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

FCC Form 399: Reimbursement Request

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

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

Facility ID:
68061
Service:
LPX
Call Sign:
WRJK-LD
Channel:
11 (High VHF)
File Number:
0000089887
FRN:
0021414032
Eligibility Status:
Eligible
Date Submitted:
01/03/2024

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

CHICAGO 22, LLC

Doing Business As: CHICAGO 22, LLC

Ravi Kapur

2118 WALSH AVE.

SUITE 208

SANTA CLARA, CA 95050

United States

+1 (415) 886-7284 FCC@CHICAGO22.COM Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Tony Zummallen

QCommunications, LLC

Tony zumMallen

705B SE Melody Lane

STE B

LEES SUMMIT, MO 64063

United States

+1 (816) 882-5600 Tony@qcomm.tv

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan Replace the transmitter, line and antenna per the channel reassignment with reasonable and customary engineering and business practices. Tenant on Willis Tower, Chicago.

Question Response
Sharee Station Facility ID 10801
Call Sign WFMT
Type Commercial
Licensee Name WINDOW TO THE WORLD COMMUNICATIONS
Status LICENSED
DTS No
Community of License CHICAGO, IL
Pre-auction RF Channel 254
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 53971
Call Sign WCHI-FM
Type Commercial
Licensee Name IHM LICENSES, LLC
Status LICENSED
DTS No
Community of License CHICAGO, IL
Pre-auction RF Channel 238
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 74178
Call Sign WKSC-FM
Type Commercial
Licensee Name IHM LICENSES, LLC
Status LICENSED
DTS No
Community of License CHICAGO, IL
Pre-auction RF Channel 278
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 28621
Call Sign WBMX
Type Commercial
Licensee Name Audacy License, LLC
Status LICENSED
DTS No
Community of License CHICAGO, IL
Pre-auction RF Channel 282
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 6377
Call Sign WTMX
Type Commercial
Licensee Name CHICAGO FCC LICENSE SUB, LLC
Status LICENSED
DTS No
Community of License SKOKIE, IL
Pre-auction RF Channel 270
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 51165
Call Sign WGCI-FM
Type Commercial
Licensee Name IHM LICENSES, LLC
Status LICENSED
DTS No
Community of License CHICAGO, IL
Pre-auction RF Channel 298
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 10802
Call Sign WTTW
Type Noncommercial Educational
Licensee Name WINDOW TO THE WORLD COMMUNICATIONS, INC.
Status LICENSED
DTS No
Community of License CHICAGO, IL
Pre-auction RF Channel 25
Post-auction RF Channel 47
Neilsen DMA CHICAGO
Network Affiliation
Question Response
Sharee Station Facility ID 9617
Call Sign WBBM-TV
Type Commercial
Licensee Name CBS BROADCASTING INC.
Status LICENSED
DTS No
Community of License CHICAGO, IL
Pre-auction RF Channel 12
Post-auction RF Channel 12
Neilsen DMA Chicago
Network Affiliation
Question Response
Sharee Station Facility ID 71425
Call Sign WWME-CD
Type
Licensee Name CHANNEL 23 LIMITED PARTNERSHIP
Status LICENSED
DTS No
Community of License CHICAGO, IL
Pre-auction RF Channel 20
Post-auction RF Channel 20
Neilsen DMA Chicago
Network Affiliation
Question Response
Sharee Station Facility ID 9613
Call Sign WBBM-FM
Type Commercial
Licensee Name Audacy License, LLC
Status LICENSED
DTS No
Community of License CHICAGO, IL
Pre-auction RF Channel 242
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 32334
Call Sign WJYS
Type Commercial
Licensee Name Millenial Telecommunications, Inc.
Status LICENSED
DTS No
Community of License HAMMOND, IN
Pre-auction RF Channel 21
Post-auction RF Channel 21
Neilsen DMA Chicago
Network Affiliation
Question Response
Sharee Station Facility ID 73228
Call Sign WLS-FM
Type Commercial
Licensee Name RADIO LICENSE HOLDINGS LLC
Status LICENSED
DTS No
Community of License CHICAGO, IL
Pre-auction RF Channel 234
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 168662
Call Sign WMEU-CD
Type
Licensee Name WEIGEL BROADCASTING CO.
Status LICENSED
DTS No
Community of License CHICAGO, IL
Pre-auction RF Channel 18
Post-auction RF Channel 18
Neilsen DMA Chicago
Network Affiliation
Question Response
Sharee Station Facility ID 48772
Call Sign WPWR-TV
Type Commercial
Licensee Name FOX TELEVISION STATIONS, LLC
Status LICENSED
DTS No
Community of License GARY, IN
Pre-auction RF Channel 31
Post-auction RF Channel 31
Neilsen DMA Chicago
Network Affiliation
Question Response
Sharee Station Facility ID 66978
Call Sign WEDE-CD
Type
Licensee Name FIRST UNITED, INC.
Status LICENSED
DTS No
Community of License ARLINGTON HEIGHTS, IL
Pre-auction RF Channel 28
Post-auction RF Channel 28
Neilsen DMA Chicago
Network Affiliation
Question Response
Sharee Station Facility ID 73226
Call Sign WLS-TV
Type Commercial
Licensee Name WLS TELEVISION, INC.
Status LICENSED AND REDUCED POWER
DTS No
Community of License CHICAGO, IL
Pre-auction RF Channel 44
Post-auction RF Channel 44
Neilsen DMA Chicago
Network Affiliation
Question Response
Sharee Station Facility ID 70119
Call Sign WSNS-TV
Type Commercial
Licensee Name NBC TELEMUNDO LICENSE LLC
Status LICENSED
DTS No
Community of License CHICAGO, IL
Pre-auction RF Channel 29
Post-auction RF Channel 29
Neilsen DMA Chicago
Network Affiliation
Question Response
Sharee Station Facility ID 71283
Call Sign WCFS-FM
Type Commercial
Licensee Name Audacy License, LLC
Status LICENSED
DTS No
Community of License ELMWOOD PARK, IL
Pre-auction RF Channel 290
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 72115
Call Sign WGN-TV
Type Commercial
Licensee Name Tribune Media Company
Status LICENSED
DTS No
Community of License CHICAGO, IL
Pre-auction RF Channel 19
Post-auction RF Channel 19
Neilsen DMA Chicago
Network Affiliation
Question Response
Sharee Station Facility ID 71428
Call Sign WCIU-TV
Type Commercial
Licensee Name WCIU-TV LIMITED PARTNERSHIP
Status LICENSED
DTS No
Community of License CHICAGO, IL
Pre-auction RF Channel 23
Post-auction RF Channel 23
Neilsen DMA Chicago
Network Affiliation
Question Response
Sharee Station Facility ID 70042
Call Sign WLIT-FM
Type Commercial
Licensee Name IHM LICENSES, LLC
Status LICENSED
DTS No
Community of License CHICAGO, IL
Pre-auction RF Channel 230
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 22211
Call Sign WFLD
Type Commercial
Licensee Name FOX TELEVISION STATIONS, LLC
Status LICENSED
DTS No
Community of License CHICAGO, IL
Pre-auction RF Channel 31
Post-auction RF Channel 31
Neilsen DMA Chicago
Network Affiliation

