justification for New Transmitter	Support for existing transmitter ends on 12/31/2019 and we are concerned about reliability with the extended use required as part of the repack and the lack of any backup once the existing main transmitter is moved to the new channel.

Auxiliary 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	No
	Description	N/A
HVAC Service	Does the replacement transmitter require HVAC Service?	No
	Type	N/A
	Size	N/A
	Other Size	N/A
Transmitter Building Addition/Modification or Leasehold Improvement	Does the Transmitter Building require an addition, modification, other leashold improvement?	No
	Size	N/A
Channel 14 Costs	Is an RF Consulting Engineer needed?	N/A
	Is a channel 14 Mask Filer needed?	N/A
	Is additional field engineering time needed?	N/A
	Number of Days	N/A

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Auxilary Transmitter Installation Costs	Installation cost including RF system modification and electrical work

Antennas

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

Auxiliary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Purchase New
	Antenna Use	Auxiliary (Backup)
	Description of Use	Backup and operation during maintenance of 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?	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	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:	230.0 kW
	Manufacturer
	Model	TLP-16E-SP
	Year	2006

Auxiliary Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Auxiliary (Backup)
	Description of Use	During tower maintenance
	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	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	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:	205.0 kW
	Manufacturer
	Model	TLP-16E-SP
	Year	2018
	Justification for New Antenna	Existing auxiliary antenna is single channel only and current location is blocked by new tower.

Auxiliary Antenna

Other Antenna Costs

Section	Question	Response
Combiner for Shared Antenna	Do you need a Combiner for a Shared Antenna?	No
	Type
	Number of channels supported	N/A
	Frequencies of channels supported	N/A
	Frequency	N/A
	Do you need a combiner output splitter/switcher for dual feed lines?	N/A
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	No
	Broadband or Single Channel?	N/A
	Feed Line Size	N/A
Side Mount Brackets	Do you require the separate purchase of side mount brackets for 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

Other Antenna Cost Not Listed

Information not provided.

Primary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Purchase New
	Antenna Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing antenna shared with another station or stations?	No
	Is the existing antenna directional?	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	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:	1000.0 kW
	Manufacturer
	Model	ATW16H3-HSC5U-39S
	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?	Yes
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	Yes
	Will antenna be located on or in close proximity to an antenna farm?	Yes
New Antenna Manufacturer and Types	Class	Full Power
	Mounting	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:	655.0 kW
	Manufacturer
	Model	TFU-17ETT/VP-R S340
	Year	2018
	Justification for New Antenna	Existing antenna will not operate on thenew channel. New tower was designed for top mount antenna. Adding structure to top for side mount would increase cost. Upgraded to elliptical polarization.

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	4 1/16 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?	Yes

Primary Antenna

Other Antenna Cost Not Listed

Name	Description
Vertical Component	Addition of Vertical Component

Transmission Line

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

Auxiliary Transmission Line

Existing Transmission Line

Section	Question	Response
Existing Transmission Line Description	Type of change	Purchase New
	Use	Auxiliary (Backup)
	Description of Use	Connection to new aux antenna
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing transmission line shared with another station or stations?	No
	Is Transmission Line in operating condition?	Yes
Existing Transmission Line Manufacturer and Type	Manufacturer
	Type	Flexible Air
	Diameter	3 inches
	Other Diameter	N/A
	Segment Length	N/A
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	285 feet per run

Auxiliary Transmission Line

New Transmission Line

Section	Question	Response
New Transmission Line Costs	Use	Auxiliary (Backup)
	Description of Use	Allows station to stay on air in event of failure and to protect workers on tower top
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Type	Flexible Air
	Diameter	3 inches
	Other Diameter	N/A
	Segment Length	N/A
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	240 feet per run
	Justification for New Transmission Line	Existing line goes to a different tower that is no longer usable and was installed in conduit. Removing it will destroy it making it unusable for use with this antenna.

