Approved by OMB (Office of Management and Budget) 3060-1178 (REFERENCE COPY - Not for submission) FCC Form 399: Reimbursement Request
Facility 49326 Service: DTV Call KDTN Channel: 43 (UHF) ID: Sign: File 0000028095 Number: FRN: 0009436411 Date 08/07 Submitted: /2020
Applicant Name, Type, and Contact Information Applicant Information Applicant Applicant Address Phone Email Type
COMMUNITY Arnold +1 ARNOLD. Private Not- TELEVISION Torres (817) TORRES@DAYSTAR. for-Profit EDUCATORS OF DFW, 3901 571- COM Educational INC. HIGHWAY 1229 Institution Doing Business As: 121 SOUTH COMMUNITY BEDFORD, TELEVISION TX 76021 EDUCATORS OF DFW, United INC. States
Reimbursement Contact Name and Information Reimbursement Contact Applicant Address Phone Email Information [Confidential]
Preparer Contact Name and Information Preparer Contact Applicant Address Phone Email Information Samuel Hariton Samuel +1 (339) sam. Engineer Hariton 222-8107 hariton@widelity. COMMUNITY TELEVISION 4031 com EDUCATORS OF DFW, INC. University Drive Ste 100 Fairfax, VA 22030 United States Broadcaster Question Response Information Will the station be sharing equipment with Yes and another broadcast television station or Transition Plan 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.
Briefly describe transition plan See attached narrative describing KDTN's transition plan.
Transmitters Section Question Response
Transmitter Related Do you have transmitter related expenses? Yes Expenses Existing Transmitter Information Primary Transmitter Section Question Response
Existing Transmitter Type of change Purchase Description New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with No another station?
Is this transmitter currently in operating Yes condition?
Existing Transmitter Manufacturer Manufacturer and Type Model Vissionary
Year 2004
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 26 kW New Transmitter Costs Primary Transmitter Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model TXUD40000ALC
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 40 kW
Justification for New Transmitter Transmitter is not capable if the power level that will be needed. Current transmitter cannot be retuned to new antenna due to banding issues. Current transmitter will remain on air transmitting pre auction channel during transition.
Other Transmitter Costs Primary Transmitter Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 500 kVA Rigid Conduit and Wiring Yes
Size 4 inches
Length 1102.0 feet
Other Electrical Service Yes
Description Minimal electric services not listed above will be needed to implement new facility.
HVAC Service Does the replacement transmitter require Yes HVAC Service?
Type Cooling Only
Size 25 tons
Other Size N/A
Transmitter Building Does the Transmitter Building require an Yes Addition/Modification or addition, modification, other leashold Leasehold Improvement improvement?
Size 550.0 square feet
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
Other Transmitter Cost Not Listed Primary Transmitter Name Description
3 Inch Rigid Conduit and Wiring 3 inch Rigid Conduit and wiring at 500 feet required for repack per ATC
Mask Filter Mask Filter Electrical Sub-Panels Electrical sub-panels required for operation of repack equipment
Transmitter Installation Installation of primary transmitter
Ice Shield ice Shield for HVAC equipment Antennas Section Question Response
Antenna Related Expenses Do you have antenna related expenses? Yes Existing Antenna Information Primary Antenna Section Question Response
Existing Antenna Type of change Lease New Description Antenna Use Primary (Main)
Description of Use N/A
Ownership Leased
Owner American Tower Corporation
Site N/A
Is the existing antenna shared with another Yes station or stations?
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity Yes to an antenna farm?
Existing Antenna Class Full Power Manufacturer and Type Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 4
Number of Panels 36
Design power capacity in use 90.0 %
Lower Limit 605.00 MHz
Upper Limit 665.00 MHz
Other Antenna Type N/A
ERP: (Effective Radiated Power) 1000.0 kW Manufacturer
Model PHP36C
Year 2003
Facility ID's and Call Signs of all stations with whom the antenna is shared.