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Ownership Owned
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model unknown
Year 2013
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 600 W

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model VAXTE-1R37
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 800 W
Justification for New Transmitter New transmitter required for new channel.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Other Transmitter Costs
Does the transmitter installation require a Transmitter Building Site Survey/Installation? Yes
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Rigid Conduit and Wiring No
Other Electrical Service Yes
Description Willis tower electrical service required
HVAC Service Does the replacement transmitter require HVAC Service? No
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Interim Transmitter Shipping fee

Shipping fees for interim transmitter

Electrical Service at Hancock Building

Due to forced move from Willis Tower to Hancock building, additional electrical infrastructure was necessary to support transmitting activities.

Final Transmitter Taxes

Transmitter sales taxes required for final configuration

Final Transmitter - Decommission

Decommissioning of STA transmitter in preparation for final config transmitter

Interim Transmitter -Decommissioning

Harvesting and removal of old transmitter

Final Transmitter Installation

Transmitter installation costs required for final configuration

Interim Transmitter Taxes

Sales tax for interim transmitter

Final Transmitter - Site prep

Preparation of site for final config transmitter

Final Transmitter Shipping fees

Transmitter shipping fees required for final configuration

Interim Site Prep

Preparation of site for interim transmitter

Final Transmitter

Transmitter required for final configuration

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Ownership Owned
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
Mounting Side Mount
Antenna position in stack Middle
Polarization Horizontal
Type Slotted Coaxial
ERP: 1.4 kW
Manufacturer
Model 4DR-16-2HW
Year 2013

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Change Type Purchase New
Ownership Owned
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
Mounting Side Mount
Antenna position in stack Middle
Polarization Elliptical
Type Slotted Coaxial
ERP: 0.4 kW
Manufacturer
Model JUED-4-3(12)-4(16)
Year 2019
Justification for New Antenna New antenna required for new channel.