Auxiliary Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Primary Transmission Line

Existing Transmission Line

Section	Question	Response
Existing Transmission Line Description	Type of change	Purchase New
	Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing transmission line shared with another station or stations?	No
	Is Transmission Line in operating condition?	Yes
Existing Transmission Line Manufacturer and Type	Manufacturer
	Type	Flexible Air
	Diameter	5 inches
	Other Diameter	N/A
	Segment Length	N/A
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	245 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	4 1/16 inches
	Other Diameter	N/A
	Segment Length	19 1/2 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	410 feet per run
	Justification for New Transmission Line	Existing line needs to be kept on old tower during the transition to allow operation on the current channel while equipment for the new channel is installed and tested.

Primary 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

Auxiliary Tower

Existing Tower

Section	Question	Response
Existing Tower Description	Type of change	Move Equipment
	Tower Use	Auxiliary (Backup)
	Description of Use	Backup and for use during maintenance on main tower
	Ownership	Leased
	Is this tower consider Complex?	No
	Is this tower currently shared with any other stations?	No
	One or more FM, AM or TV radio broadcaster(s)	N/A
	Others Types of Users	N/A
	Is tower documented for structural analysis?	No
	Is tower compliant with Rev G?	No
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1058295
Coordinates (NAD83)	Latitude (NAD83)	36° 00' 34.2" N-
	Longitude (NAD83)	115° 00' 22.1" W-
	Overall Structure Height	102.03 feet
	Support Structure Height	80.05 feet
	Ground Elevation Above Mean Sea Level (AMSL)	3268.66 feet
	Structure Type	LTOWER - Lattice Tower
	Tower Owner	American Towers, LLC
	Date Constructed	03/01/1999

Auxiliary Tower

Tower Rigging Costs

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

Auxiliary Tower

Other Tower Expenses Not Listed

Name	Description
Remove ch 40 aux antenna	Remove and dispose of channel 40 antenna and transmission line.

Primary Tower

Existing Tower

Section	Question	Response
Existing Tower Description	Type of change	Construct New
	Tower Use	Primary (Main)
	Description of Use	N/A
	Ownership	Leased
	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	Yes
	Is tower documented for structural analysis?	Yes
	Is tower compliant with Rev G?	No
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1009985
Coordinates (NAD83)	Latitude (NAD83)	36° 00' 36.4" N-
	Longitude (NAD83)	115° 00' 22.7" W-
	Overall Structure Height	251.97 feet
	Support Structure Height	247.04 feet
	Ground Elevation Above Mean Sea Level (AMSL)	3227.98 feet
	Structure Type	LTOWER - Lattice Tower
	Tower Owner	American Tower, LLC
	Date Constructed	08/24/2001

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
14302	K43FO-D	DTV
10498	KEEN-CD	DTV
66807	KHDF-CD	DTV
57281	KCYE	FM
40757	KKLZ	FM

Other Types of Users

Users
KVEG-FM1 92496
KLVD-LD 69786

Primary Tower

Tower Construction Costs

Section	Question	Response
Construct New Tower	Use	Primary (Main)
	Description of Use	N/A
	Is this a request for upgraded equipment?	No
	Height	200.00 feet
	Justification for New Tower	See attachment "KBLR Tower Justification Letter 060817.pdf" from American Tower Company

Primary Tower

Tower Rigging Costs

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

Primary Tower

Other Tower Expenses Not Listed

Name	Description
Remove channel 40 antenna	Cost to remove and dispose of old channel 40 main antenna and line and relocate FM stations during tower work

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	1040
	Explanation	6 months of PM at $150/hr for 40 hours per week total cost $156,000
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	Yes
	ASR Modification	Yes
	FAA Consultation (including preparation of FAA Form 7460)	Yes
	Negotiation of Lease and other Matter for Shared Locations	Yes
	Prepare or Review FCC Form 399 for Reimbursement	Yes
	Address transition timing and coordination issues w/ other stations and wireless providers	Yes
RF Field Engineering Services	Comprehensive coverage verification via field study	Yes
	RF exposure measurements	Yes
	Additional Field Engineering Service	Yes
	Number of Days	30
	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