Facility ID Call Sign
22201 KDAF
67910 KDTX-TV
42359 KTXD-TV New Antenna Costs Primary Antenna Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Lease New
Is this a request for upgraded equipment? Yes
Ownership Leased
Owner American Tower Corporation
Is antenna shared? Yes
Is antenna directional? Yes
Will antenna be located on or in close Yes proximity to an antenna farm?
New Antenna Class Class A Manufacturer and Types Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 5
Number of Panels/Bays 54
Lower Limit 482.00 MHz
Upper Limit 608.00 MHz
Design power capacity in use 14.0 %
Other Antenna Type N/A
ERP: (Effective Radiated Power) 757.0 kW
Manufacturer Model TUM-AP- C4-14/48H- 2-R-B
Year 2017
Justification for New Antenna Current Broadband antenna is in a frequency range outside of new transition channel's frequency.
Other Antenna Costs Primary Antenna Section Question Response
Combiner for Shared Do you need a Combiner for a Shared Yes Antenna Antenna?
Type New
Number of channels supported 5
Frequencies of channels supported RF channel
Frequency N/A
Do you need a combiner output splitter No /switcher for dual feed lines?
Elbow Complex Do you require the separate purchase of Yes the Elbow Complex?
Broadband or Single Channel? Broadband
Feed Line Size 7 3/16 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 No pattern scatter analysis for a side mount high or medium power antenna?
Sweep Test Do you require the sweep testing of Yes transmission line and antenna?
Enter a list of RF channel numbers.
RF Channel Number
21
18
19
23
29
Other Antenna Cost Not Listed Primary Antenna Name Description
Combiner Installation Installation of the combiner; Dual chain combiner system, Single chain of 2 constant impedance waveguide modules, and or single chain of 2 directional filter modules per Dielectric layout plus a third low power filter for the wideband port. TransmissionSection Question Response Line Transmission Line Do you have transmission line related Yes Related Expenses expenses? Existing Transmission Line Primary TransmissionSection Question Response Line Existing Transmission Type of change Lease New Line Description Use Primary (Main)
Description of Use N/A
Ownership Leased
Owner American Tower Corporation
Site N/A
Is the existing transmission line shared with Yes another station or stations?
Is Transmission Line in operating condition? Yes
Existing Transmission Manufacturer Line Manufacturer and Type Type Rigid
Diameter 8 3/16 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 1675 feet per run
Facility ID's and Call Signs of all stations with whom the transmission line is shared.
Facility ID Call Sign
22201 KDAF
42359 KTXD-TV 67910 KDTX-TV New Transmission Line Primary TransmissionSection Question Response Line New Transmission Line Use Primary Costs (Main)
Description of Use N/A
Change Type Lease New
Is this a request for upgraded equipment? Yes
Type Rigid
Diameter 7 3/16 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 2
Length 1650 feet per run
Justification for New Transmission Line New line runs for new line feeding new broadband array at new tower site.
Other Transmission Line Expenses Not Listed Primary TransmissionName Description Line Nitrogen Generator Nitrogen Generator required for repack transmission line Tower Section Question Response Equipment Tower Equipment or Do you have tower equipment or rigging Yes And costs changes? Rigging Rigging Costs Changes Costs
Add Tower Primary Tower Section Question Response
Existing Tower Type of change Modify Existing Description Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Candelabra
Is this tower currently shared with any other Yes stations?
One or more FM, AM or TV radio Yes broadcaster(s)
Others Types of Users Yes
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Do you have a tower registration number? Yes Structure Registration ASR Number 1055009
Coordinates (NAD83 ( Latitude (NAD83) 32° 35' 22.0" N- North American Datum of 1983)) Longitude (NAD83) 096° 58' 12.9" W-
Overall Structure Height 1550.83 feet
Support Structure Height 1453.07 feet
Ground Elevation Above Mean Sea Level 829.71 feet (AMSL) Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Tower, LLC
Date Constructed 11/04/2008
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
35841 KUVN-DT DTV
41380 KLNO FM
26950 KATA-CD DTV
59702 KKDA-FM FM
47739 KDMX FM
14524 KCBI FM
9620 KDGE FM
11451 WRR FM
6378 KZPS FM
23084 KHKS FM
18114 KEGL FM
Other Types of Users
Users
KODF-LD
KNAV-LP KJJM-LD
KHPK-LD
K31GL-D
KVFW-LD
Tower Modification Costs Primary Tower Section Question Response
Engineering Study Please what type of engineering study is Study needed required, if any: for undocumented /poorly documented tower
Tower Reinforcements Please select whether tower reinforcements Serious are needed: Reinforcements needed
Tower Rigging Costs Primary Tower Section Question Response
Tower Rigging Costs Complex Tower Candelabra
Helicopter Services Are helicopter services required? No Required
Other Tower Expenses Not Listed Primary Tower Name Description
Ground and Building A and E Permit Ground and Building A and E Permit Drawing Package Drawing Package
Tower Permit Drawing package The generation of a construction drawing package for one broadcaster.