Primary Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 1 5/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Mount Design

Design of antenna mount to support proposed antenna to be placed upon the West Bridge of Willis Tower broadcast facilities.

Interim Antenna Shipping fee

Shipping fees for interim antenna

Final Antenna Sales Tax

Sales tax for final antenna

Final Antenna Shipping fee

Shipping fees for final antenna

Final Antenna costs

Costs of final antenna

Interim Antenna Sales Tax

Sales tax for interim antenna

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Ownership Owned
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Foam
Diameter 1 5/8 inches
Number of parallel runs 1
Length 200 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Foam
Diameter 1 5/8 inches
Number of parallel runs 1
Length 400 feet per run
Justification for New Transmission Line New transmission line required for new channel.
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? Yes

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Final Transmission line taxes

Sales tax for final transmission line

Interim Transmission line shipping

Shipping for interim transmission line

Interim Transmission line taxes

Sales tax for interim transmission line

Final transmission line

Costs for final line

Final Transmission line shipping

Shipping for final transmission line

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Ownership Leased
Is this tower consider Complex? Located on Building
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1032960
Coordinates (NAD83) Latitude (NAD83) 41° 52' 44.0" N-
Longitude (NAD83) 087° 38' 08.0" W-
Overall Structure Height 1722.09 feet
Support Structure Height 1435.35 feet
Ground Elevation Above Mean Sea Level (AMSL) 595.14 feet
Structure Type BMAST - Building with Mast
Tower Owner BRE 312 Broadcast, LLC
Date Constructed 09/30/2012

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
32334 WJYS DTV
73228 WLS-FM FM
51165 WGCI-FM FM
10802 WTTW DTV
72115 WGN-TV DTV
6377 WTMX FM
22211 WFLD DTV
73226 WLS-TV DTV
28621 WBMX FM
70119 WSNS-TV DTV
48772 WPWR-TV DTV
9617 WBBM-TV DTV
10801 WFMT FM
71428 WCIU-TV DTV
9613 WBBM-FM FM
70042 WLIT-FM FM
71283 WCFS-FM FM
140658 W236CF FX
74178 WKSC-FM FM

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: No study needed
Tower Reinforcements Please select whether tower reinforcements are needed: No reinforcements needed

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 500
Explanation Required to assist in the turnkey management of the channel relocation project in order that the existing internal personal can maintain and operate the stations daily operational requirements and plans. Willis Tower adds complexity to project.
Outside RF consulting Engineering Services Perform engineering study for displacement application Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
Prepare Form 601 Yes
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Form 399 assistance or other program management costs Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 50
Justification Field engineering costs expected for transition on Willis Tower.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Engineering - General services

General outside engineering services related to Willis Tower

Attorney - General services

General legal fees related to Willis Tower

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Permit and Filing Costs FCC Construction Permit Major Change Yes
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System No
New Point to Point Microwave System No

Other Expenses

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Other Expenses Not Listed

Name Description

Building Permits for CP

building, electrical, and zoning permits

Willis Tower Connection Fees

Connection fees for Willis Tower

Internet Installation

Internet installation at new location

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $335,216.23 $340,792.09 N/A $58,792.09 N/A
Total for all systems $1,158,404.75 $1,597,345.61 N/A $843,988.76 N/A
Primary Transmitter VAXTE-1R37 $335,216.23 $340,792.09 $58,792.09
Final Transmitter Installation $100,000.00 $100,000.00 Estimated costs for installation. Actual costs to be determined. $0.00 N/A
Final Transmitter - Site prep $20,000.00 $20,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Transmitter Building Site Survey/Installation $10,000.00 $10,108.53 Estimated costs for site survey and transmitter installation. Revised upon Site Survey. $10,108.53 N/A
Interim Transmitter -Decommissioning $25,000.00 $25,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Final Transmitter - Decommission $25,000.00 $25,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Final Transmitter Taxes $2,305.38 $2,305.38 Estimated costs. Actual costs to be determined. $2,305.38 N/A
Interim Site Prep $20,000.00 $20,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Interim Transmitter Shipping fee $5,000.00 $5,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Interim Transmitter Taxes $8,000.00 $8,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Other Electrical Service: Willis tower electrical service required $1,536.00 $1,536.00 Estimate of costs for electrical service in Willis Tower for new equipment. Actual costs to be determined. $1,536.00 N/A
High VHF - Air Cooled Solid State Transmitter 400 - 1000 Watts $30,000.00 $35,467.33 Cost determined by quote and invoices attached $35,467.33 N/A
Final Transmitter Shipping fees $3,117.89 $3,117.89 Estimated costs. Actual costs to be determined. $3,117.89 N/A
Final Transmitter $79,000.00 $79,000.00 Estimate of final transmitter costs. Actual costs to be determined. N/A N/A
Electrical Service at Hancock Building $6,256.96 $6,256.96 Additional electrical service necessary to support transmitting activities. $6,256.96 N/A