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

Other Expenses

Other Expenses Not Listed

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	$799,705.95	$732,094.94	N/A	$480,604.44	N/A
Total for all systems	$2,963,085.62	$2,145,549.50	N/A	$1,503,654.73	N/A
Primary Transmitter THU-9/24	$366,205.95	$376,094.94		$259,386.74
UHF and VHF - minor banding issues	$105,200.00	$105,200.00	Modifications to RF system, retune 24 amplifiers. See attachment "KBLR Marsand Quote REVISED" 2nd line item. 8% NV tax added	$0.00	N/A
Transmitter Installation	$224,075.95	$224,075.95	N/A	$212,567.75	N/A
30 kW mask filter	$32,600.00	$42,488.99	See attachment "Marsand Filter Quote". 8% NV tax added to quoted price	$42,488.99	N/A
Other Electrical Service: Transformer - 45 KVA K13 480/400Y-230	$4,330.00	$4,330.00	See attached quote	$4,330.00	N/A
Auxiliary Transmitter THU9-5 (Non-EVO)	$433,500.00	$356,000.00		$221,217.70
Auxilary Transmitter Installation Costs	$160,000.00	$160,000.00	See attached quote "KBLR Marsand Quote REVISED" - 1st item "Install 1 cabinet R&S, coax, SW, electrical & load" plus first item in post-cutover work order	$26,370.00	N/A
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW	$273,500.00	$196,000.00	See quote "KBLR Transmitter Quote Updated 9-11". 8% NV sales tax added to quoted price	$194,847.70	N/A

Components

Actual Information Description	File Name
UHF and VHF - minor banding issues	Component Description: Wrong upload/399 category Amount: N/A Component Description: wrong line Amount: N/A Component Description: See 2nd item of invoice. Amount: $51,390.40 Component Description: Wrong upload Amount: N/A Component Description: See 2nd line of invoice Amount: $10,278.08 Component Description: See line 2 on invoice. Amount: $41,112.32
Transmitter Installation	Component Description: Please see line item 1& 2 for the reimbursement request for the install I cabinet R&S and convert add switches Amount: $112,037.98 Component Description: Install I cabinet R&S and Convert & add switches, please see line item 1 & 2. Amount: $22,407.60 Component Description: Install I cabinet R&S and Convert & add switches, line item 1 & 2. Amount: $78,122.17
30 kW mask filter	Component Description: 8 Pole Mask Filter Amount: $42,488.99
Other Electrical Service: Transformer - 45 KVA K13 480/400Y-230	Component Description: Transformer Amount: $4,330.00
Auxilary Transmitter Installation Costs	Component Description: uploaded into the wrong category Amount: N/A Component Description: See Line 1: Post Repack - re-route aux transmitter, retune to post repack channel, connect aux mask filter to output switch Amount: $13,185.00 Component Description: Wrong upload Amount: N/A Component Description: Post Repack - re-route aux transmitter, retune to post repack channel, connect aux mask filter to output switch Amount: $13,185.00 Component Description: See line 1 on invoice. Amount: $48,518.06 Component Description: See 1st line of invoice Amount: $12,129.52 Component Description: See line 1 of invoice. Amount: $60,647.58 Component Description: Wrong category Amount: N/A
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW	Component Description: Transmitter Cost plus tax Amount: $194,068.30 Component Description: TEST SYSTEM REVISED Amount: $779.40 Component Description: Test System ERST.2 2108.4809.40 Amount: $779.40 Component Description: GD900Z3 TEST SYSTEM REVISED Amount: $779.40