Construction project management Tower 60 hours on Modification project Modification reinforcements and facilties management and RF installation project management Tower Load Study Rigorous analysis to access the structural capacity and modifications needed to accommodate the repack equipment. Existing Tower Primary Tower Section Question Response
Existing Tower Type of change Move Description Equipment
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Candelabra
Is this tower currently shared with any other Yes stations?
One or more FM, AM or TV radio Yes broadcaster(s)
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Unknown
Existing Tower Do you have a tower registration number? Yes Structure Registration ASR Number 1059733
Coordinates (NAD83 ( Latitude (NAD83) 32° 32' 36.0" N- North American Datum of 1983)) Longitude (NAD83) 096° 57' 33.0" W-
Overall Structure Height 1635.15 feet
Support Structure Height 1523.60 feet
Ground Elevation Above Mean Sea Level 813.97 feet (AMSL)
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers, LLC Date Constructed 06/18/2000
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
63779 KJKK FM
23440 KMVK FM
67910 KDTX-TV DTV
67195 KLUV FM
17037 KDFI DTV
49324 KERA-TV DTV
49323 KERA FM
22201 KDAF DTV
23422 KTVT DTV
1087 KRLD-FM FM
55768 KKXT FM
68834 KPXD-TV DTV
9627 KBFB FM
60534 KSTR-DT DTV
42359 KTXD-TV DTV
51517 KTXA DTV
41380 KLNO FM
49326 KDTN DTV
28624 KVIL FM Tower Rigging Costs Primary Tower Section Question Response
Tower Rigging Costs Complex Tower Candelabra
Helicopter Services Are helicopter services required? No Required
Other Tower Expenses Not Listed Primary Tower Name Description
Tower Permit Drawing Package The generation of a construction drawing package for one broadcasters/customers.
Ground and Building A and E Permit The generation of a construction drawing Drawing Package package for one broadcasters/customers. Outside Section Question Response Professional Outside Project Do you require outside project management Yes Services services? Costs Management Services
Number of Hours 595
Explanation KDTN lacks sufficient resources in house to handle all activities for on-time completion of build and requires the aid of outside project management services to fulfill repack requirements. KDTN will hire an outside firm to support KDTN's transition.
Outside RF consulting Perform engineering study for new channel Yes Engineering Services assignment and antenna development
Prepare engineering section of Form FCC Yes Construction Permit Application
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC Yes License to Cover Application
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Yes Authority
Quantity 2 Do you have Distributed Transmission N/A System engineering services?
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Prepare and file Form FCC Construction Yes Outside Consulting Permit Application Services For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Yes Cover Application
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Yes Authority
Quantity 2
NEPA Section 106 environmental review Yes
Environmental Assessment Yes
ASR Modification Yes
FAA Consultation (including preparation of Yes FAA Form 7460)
Negotiation of Lease and other Matter for Yes Shared Locations
Prepare or Review FCC Form 399 for Yes Reimbursement
Address transition timing and coordination Yes issues w/ other stations and wireless providers
RF Field Engineering Comprehensive coverage verification via No Services field study
RF exposure measurements Yes
Additional Field Engineering Service Yes
Number of Days 10 Justification Installation of transmitter and supervision of antenna installation.