Components

Actual Information Description File Name
Final Transmitter Installation

Component Description:
Delete
Amount:
N/A

Component Description:
Delete
Amount:
N/A

Component Description:
Delete
Amount:
N/A

Component Description:
Zeroed out. Not for installation of transmitter, but other electrical service. Electrical work due to installation of transmitter.
Amount:
N/A
Final Transmitter - Site prep Information not provided.
Transmitter Building Site Survey/Installation

Component Description:
Tx Installation
Amount:
$4,209.45

Component Description:
Tx Installation
Amount:
$4,209.45

Component Description:
Tx Installation
Amount:
$1,689.63
Interim Transmitter -Decommissioning Information not provided.
Final Transmitter - Decommission Information not provided.
Final Transmitter Taxes

Component Description:
Transmitter Taxes
Amount:
$2,305.38
Interim Site Prep Information not provided.
Interim Transmitter Shipping fee Information not provided.
Interim Transmitter Taxes Information not provided.
Other Electrical Service: Willis tower electrical service required

Component Description:
Electrical work for Transmitter Installation.
Amount:
$1,536.00
High VHF - Air Cooled Solid State Transmitter 400 - 1000 Watts

Component Description:
Transmitter cost payment 3 of 3 invoices
Amount:
$11,822.45

Component Description:
Transmitter Installment payment for transmitter 1 of 3 invoices.
Amount:
$11,822.44

Component Description:
Transmitter cost Payment 2 of 3 invoices
Amount:
$11,822.44
Final Transmitter Shipping fees

Component Description:
Transmitter shipping cost
Amount:
$3,117.89
Final Transmitter Information not provided.
Electrical Service at Hancock Building

Component Description:
Additional electrical work at Hancock Bldg; Prime Electric INV 150617
Amount:
$6,256.96

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $157,055.00 $183,390.00 N/A $84,563.92 N/A
Total for all systems $1,158,404.75 $1,597,345.61 N/A $843,988.76 N/A
Primary Antenna JUED-4-3(12)-4(16) $157,055.00 $183,390.00 $84,563.92
Interim Antenna Sales Tax $2,000.00 $2,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Side Mount antenna brackets $4,625.00 $16,690.00 Actual costs per Jampro invoice $16,690.00 N/A
Sweep test of transmission line and antenna $5,730.00 $20,000.00 Estimated costs for interim and final sweeps. Actual costs to be determined. N/A N/A
High VHF-Low Power, Side Mount, Slotted Coaxial, 0.4kW input, Elliptical $64,800.00 $64,800.00 N/A $64,800.00 N/A
Final Antenna costs $50,000.00 $50,000.00 Estimated costs. Actual costs to be determined. $0.00 N/A
Interim Antenna Shipping fee $5,000.00 $5,000.00 Estimated costs. Actual costs to be determined. $0.00 N/A
Elbow complex, single channel, 1 5/8” input (if needed) $6,900.00 $6,900.00 N/A N/A N/A
Mount Design $8,000.00 $8,000.00 Per attached ERE quote, plus estimated costs for final config. Actual costs to be determined. N/A N/A
Final Antenna Sales Tax $5,000.00 $5,000.00 Estimated costs. Actual costs to be determined. $0.00 N/A
Final Antenna Shipping fee $5,000.00 $5,000.00 Estimated costs. Actual costs to be determined. $3,073.92 N/A

Components

Actual Information Description File Name
Interim Antenna Sales Tax Information not provided.
Side Mount antenna brackets

Component Description:
Mounting Brackets - final invoice - Jampro - INV 20164-A-B-1
Amount:
$8,345.00

Component Description:
Side mount brackets - INV 20164-A-B
Amount:
$8,345.00
Sweep test of transmission line and antenna Information not provided.
High VHF-Low Power, Side Mount, Slotted Coaxial, 0.4kW input, Elliptical

Component Description:
2nd half antenna - Jampro - INV 20164-A-B-1
Amount:
$32,400.00

Component Description:
HPOL equivalent; Jampro - INV 20164-A-B
Amount:
$32,400.00
Final Antenna costs