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	$546,865.00	$232,765.78	N/A	$147,194.61	N/A
Total for all systems	$2,963,085.62	$2,145,549.50	N/A	$1,503,654.73	N/A
Primary Antenna TFU-17ETT/VP-R S340	$322,225.00	$189,028.00		$110,868.52
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	$289,500.00	$150,000.00	See quote "DMS081 NBC KBLR REPACK.pdf ",. $16,425.00 cost for vertical polarization removed. 8% NV tax of $13,675.44 added to remaining total.	$91,986.05	N/A
Vertical Component	$16,425.00	$16,425.00	Addition of Vertical Component	$0.00	N/A
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)	$9,570.00	$16,203.00	See quote "DMS081 NBC KBLR REPACK.pdf". 8% NV tax of $644.40 added.	$12,482.47	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	See Dielectric quote.	$6,400.00	N/A
Auxiliary Antenna TLP-16E-SP	$224,640.00	$43,737.78		$36,326.09
Sweep test of existing antenna	$6,730.00	$4,500.00	N/A	$4,268.89	N/A
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized	$189,500.00	$24,311.80	*System Notice: Estimate adjusted and locked because line has been superseded.*See line 1 of attached quote	$24,311.80	N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	$5,260.00	$3,800.00	N/A	$0.00	N/A
Side mount brackets for high power antennas (if not included in antenna base cost)	$23,150.00	$11,125.98	Required for side mount on tapered tower. Included in attached quote "700353CMZ KBLR AUX NBC.pdf" from Dielectric. Added 8% NV tax to quote.	$7,745.40	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: wrong upload Amount: N/A Component Description: UHF High Power Top Mount (200 and 1000 KW), included in this area. REVISED Amount: $76,924.35 Component Description: UHF High Power Top Mount 200 to 1000 KW, included in this area. REVISED Amount: $76,924.35 Component Description: 45% of line 1 on invoice Amount: $76,924.35 Component Description: UHF High Power Top Mount 200 and 1000 KW, included in this area. 10% is more than the outstanding balance. The outstanding balance is 9% of the remaining balance of the Quote. Please see reconciliations calculations attached. REVISED Amount: $15,061.70 Component Description: See Line 1 - UHF - HIGH POWER TOP MOUNT (200- 1000KW) ONE STATION ANTENNA, ELLIPTICALLY POLARIZED OR CIRCULARLY POLARIZED ANT TFU-17ETT/VP-R S340 CH 20 KBLR Amount: $17,094.30
Vertical Component	Component Description: See Line 2 - 45% of VPOL Component Amount: $7,391.25 Component Description: Line 2 - 10% OTHER VPOL COMPONENTS Amount: $1,642.50 Component Description: Line 2 - 45% VPOL Component Amount: $7,391.25
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)	Component Description: Line 3, Elbow complex 4-50 CH 20 KBLR included under this area. 10% is more than the outstanding balance. The outstanding balance is 9% of the remaining balance of the Quote. Please see reconciliations calculations attached. REVISED Amount: $709.72 Component Description: ELBOW 4-50 DIGIT 7 X 14 "QS" Amount: $8,148.00 Component Description: 45% of line 3 on invoice Amount: $3,624.75 Component Description: Elbow complex 4-50 CH 20 KBLR are included in this area REVISED Amount: $3,624.75 Component Description: Wrong upload Amount: N/A Component Description: See Line 3 - 10% of ELBOW COMPLEX 4-50 CH20 KBLR Amount: $805.50
Sweep test of existing antenna	Component Description: SWEEP KBLR MAIN ANTENNA DONE BY MATT SANDERFORD. REVISED Amount: $6,400.00 Component Description: Duplicate submission Amount: N/A Component Description: Wrong upload Amount: N/A
Sweep test of existing antenna	Component Description: Antenna line sweep REVISED Amount: $2,250.00 Component Description: See "Antenna line sweep" on invoice. Amount: $1,800.00 Component Description: Sweep test of existing antenna costs are requested here. REVISED Amount: $1,568.89 Component Description: See "Antenna line sweep" on invoice. Amount: $2,250.00 Component Description: Sweep test of existing antenna. REVISED Amount: $450.00 Component Description: Aux antenna line sweep Amount: $450.00
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized	Component Description: TLSCR 4/50 SWIVEL FLANGE ONE END FIXED FLANGE ONE END REVISED Amount: $2,404.50 Component Description: See line 1 of invoice Amount: $9,873.90 Component Description: TLSCR 4/50 @ 34-7/16 inch Amount: $577.50 Component Description: See line 1 on invoice. Amount: $9,873.90 Component Description: TLSCR 4/50 SWIVEL FLANGE ONE END FIXED FLANGE ONE END Amount: $2,404.50 Component Description: TLSCR 4/50 @ 34-7/16" SWIVEL FLANGE ONE END FIXED FLANGE ONE END REVISED Amount: $577.50 Component Description: TLSCR 4/50 Swivel Flange One end Fixed One End Amount: $1,582.00 Component Description: TLSCR 4/50 SWIVEL FLANGE ONE END. FIXED FLANGE ONE END. REVISED Amount: $1,582.00
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)	Component Description: Additional items needed to move location of antenna on tower and replacement of damaged slot covers Amount: $1,254.00 Component Description: See line 2 of invoice. Amount: $3,872.70 Component Description: See line 2 on invoice. Amount: $3,872.70 Component Description: Additional items needed to move location of antenna on tower and replacement of damaged slot covers REVERSED Amount: $1,254.00