Other Professional Services Expenses Not Listed Outside Professional Name Description Services Costs Site Coordination Meeting Site coordination meetings with all broadcasters, contractors and vendors involved with the site deliveries and construction.
RF System Test Testing of the combiner to ensure all, but specifically this broadcaster frequencies are tuned for optimal patterns.
Migratory Bird Assessment Permitting if Migratory Bird Assessment Permitting if needed needed Other Section Question Response Expenses AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System N/A Expenses Not listed
Name N/A
Is Notification of a Medical Facility required Yes as a result of DTV broadcasting?
Permit and Filing Costs Local Zoning Yes
Non-zoning permits Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Yes Application
Other Miscellaneous Does this relocation require paying Yes Expenses Disposal Costs (for equipment and other waste, net of any salvage value)?
Does this relocation require Equipment Yes Delivery or Handling Charges not otherwise included in individual item costs?
Does this relocation require Equipment Yes Storage?
Does this relocation require the Yes Development and Airing of an Announcement regarding an upcoming channel change?
Does this relocation require MVPD Yes Notification of a Channel Change? Other Expenses Not Listed Other Expenses Name Description
Cost of Construction and Electrical 2% construction cost, excluding the material permits and equipment for electrical and building permits.
Site Secuirty Company during Site security for installation and storage of construction for theft prevention and Transmission line and materials for 57 days vandalism X 12 hours. The materials are a high risk of theft due to the material makeup such as copper, brass and aluminum.
Transmission Line Bridge New Ice Bridge required to support new transmission lines from all four repack tenants space to tower, estimated to be 200 linear ft. This cost includes the materials, foundations and installation.
Tree Clearing Tag Alley This cost is for the removal of trees and vegetation to ensure the proper clearance of taglines and laydown areas, required for construction.
Leasing Application Fees Leasing Application Fees incurred due to repack Transmitters Cost Information Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Estimated Predetermined Estimated Cost Actual Cost Description Cost Estimate Cost Justification Actual Cost Justification
Primary $2,078,323.84 $1,461,257.81 $1,340,150.71 Transmitter TXUD40000ALC
Electrical Sub- $7,500.00 $7,500.00 Please see $7,500.00 N/A Panels ATC Customer Project Cost Estimation
4" Rigid $111,302.00 $14,893.00 Please see $14,893.00 N/A Conduit and ATC Wiring (Cost Customer per foot) Project Cost Estimation
3 Inch Rigid $7,000.50 $7,000.50 Please see $7,000.50 N/A Conduit and ATC Wiring Customer Project Cost Estimation
Transformer 3 $48,400.00 $46,000.00 N/A $17,500.00 N/A phase/480v - 500 KVA
Other -- $134,342.25 $134,342.25 see $132,543.05 N/A Building Estimated Addition Size: Cost 550.0 Justification KDTN-110- 1st Primary Transmitter - Building Addition, 550 Sq. Ft. v0 Ice Shield $54,633.00 $54,633.00 see $54,633.00 N/A Estimated Cost Justification KDTN-110- 1st Primary Transmitter - Ice Shield v0
Switchgear - $38,200.00 $36,300.00 N/A $34,500.00 N/A industrial 800 amp
Transmitter $25,546.09 $25,546.09 Please see $25,271.17 N/A Installation KDTN Primary Transmitter Installation Revision Justification Cover Letter
Mask Filter $67,500.00 $67,500.00 See $867.02 N/A attached price quote.
25 Ton system $91,500.00 $46,400.00 N/A $35,114.71 N/A
Other $5,000.00 $5,000.00 N/A $3,385.29 N/A Electrical Service: Minimal electric services not listed above will be needed to implement new facility.