Component Description:
10/12/22 Zeroed out. For another station. Submitted incorrectly to this one. Main antenna - Kathrein - INV 4370
Amount:
N/A
Interim Antenna Shipping fee

Component Description:
5.18.2022 - Zeroed out and placed shipping in "Other Expenses" Shipping - antenna - Jampro INV 20164-A-B
Amount:
N/A
Elbow complex, single channel, 1 5/8” input (if needed) Information not provided.
Mount Design Information not provided.
Final Antenna Sales Tax Information not provided.
Final Antenna Shipping fee

Component Description:
Shipping costs - Jampro - INV 20164-A-B-1 (full amount of shipping)
Amount:
$3,073.92

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $35,200.00 $35,200.00 N/A $5,476.80 N/A
Total for all systems $1,158,404.75 $1,597,345.61 N/A $843,988.76 N/A
Primary Transmission Line $35,200.00 $35,200.00 $5,476.80
Final Transmission line taxes $1,000.00 $1,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators $10,000.00 $10,000.00 Estimate of interior RF systems required for transition to new channel. Actual costs to be determined. N/A N/A
Flexible Foam Transmission Line - dielectric, 1 5/8" $9,600.00 $9,600.00 N/A N/A N/A
Interim Transmission line shipping $2,000.00 $2,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Interim Transmission line taxes $1,000.00 $1,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Final transmission line $9,600.00 $9,600.00 Estimated costs. Actual costs to be determined. $5,476.80 N/A
Final Transmission line shipping $2,000.00 $2,000.00 Estimated costs. Actual costs to be determined. N/A N/A

Components

Actual Information Description File Name
Final Transmission line taxes Information not provided.
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators Information not provided.
Flexible Foam Transmission Line - dielectric, 1 5/8" Information not provided.
Interim Transmission line shipping Information not provided.
Interim Transmission line taxes Information not provided.
Final transmission line

Component Description:
Transmission Line - Kathrein - INV 4355
Amount:
$5,476.80
Final Transmission line shipping Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $112,519.00 $112,519.00 N/A $112,519.00 N/A
Total for all systems $1,158,404.75 $1,597,345.61 N/A $843,988.76 N/A
Primary Tower BMAST $112,519.00 $112,519.00 $112,519.00
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas) $112,519.00 $112,519.00 Cost determined by invoices. Includes both an interim antenna installation as well as the main antenna installation. $112,519.00 actual costs

Components

Actual Information Description File Name
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas)

Component Description:
Remaining balance due upon completion.
Amount:
$4,908.50

Component Description:
weather days - antenna install - Dyros - INV 125159
Amount:
$23,100.00

Component Description:
75% due upon acceptance
Amount:
$14,725.50

Component Description:
2nd half main antenna install - Dyros - INV 125157
Amount:
$33,145.00

Component Description:
Main antenna install - Dyros - INV 125139
Amount:
$33,145.00

Component Description:
Tower Rigging
Amount:
$3,495.00

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $354,429.52 $754,134.52 N/A $487,157.99 N/A
Total for all systems $1,158,404.75 $1,597,345.61 N/A $843,988.76 N/A
Outside Professional Services $354,429.52 $754,134.52 $487,157.99
Attorney Fees - Prepare and File request for Special Temporary Authorization $4,470.00 $10,000.00 Estimate of costs. Actual costs to be determined. N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $3,262.50 $100,000.00 Estimate of costs. Actual costs to be determined. N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $5,000.00 Estimate of costs. Actual costs to be determined. N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $5,000.00 Estimate of costs. Actual costs to be determined. N/A N/A
Prepare request for Special Temporary Authorization $2,560.00 $6,000.00 Estimate of costs. Actual costs to be determined. N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $10,000.00 Estimate of costs. Actual costs to be determined. N/A N/A
Perform engineering study for displacement application $1,800.00 $5,000.00 Estimate of expected costs. Actual costs to be determined. $2,625.00 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $2,500.00 Per attached Anywave invoice. $2,500.00 N/A
Form 399 assistance or other Program Management costs $34,457.00 $34,457.00 Estimated costs. Actual costs to be determined. $33,687.00 Actual costs equal estimated costs
Project management of the transition $52,750.00 $334,383.00 Per actual costs $334,383.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $5,000.00 Estimate of costs. Actual costs to be determined. N/A N/A
Prepare Form 601 $755.00 $755.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $52,600.00 $43,732.00 Per-attached quote number 726-R for Coverage Verification N/A N/A
Additional Field Engineering Service, 50 Days $55,395.02 $55,395.02 Estimate of field engineering required to assist in transition activities. Includes engineering services for installation activities as well as engineering services to coordinate/facilitate move from Willis Tower to Hancock Bldg. $55,282.99 Per actual costs
Engineering - General services $36,912.50 $36,912.50 Cost determined from invoices $36,512.50 Costs same as estimated
Attorney - General services $100,000.00 $100,000.00 Estimated costs of general attorney fees related to Willis Tower project. Actual costs to be determined. $22,167.50 N/A