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	$72,380.00	$72,736.49	N/A	$37,273.77	N/A
Total for all systems	$2,963,085.62	$2,145,549.50	N/A	$1,503,654.73	N/A
Primary Transmission Line	$58,220.00	$58,220.00		$25,176.69
Rigid Transmission Line - copper, 4 1/16"	$58,220.00	$58,220.00	See quote "DMS081 NBC KBLR REPACK.pdf" Item 3.	$25,176.69	N/A
Auxiliary Transmission Line	$14,160.00	$14,516.49		$12,097.08
Flexible Air Transmission Line - dielectric, 3"	$14,160.00	$14,516.49	Price includes dehydrator, line support, and connectors. See "700353CMZ KBLR AUX NBC.pdf". 8% NV sales tax added to quote.	$12,097.08	N/A

Components

Actual Information Description	File Name
Rigid Transmission Line - copper, 4 1/16"	Component Description: T/L accessories. please find attached quote Amount: $2,404.50 Component Description: Rigid Transmission Line costs are Requested here. REVISED Amount: $21,054.29 Component Description: 45% of line 4 on invoice Amount: $21,054.29 Component Description: See Line 4 - 10% for Rigid Transmission Line Copper - 4-1/16" 50 OHM 410' (240' V - 170' H) Amount: $4,678.73 Component Description: Line 4, RIGID Transmission Line included under this area. 10% is more than the outstanding balance. The outstanding balance is 9% of the remaining balance of the Quote. Please see reconciliations calculations attached. REVISED Amount: $4,122.40 Component Description: RIGID Transmission Line are included under this area. REVISED Amount: $21,054.29
Flexible Air Transmission Line - dielectric, 3"	Component Description: See line 3 on invoice. Amount: $6,048.54 Component Description: See line 3 of invoice. Amount: $6,048.54

Actual Information Description

File Name

Rigid Transmission Line - copper, 4 1/16"

Component Description:: T/L accessories. please find attached quote
Amount:: $2,404.50

Component Description:: Rigid Transmission Line costs are Requested here. REVISED
Amount:: $21,054.29

Component Description:: 45% of line 4 on invoice
Amount:: $21,054.29

Component Description:: See Line 4 - 10% for Rigid Transmission Line Copper - 4-1/16" 50 OHM 410' (240' V - 170' H)
Amount:: $4,678.73

Component Description:: Line 4, RIGID Transmission Line included under this area. 10% is more than the outstanding balance. The outstanding balance is 9% of the remaining balance of the Quote. Please see reconciliations calculations attached. REVISED
Amount:: $4,122.40

Component Description:: RIGID Transmission Line are included under this area. REVISED
Amount:: $21,054.29

Flexible Air Transmission Line - dielectric, 3"

Component Description:: See line 3 on invoice.
Amount:: $6,048.54

Component Description:: See line 3 of invoice.
Amount:: $6,048.54

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	$1,123,574.67	$812,113.67	N/A	$621,093.70	N/A
Total for all systems	$2,963,085.62	$2,145,549.50	N/A	$1,503,654.73	N/A
Primary Tower LTOWER	$0.00	$0.00		$0.00
Auxiliary Tower LTOWER	$156,200.00	$115,739.00		$76,801.50
Remove ch 40 aux antenna	$72,000.00	$72,000.00	See quote "Quote1743B-2 - kblr - post repack.pdf" - 4th item	$70,787.50	N/A
Short Tower (less than 500')	$84,200.00	$43,739.00	See quote "KBLR Marsand Quote REVISED" - attached. Auxiliary antenna installation along with antenna line sweep. Plus additional charges for unexpected delays.	$6,014.00	N/A
Primary Tower	$967,374.67	$696,374.67		$544,292.20
Remove channel 40 antenna	$385,000.00	$385,000.00	See attachment "Quote1743B-2 - kblr - post repack.pdf". Work must be done at night as lease does not require other tower users to shutdown or reduce power during the day to protect workers.	$382,917.53	N/A
New tower	$161,374.67	$161,374.67	See attachment "KBLR Justification Letter 0601817.pdf" from ATC for KBLR portion of new tower cost. Also see attached quote.	$161,374.67	N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	$421,000.00	$150,000.00	See quote "KBLR Marsand Quote REVISED" - 6th item - main antenna installation. Also see invoice for additional charges due to unexpected delay.	$0.00	N/A