Service $14,400.00 $13,700.00 N/A $4,500.00 N/A entrance 3 phase/800 amp /208 volt UHF - Liquid $1,473,000.00 $1,002,442.97 Please see $1,002,442.97 a Cooled Solid Estimated State Cost Transmitter 35 Justification - 50 kW KDTN-110- 1st Primary Transmitter - UHF Liquid Cooled Solid State, 35-50 kW v3
Sub-total $2,078,323.84 $1,461,257.81 N/A $1,340,150.71 N/A
Total for all $5,720,482.17 $2,645,514.33 N/A $2,379,058.53 N/A systems
Components
Actual Information Description File Name
Electrical Sub-Panels
Component Description: Capital Contribution Milton-Cedar Hill Amount: $7,500.00
4" Rigid Conduit and Wiring (Cost per foot) Component Description: Capital Contribution Milton-Cedar Hill Amount: $14,893.00
3 Inch Rigid Conduit and Wiring Component Description: Capital Contribution Milton-Cedar Hill Amount: $7,000.50
Transformer 3 phase/480v - 500 KVA Component Description: Capital Contribution Milton-Cedar Hill Amount: $17,500.00 Other -- Building Addition Size: 550.0 Component Description: Capital Contribution Milton-Cedar Hill Amount: $64,615.26
Component Description: 1. KDTN-110-1st Primary Transmitter - Building Addition, 550 Sq. Ft. Amount: $20,900.00
Component Description: ITEM: Pluming Material Amount: $4,087.79
Component Description: KDTN-110-1st Primary Transmitter - Building Addition, 550 Sq. Ft. Amount: $41,800.00
Component Description: Weld Stands Amount: $1,140.00
Ice Shield
Component Description: Capital Contribution Milton-Cedar Hill Amount: $24,633.00
Component Description: 2. KDTN-110-1st Primary Transmitter - Ice Shield Amount: $10,000.00
Component Description: KDTN-110-1st Primary Transmitter - Ice Shield Amount: $20,000.00 Switchgear - industrial 800 amp Component Description: Capital Contribution Milton-Cedar Hill Amount: $12,000.00
Component Description: Transport Stream Automatic Changeover Unit Amount: $22,500.00 Transmitter Installation
Component Description: 1-5/8" to type N female plate Amount: $966.00
Component Description: Labor Amount: $686.95
Component Description: Repack Travel Expenses Amount: $37.89
Component Description: Repack Travel Expenses Amount: $274.92
Component Description: Labor Amount: $696.34
Component Description: Labor Transport Amount: $569.66
Component Description: Labor Amount: $536.37
Component Description: Labor Amount: $150.56
Component Description: Repack Travel Expenses Amount: $481.40
Component Description: Professional Fees Amount: $21,146.00 Mask Filter
Component Description: 1/2X100 H/C PEX Tube Amount: $867.02
Component Description: LF 1 ID X 1 MIP Amount: $46.94
25 Ton system
Component Description: CAPITAL CONTRIBUTION - MILTON/CEDAR HILL Amount: $11,600.00
Component Description: 5/8-11 X 2" Hex Amount: $314.71
Component Description: Capital Contribution Amount: $23,200.00 Other Electrical Service: Minimal electric services Component Description: 73405WS 008100 not listed above will be Amount: $931.20 needed to implement new facility.
Component Description: Belden Wire & Cable Amount: $185.77
Component Description: EMT Amount: $424.54
Component Description: Welding on rack at TV Tower Cedar Hill, TX Amount: $812.50
Component Description: 508 2-1/2 MI Beam Clamp 1/2-13 Amount: $1,031.28
Service entrance 3 phase /800 amp/208 volt Component Description: Capital Contribution Milton-Cedar Hill Amount: $4,500.00 UHF - Liquid Cooled Solid State Transmitter 35 - 50 Component Description: Elettronika TXUD40. kW 000ALC UHF Digital TV Transmitter. Amount: $981,566.30
Component Description: Bleeder Kit Amount: $13,607.00
Component Description: Invoice moved to correct budget category per RFI. Amount: N/A
Component Description: Shipping and Handling Amount: $7,269.67
Component Description: Invoice moved to correct budget category per RFI. Amount: N/A
Component Description: Invoice moved to correct budget category per RFI. Amount: N/A