Components

Actual Information Description File Name
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Perform engineering study for displacement application

Component Description:
interference studies - July 2021 - Mid States INV 2107-5007
Amount:
$1,125.00

Component Description:
May 2021 interference studies - Mid State - INV 2105-5006
Amount:
$1,125.00

Component Description:
Interference studies June 2021 - Mid State - INV 2106-5009
Amount:
$375.00
Prepare/ Review 399 reimbursement form

Component Description:
399 Submittal
Amount:
$2,500.00
Form 399 assistance or other Program Management costs

Component Description:
399 Follow Up Work
Amount:
$616.00

Component Description:
PM Paperwork
Amount:
$1,509.20

Component Description:
PM Paperwork
Amount:
$1,093.40

Component Description:
May 2022 PM - Anywave - INV FA22206-1462
Amount:
$1,694.00

Component Description:
Sept 2021 PM - Anywave - INV FA2110-1149
Amount:
$1,232.00

Component Description:
PM Paperwork
Amount:
$1,278.20

Component Description:
March 2022 PM - Anywave - INV FA2204-1356
Amount:
$377.30

Component Description:
April 2022 PM - Anywave - INV FA2205-1381
Amount:
$739.20

Component Description:
Oct 2021 PM - Anywave - INV FA2112-1223
Amount:
$1,401.40

Component Description:
Aug 2022 thru closeout - QComm - INV 20220845
Amount:
$2,725.80

Component Description:
Nov 2021 PM - Anywave - FA2202-1288
Amount:
$154.00

Component Description:
1st Qtr 2023 399 PM - QComm - INV 20221040
Amount:
$770.00

Component Description:
July 2022 PM - QComm - INV 20220816
Amount:
$1,778.70

Component Description:
June 2022 Tech PM - QComm - INV 20220715
Amount:
$770.00

Component Description:
Aug 1 - Sept 6, 2022 PM - QComm - INV 20220845
Amount:
$2,725.80

Component Description:
PM Paperwork
Amount:
$1,370.60

Component Description:
Paperwork
Amount:
$2,895.20

Component Description:
Paperwork
Amount:
$1,247.40

Component Description:
Paperwork PM
Amount:
$569.80

Component Description:
Form 399 Assistance
Amount:
$500.00

Component Description:
Paperwork PM
Amount:
$523.60

Component Description:
Jan 2022 PM - Anywave - INV FA2202-1310
Amount:
$231.00

Component Description:
July 2021 PM - Anywave - INV FA2109-1100
Amount:
$924.00

Component Description:
399 Follow Up Work
Amount:
$338.80

Component Description:
Aug 2021 PM - Anywave - INV FA2109-1075
Amount:
$1,093.40

Component Description:
Dec 2021 PM - Anywave - INV FA2202-1256
Amount:
$554.40

Component Description:
PM Paperwork
Amount:
$3,403.40

Component Description:
Paperwork
Amount:
$1,632.40

Component Description:
Follow up Paperwork.
Amount:
$1,817.20

Component Description:
399 Follow Up Work
Amount:
$154.00

Component Description:
PM Paperwork
Amount:
$1,062.60
Project management of the transition

Component Description:
4th Qtr 2018 - PM - Dewar - INV 1507
Amount:
$5,780.00

Component Description:
1st Qtr 2020 PM - Dewar - INV 1512
Amount:
$17,340.00

Component Description:
3rd Qtr 2020 PM - Dewar - INV 1514
Amount:
$6,715.00

Component Description:
8/10/2023 Zero Out. 3rd Qtr 2022 - PM - INV 1524
Amount:
N/A