Components

Actual Information Description	File Name
Remove ch 40 aux antenna	Component Description: Wallen crew to install aux antenna line Amount: $18,862.50 Component Description: Wallen crew to install Aux antenna line Amount: $13,152.50 Component Description: Wallen crew to install Aux antenna line Amount: $3,772.50 Component Description: Removal of aux antenna and line and disposal Amount: $35,000.00
Short Tower (less than 500')	Component Description: Wallen crew installation aux antenna and line. REVISED Amount: $4,316.12 Component Description: Additional tower charges for aux installation Amount: $6,014.00 Component Description: See "Wallen crew" on invoice. Amount: $15,090.00 Component Description: See "Wallen crew" on invoice. Amount: $18,862.50 Component Description: See line "Wallen crew to install Aux antenna and line" Amount: $3,772.50 Component Description: Wrong line item Amount: N/A
Remove channel 40 antenna	Component Description: ERI crew to install main antenna line Amount: $64,950.00 Component Description: ITI to remove main antenna and line and dispose of after repack Amount: $86,145.00 Component Description: Line 2, ITII to remove main antenna channel 39 and dispose of after repacked. REVISED Amount: $86,145.00 Component Description: Additional items to remove antenna on tower and replacement of damaged slot covers. Amount: $1,254.00 Component Description: ERI tower crew costs for main antenna Amount: $45,288.53 Component Description: See Line 2: ITI to remove main antenna and line and dispose of after repack Amount: $86,145.00 Component Description: ERI crew to install main antenna Amount: $12,990.00
New tower	Component Description: New tower capital contribution Amount: $161,374.67
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	Component Description: Complex Tower includes, for example, those with candelabras and or stacked antennas. REVISED Amount: $14,861.87 Component Description: Wrong upload Amount: N/A Component Description: See line "ERI crew to install main antenna and line" and line "ERI extra charges due to weather and delivery delays" Amount: $23,210.00 Component Description: See 6th item of invoice for antenna installation cost. Amount: $64,950.00 Component Description: Wrong upload Amount: N/A Component Description: See "ERI crew" line on invoice. Amount: $51,960.00

Cost Information

Outside Professional Services

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

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$330,605.00	$213,450.00	N/A	$156,785.01	N/A
Total for all systems	$2,963,085.62	$2,145,549.50	N/A	$1,503,654.73	N/A
Outside Professional Services	$330,605.00	$213,450.00		$156,785.01
Internal Reimbursement	$10,000.00	$10,000.00	N/A	$0.00	N/A
Additional Field Engineering Service, 30 Days	$15,000.00	$15,000.00	See "post-repack" quote, plus invoice attached for site survey	$10,000.00	N/A
RF Exposure Measurements	$21,050.00	$10,000.00	N/A	N/A	N/A
Comprehensive coverage verification via field study, if needed	$84,200.00	$50,000.00	N/A	$48,395.00	N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	$2,105.00	$2,000.00	N/A	N/A	N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet	$10,520.00	$10,000.00	N/A	N/A	N/A
Attorney Fees - Negotiation of lease and other matters for shared locations	$4,210.00	$1,000.00	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	$947.00	N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application	$4,210.00	$2,000.00	N/A	N/A	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$1,500.00	N/A	$872.55	N/A
Prepare and or review reimbursement form	$2,630.00	$5,200.00	Additional costs associated with revisions to Form 399.	$3,530.82	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
ASR modification (prepare FCC Form 854)	$2,105.00	$2,000.00	N/A	N/A	N/A
Project management of the transition	$164,320.00	$100,000.00	N/A	$93,039.64	N/A