Component Description: Invoice moved to correct budget category per RFI. Amount: N/A
Component Description: Invoice moved to correct budget category per RFI. Amount: N/A Antennas Cost Information Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Estimated Predetermined Estimated Cost Actual Cost Description Cost Estimate Cost Justification Actual Cost Justification
Primary $278,996.43 $287,416.68 $274,593.88 Antenna TUM-AP-C4- 14/48H-2-R- B
Combiner $13,369.00 $13,369.00 see $13,369.00 N/A Installation Estimated Cost Justification KDTN-210- Primary Antenna - Combiner Installation v0
New $84,200.00 $100,634.00 Please see $87,961.20 N/A combiner, KDTN cost per American channel Towers (without Cost antenna) Estimation and KDTN Main 75253 Dallas Milton Repack Cost Estimates
Sweep test $6,730.00 $6,400.00 N/A $6,250.00 N/A of existing antenna Elbow $16,850.00 $9,166.25 see $9,166.25 N/A complex, Estimated broadband, Cost at antenna Justification input, per 7 KDTN-210- 3/16. Primary feedline (if Antenna - 7 needed) 3_16 Broadband Elbow Complex v0
UHF - $157,847.43 $157,847.43 see $157,847.43 N/A Lower Estimated Power, Cost Top Mount, Justification Class A, KDTN-210- broadband Primary panel, 54 Antenna - bay,, 757 UHF Lower kW input, Power Top directional,, Mount elliptically Broadband or circularly E-POL v0 polarized
Sub-total $278,996.43 $287,416.68 N/A $274,593.88 N/A
Total for $5,720,482.17 $2,645,514.33 N/A $2,379,058.53 N/A all systems
Components
Actual Information Description File Name Combiner Installation
Component Description: Capital Contribution Milton-Cedar Hill Amount: $3,351.00
Component Description: 7. KDTN-210- Primary Antenna - Combiner Installation Amount: $1,562.50
Component Description: KDTN-210-Primary Antenna - Combiner Installation Amount: $3,125.00
Component Description: KDTN-210-Primary Antenna - Combiner Installation Amount: $5,330.50
New combiner, cost per channel (without antenna) Component Description: Capital Contribution Milton-Cedar Hill Amount: $2,327.20
Component Description: 4. KDTN-210- Primary Antenna - Combiner Amount: $15,000.00
Component Description: KDTN-210-Primary Antenna - Combiner Amount: $30,000.00
Component Description: CAPITAL CONTRIBUTION Amount: $40,634.00 Sweep test of existing antenna Component Description: Capital Contribution Milton-Cedar Hill Amount: $937.50
Component Description: 5. KDTN-210- Primary Antenna - Sweep Test Amount: $937.50
Component Description: KDTN-210-Primary Antenna - Sweep Test Amount: $2,500.00
Component Description: KDTN-210-Primary Antenna - Sweep Test Amount: $1,875.00
Elbow complex, broadband, at antenna Component Description: Capital Contribution input, per 7 3/16. feedline Milton-Cedar Hill (if needed) Amount: $4,291.25
Component Description: 6. KDTN-210- Primary Antenna - 7 3/16" Broadband Elbow Complex Amount: $1,625.00
Component Description: KDTN-210-Primary Antenna - 7 3/16" Broadband Elbow Complex Amount: $3,250.00 UHF - Lower Power, Top Mount, Class A, Component Description: Capital Contribution broadband panel, 54 bay,, Milton-Cedar Hill 757 kW input, directional,, Amount: $56,847.33 elliptically or circularly polarized
Component Description: 3. KDTN-210- Primary Antenna - UHF Lower Power Top Mount Broadband E-POL Amount: $33,666.70
Component Description: KDTN-210-Primary Antenna - UHF Lower Power Top Mount Broadband E- POL Amount: $67,333.40 Transmission Line Cost Information Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Estimated Predetermined Estimated Cost Actual Cost Description Cost Estimate Cost Justification Actual Cost Justification
Primary $1,102,606.00 $336,165.44 $335,715.43 Transmission Line
Nitrogen $3,706.00 $3,706.00 Please see $3,706.00 N/A Generator ATC Customer Project Cost Estimation