Component Description:
1st Qtr 2019 PM - Dewar - INV 1508
Amount:
$16,660.00

Component Description:
3rd Qtr 2019 PM - Dewar - INV 1510
Amount:
$26,520.00

Component Description:
2nd Qtr 2018 PM - Dewar - INV 1505
Amount:
$12,070.00

Component Description:
3rd Qtr 2017 PM - Dewar - INV 1502
Amount:
$4,420.00

Component Description:
1st Qtr 2020 PM - Dewar - INV 1512
Amount:
$17,340.00

Component Description:
3rd Qtr 2018 PM - Dewar - INV 1506
Amount:
$11,560.00

Component Description:
2nd Qtr 2019 PM - Dewar - INV 1509
Amount:
$12,920.00

Component Description:
3rd Qtr 2022 PM - Dewar - INV 1524
Amount:
$7,820.00

Component Description:
1st Qtr 2018 PM - Dewar - INV 1504
Amount:
$9,180.00

Component Description:
Tech PM - April 2022 - QComm - INV 20220518
Amount:
$1,540.00

Component Description:
4th Qtr 2021 - PM - Dewar - INV 1519
Amount:
$11,645.00

Component Description:
3rd Qtr 2019 PM - Dewar - INV 1510
Amount:
$26,520.00

Component Description:
2nd Qtr 2017 PM - Dewar - INV 1501
Amount:
$1,190.00

Component Description:
3rd Qtr 2020 PM - Dewar - INV 1514
Amount:
$6,715.00

Component Description:
4th Qtr 2019 PM - Dewar - INV 1511
Amount:
$28,050.00

Component Description:
3rd Qtr 2022 PM - Dewar - INV 1522
Amount:
$33,150.00

Component Description:
3rd Qtr 2017 PM - Dewar - INV 1502
Amount:
$4,420.00

Component Description:
1st Qtr 2022 PM - Dewar - INV 1520
Amount:
$7,310.00

Component Description:
4th Qtr 2020 PM - Dewar - INV 1515
Amount:
$7,633.00

Component Description:
1st Qtr 2019 PM - Dewar - INV 1508
Amount:
$16,660.00

Component Description:
2nd Qtr 2021 PM - Dewar - INV 1517
Amount:
$31,110.00

Component Description:
1st Qtr 2021 PM - Dewar - INV 1516
Amount:
$12,920.00

Component Description:
4th Qtr 2018 PM - Dewar - INV 1507
Amount:
$5,780.00

Component Description:
3rd Qtr 2018 PM - Dewar - INV 1506
Amount:
$11,560.00

Component Description:
2nd Qtr 2018 PM - Dewar - INV 1505
Amount:
$12,070.00

Component Description:
4th Qtr 2021 PM - Dewar - INV 1519
Amount:
$11,645.00

Component Description:
2nd Qtr 2017 PM - Dewar - INV 1501
Amount:
$1,190.00

Component Description:
3rd Qtr 2021 PM - Dewar - INV 1518
Amount:
$13,345.00

Component Description:
2nd Qtr 2022 PM - Dewar - INV 1521
Amount:
$39,780.00

Component Description:
4th Qtr 2017 PM - Dewar - INV 1503
Amount:
$3,825.00

Component Description:
8/10/2022 Zero Out. 3rd Qtr 2022 - PM - INV 1523
Amount:
N/A

Component Description:
2nd Qtr 2020 PM - Dewar - INV 1513
Amount:
$19,720.00

Component Description:
4th Qtr 2019 PM - Dewar - INV 1511
Amount:
$28,050.00

Component Description:
2nd Qtr 2021 PM - Dewar - INV 1517
Amount:
$31,110.00

Component Description:
1st Qtr 2022 PM - Dewar - INV 1520
Amount:
$7,310.00

Component Description:
3rd Qtr 2021 PM - Dewar - INV 1518
Amount:
$13,345.00

Component Description:
2nd Qtr 2019 PM - Dewar - INV 1509
Amount:
$12,920.00

Component Description:
3rd Qtr PM - PM - Dewar - INV 1522
Amount:
$33,150.00

Component Description:
4th Qtr 2017 PM - Dewar - INV 1503
Amount:
$3,825.00

Component Description:
2nd Qtr 2020 PM - Dewar - INV 1513
Amount:
$19,720.00

Component Description:
1st Qtr 2021 PM - Dewar - INV 1516
Amount:
$12,920.00

Component Description:
2nd Qtr 2022 - PM - Dewar - INV 1521
Amount:
$39,780.00

Component Description:
4th Qtr 2020 PM - Dewar - INV 1515
Amount:
$7,633.00

Component Description:
1st Qtr 2018 PM - Dewar - INV 1504
Amount:
$9,180.00

Component Description:
3rd Qtr 2022 PM - Dewar - INV 1523
Amount:
$30,600.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare Form 601 Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
Additional Field Engineering Service, 50 Days

Component Description:
Specialized engineering service to facilitate move from Willis Tower to Hancock building - PME - INV 3106
Amount:
$13,011.50