Components

Actual Information Description	File Name
Internal Reimbursement	Component Description: NBC internal reimbursement invoice for hours spent by resource Pat Stahl on KBLR FCC repack work August 2017 Amount: $5,492.92
Additional Field Engineering Service, 30 Days	Component Description: Engineering site visit, inspection, measurements, drawing, and planning for repack transmitter and RF installation, budgeting and planning. Amount: $10,000.00
RF Exposure Measurements	Information not provided.
Comprehensive coverage verification via field study, if needed	Component Description: Field Measurement at KBLR station. Please see email attachment for Vendor. REVISED Amount: $48,395.00 Component Description: Field Measurements expenses at KBLR Amount: $48,395.00
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	Information not provided.
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet	Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations	Component Description: Attorney Fees for Station KBLR Amount: $1,029.06
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Component Description: AUX CP fee Amount: $380.00 Component Description: Application fee for AUX - License to cover Amount: $380.00 Component Description: Lines 1 and 2, less a portion of the discount. Amount: $226.80 Component Description: Application fee for AUX - License to cover Amount: $380.00 Component Description: Preparation of LMS minor change application for post-repack facility. Amount: $340.20
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: KBLR AUX construction permit legal fees. Amount: $1,335.00 Component Description: Attorney Fees for Station KBLR Amount: $340.20 Component Description: AUX Construction Permit Fee Amount: $1,335.00 Component Description: KBLR AUX construction permit legal fees. Amount: $1,335.00 Component Description: Lines 1 and 2, less a portion of the discount. Amount: $226.80 Component Description: Attorney Fees for Station KBLR Amount: $305.55 Component Description: Preparation of LMS minor change application for post-repack facility Amount: $340.20
Prepare and or review reimbursement form	Component Description: Attorney Fees for Station KBLR Amount: $261.90 Component Description: Review 399 reimbursement request for Station KBLR Amount: $35.70 Component Description: Attorney Fees for Station KBLR Amount: $87.30 Component Description: Attorney Fees for Station KBLR Amount: $35.70 Component Description: Review and Revision of Form 399. Amount: $121.86 Component Description: Review of Form 399 Amount: $218.25 Component Description: Review of Form 399 Amount: $226.80 Component Description: Lines 3-6 of invoice, less 10% discount. Amount: $802.26 Component Description: Review and revision of form 399. Amount: $1,741.05
Address transition timing and coordination issues w/ other stations and wireless	Information not provided.
ASR modification (prepare FCC Form 854)	Information not provided.
Project management of the transition	Component Description: Project Management (completed by December 2017). REVISED Amount: $17,700.00 Component Description: Jan 2018 Project Management Amount: $975.00 Component Description: KBLR - Point B invoice February 2020 Amount: $316.00 Component Description: Project Management Services Amount: $2,145.00 Component Description: Repack Finance Resource Project Management Services- 63768 Amount: $1,264.00 Component Description: KBLR - Point B invoice March 2020 Amount: $316.00 Component Description: Project Management services costs are requested here. REVISED Amount: $3,525.00 Component Description: Project management services Amount: $348.95 Component Description: This is a cost for project management work that has already been performed. Hours and expenses outlined on invoice from months in 2017. Amount: $17,764.20 Component Description: Project management services Amount: $4,420.00 Component Description: Project management services Amount: $2,145.00 Component Description: See breakdown of completed project management work on invoice for months in 2017 and receipts for travel expenses. Amount: $14,211.36 Component Description: July 2018 Project Management Amount: $16,300.00 Component Description: See invoice for breakdown of project management charges Amount: $3,552.84 Component Description: Project Management: Coordination of tower crews, receipt of transmitter and antennas, site coordination with tenants costs are requested here. REVISED Amount: $11,675.31 Component Description: August 2018 Project Management Amount: $16,871.38 Component Description: November project management services Amount: $3,510.00 Component Description: June 2018 Project Management Amount: $3,300.00 Component Description: Project management services Amount: $7,280.00 Component Description: Project Management services for KBLR station Amount: $948.00