Component Description:
Specialized engineering services to facilitate move from Willis Tower to Hancock building - PME - INV 3157
Amount:
$13,011.50

Component Description:
Consulting Engineer - Driggers - INV TD-WRJK-110119
Amount:
$29,259.99

Component Description:
Engineering - Driggers - INV TD-WRJK-110119
Amount:
$29,372.02
Engineering - General services

Component Description:
Engineering - Tech Assurance - INV 1488
Amount:
$5,850.00

Component Description:
Engineering Consulting.
Amount:
$600.00

Component Description:
Engineering Consulting.
Amount:
$1,125.00

Component Description:
Engineering Consulting
Amount:
$600.00

Component Description:
Engineering - Tech Assurance Labs - INV 1488
Amount:
$5,850.00

Component Description:
engineering - Mid State - INV 2103-5006
Amount:
$600.00

Component Description:
Engineering Services.
Amount:
$30,062.50

Component Description:
interference studies - Mid State - INV 2105-5006
Amount:
$1,125.00

Component Description:
Engineering Consulting.
Amount:
$1,125.00
Attorney - General services

Component Description:
Sept 2020 Legal - TLP - INV 513
Amount:
$127.50

Component Description:
TLP - legal - INV 2950
Amount:
$1,615.00

Component Description:
TLP - Legal - INV 2700
Amount:
$6,344.50

Component Description:
TLP - Legal - INV 2700
Amount:
$6,344.50

Component Description:
Legal Services thru June 29, 2022 - TLP - INV 2511
Amount:
$313.50

Component Description:
Attorney fees
Amount:
$1,399.50

Component Description:
Legal - TLP - INV 2813
Amount:
$620.00

Component Description:
Legal Services - TLP INV 2813
Amount:
$620.00

Component Description:
Legal Services - TLP - INV 2015
Amount:
$4,216.00

Component Description:
TLP - legal - INV 2950
Amount:
$1,615.00

Component Description:
June 2020 Legal - TLP - INV 307
Amount:
$2,881.50

Component Description:
Legal services - TLP - INV 2608
Amount:
$4,650.00

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $163,985.00 $171,310.00 N/A $95,478.96 N/A
Total for all systems $1,158,404.75 $1,597,345.61 N/A $843,988.76 N/A
Other Expenses $163,985.00 $171,310.00 $95,478.96
Internet Installation $4,650.00 $4,650.00 Per Cogent Communications work order. NOT requesting monthly fee; only cost for installation $0.00 N/A
Willis Tower Connection Fees $85,000.00 $85,000.00 Willis Tower connection fees, for interim and final configs. $85,000.00 N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $3,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Building Permits for CP $2,625.00 $2,625.00 Costs per actual invoices $2,625.00 N/A
Equipment Storage $25,000.00 $25,000.00 Estimate of expected costs. Actual costs to be determined. N/A N/A
Equipment Delivery and Handling Charges $20,000.00 $20,000.00 Estimate of expected delivery and handling costs. Actual costs to be determined. $7,853.96 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $20,000.00 $20,000.00 Estimate of expected disposal costs. Actual costs to be determined. N/A N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $700.00 Estimated costs. Actual costs to be determined. N/A N/A
FCC Filing Fees - Form 2100 Major change CP application $4,960.00 $10,000.00 Estimated costs. Actual costs to be determined. N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A N/A N/A

Components

Actual Information Description File Name
Internet Installation

Component Description:
internet installation fees - Cogent - INV 3-001287534
Amount:
$4,650.00
Willis Tower Connection Fees

Component Description:
Willis Tower (WRJK) connection. One-time charge to WRJK for temporary use of the antenna owned by the building.
Amount:
$85,000.00
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
Building Permits for CP

Component Description:
building permits - Dyros - INV 125104
Amount:
$2,625.00
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges

Component Description:
Antenna Shipping - Jampro - INV 20164-A-B
Amount:
$1,536.96

Component Description:
Otis - move equip - INV CHN20874001
Amount:
$247.00

Component Description:
Move equipment - Standard - INV 87751
Amount:
$6,070.00
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 Major change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,158,404.75 $1,597,345.61 $843,988.76

Reimbursement Status

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

Certification

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Section Question Response
Submission of Estimated Expenses Statements

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

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

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

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

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

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

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

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

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

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

Ravi Kapur

President


01/03/2024

Certification

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Section Question Response
Submission of Final Allocation or Accounting Information Statements

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

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

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

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

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

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

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

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

Ravi Kapur

President


01/03/2024

Attachments

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