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	$89,955.00	$82,388.62	N/A	$60,703.20	N/A
Total for all systems	$2,963,085.62	$2,145,549.50	N/A	$1,503,654.73	N/A
Other Expenses	$89,955.00	$82,388.62		$60,703.20
MVPD Notification of Channel Change	$5,000.00	$5,000.00	N/A	N/A	N/A
Develop and air announcement of upcoming channel change	$10,000.00	$10,000.00	Production of announcements and air-time for announcements	N/A	N/A
Equipment Delivery and Handling Charges	$25,000.00	$25,000.00	N/A	$22,735.00	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$35,460.00	$35,460.00	See "KBLR Marsand Quote REVISED" item "Disposal Thales, CIF, Aux filter & RF". Channel 40 antenna disposal costs are included in tower rigging estimates.	$33,809.58	N/A
Local Zoning	$1,500.00	$1,500.00	To be provided by ATC	$125.00	N/A
FCC Filing Fees - Form 2100 license to cover application	$335.00	$325.00	N/A	$0.00	N/A
FCC Filing Fees - Form 2100 minor change CP application	$1,110.00	$1,070.00	N/A	N/A	N/A
DTV Medical Facility Notification	$11,550.00	$4,033.62	N/A	$4,033.62	N/A

Components

Actual Information Description	File Name
MVPD Notification of Channel Change	Information not provided.
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Delivery and Handling Charges	Component Description: Revised invoice uploaded with correct EIN#. Amount: $212.89 Component Description: Vehicle ordered but not used. not reimbursable, Amount: N/A Component Description: vehicle Ordered but not used Amount: $250.00 Component Description: Revised invoice uploaded with correct EIN#. Amount: $310.07 Component Description: total Line Haul, Contract Minimum reached, Fuel Surcharge Percent and Gap Insurance Amount: $310.07 Component Description: Line Haul Amount: $6,650.00 Component Description: Total Line Haul and Fuel Surcharge Amount: $5,595.00 Component Description: Total Line Haul and Fuel Surcharge Amount: $5,495.00 Component Description: Total Line Haul and Fuel Surcharge Amount: $4,995.00
Disposal Costs (for equipment and other waste, net of any salvage value)	Component Description: Disposal of Thales, CIF aux filter and RF Amount: $17,820.00 Component Description: See 3rd item of invoice. Amount: $17,820.00 Component Description: See 3rd item of invoice. Amount: $14,256.00 Component Description: See 3rd line of invoice Amount: $3,564.00 Component Description: Disposal Costs for equipment and other waste, net of any salvage value. REVISED Amount: $3,564.00 Component Description: Disposal Costs for equipment and other waste, net of any salvage value. REVISED Amount: $12,425.58
Local Zoning	Component Description: Permitting Research Amount: $125.00
FCC Filing Fees - Form 2100 license to cover application	Information not provided.
FCC Filing Fees - Form 2100 minor change CP application	Information not provided.
DTV Medical Facility Notification	Component Description: Second mailing of Medical Notifications due to cutover date change. Updated invoice by attaching quote for work on second page. Amount: $283.62 Component Description: Medical Notification Mailing Amount: $3,750.00

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$2,963,085.62	$2,145,549.50	$1,503,654.73

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

08/28/2022

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

08/28/2022

Certification

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

08/28/2022

(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

Retuning Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Auxiliary Transmitter

Existing Transmitter Information

Auxiliary Transmitter

New Transmitter Costs

Auxiliary Transmitter

Other Transmitter Costs

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Antennas

Auxiliary Antenna

Existing Antenna Information

Auxiliary Antenna

New Antenna Costs

Auxiliary Antenna

Other Antenna Costs

Auxiliary Antenna

Other Antenna Cost Not Listed

Primary Antenna

Existing Antenna Information

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Transmission Line

Auxiliary Transmission Line

Existing Transmission Line

Auxiliary Transmission Line

New Transmission Line

Auxiliary Transmission Line

Other Transmission Line Expenses Not Listed

Primary Transmission Line

Existing Transmission Line

Primary Transmission Line

New Transmission Line

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Tower Equipment And Rigging Costs

Auxiliary Tower

Existing Tower

Auxiliary Tower

Tower Rigging Costs

Auxiliary Tower

Other Tower Expenses Not Listed

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

Other Types of Users

Primary Tower

Tower Construction 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