Rigid $1,098,900.00 $332,459.44 see $332,009.43 N/A Transmission Estimated Line - Cost copper, 7 3 Justification /16" KDTN-310- broadband Primary Transmission Line - 7 3_16 Broadband Rigid Copper v0
Sub-total $1,102,606.00 $336,165.44 N/A $335,715.43 N/A
Total for all $5,720,482.17 $2,645,514.33 N/A $2,379,058.53 N/A systems
Components
Actual Information Description File Name
Nitrogen Generator
Component Description: Capital Contribution Milton- Cedar Hill Amount: $3,706.00 Rigid Transmission Line - copper, 7 3/16" broadband Component Description: Capital Contribution Milton- Cedar Hill Amount: $144,022.36
Component Description: 8. KDTN-310- Primary Transmission Line - 7 3/16" Broadband Rigid Copper Amount: $50,163.75
Component Description: 4-1/2" IEC flange male to 4-1/16" flange female Amount: $1,033.89
Component Description: Comb Invoice KDTN-310- Primary Transmission Line - 7 3-16in Broadband Rigid Copper American Towers LLC 460203772 Amount: $101,227.50
Component Description: 6-1/8" 50 ohm fixed flanged Amount: $4,930.25
Component Description: 6-1/8" EIA 50 ohm fixed flanged rigid line section Amount: $30,631.68 Tower Equipment and Rigging Costs Cost Information Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Estimated Predetermined Estimated Cost Actual Cost Description Cost Estimate Cost Justification Actual Cost Justification
Primary Tower $421,000.00 $0.00 $0.00 GTOWER
Tower Permit $0.00 $0.00 This appears N/A N/A Drawing as a Package duplicate entry
Ground and $0.00 $0.00 This appears N/A N/A Building A and as a E Permit duplicate Drawing entry. Package
Complex $421,000.00 $0.00 This appears N/A N/A Tower as a (includes, for duplicate example, entry. those with candelabras and/or stacked antennas)
Primary Tower $1,527,260.40 $246,765.40 $229,028.17 GTOWER
Complex $421,000.00 $63,845.00 N/A $51,502.50 N/A Tower (includes, for example, those with candelabras and/or stacked antennas)
Serious tower $1,052,000.00 $150,000.00 N/A $147,065.27 N/A reinforcement /modifications Tower $26,300.00 $4,960.00 Please see $4,960.00 N/A mapping for 75253 Dallas an Milton undocumented Repack Cost /poorly Estimates documented tower and preparation of documentation necessary for tower load study
Construction $14,650.40 $14,650.40 see $14,650.40 N/A project Estimated management Cost Tower Justification Modification KDTN-410- reinforcements Existing and facilties Primary Tower - Construction Project Management, Tower and Facilities v0
Tower Load $3,910.00 $3,910.00 Please see $3,800.00 N/A Study 75253 Dallas Milton Repack Cost Estimates
Tower Permit $4,700.00 $4,700.00 See attached $3,525.00 N/A Drawing AMT quote. package
Ground and $4,700.00 $4,700.00 See attached $3,525.00 N/A Building A and AMT quote. E Permit Drawing Package
Sub-total $1,948,260.40 $246,765.40 N/A $229,028.17 N/A
Total for all $5,720,482.17 $2,645,514.33 N/A $2,379,058.53 N/A systems
Components Actual Information Description File Name
Tower Permit Drawing Information not provided. Package
Ground and Building A and Information not provided. E Permit Drawing Package
Complex Tower (includes, Information not provided. for example, those with candelabras and/or stacked antennas)
Complex Tower (includes, for example, those with Component Description: Capital candelabras and/or stacked Contribution Milton- antennas) Cedar Hill Amount: $3,618.60
Component Description: 13. KDTN-410- Existing Primary Tower - Tower Rigging, Complex Tower Amount: $15,961.30
Component Description: KDTN-410- Existing Primary Tower - Tower Rigging, Complex Tower Amount: $31,922.60 Serious tower reinforcement /modifications Component Description: Capital Contribution Milton- Cedar Hill Amount: $34,565.27
Component Description: 12. KDTN-410- Existing Primary Tower - Serious Tower Reinforcement /Modifications Amount: $37,500.00
Component Description: KDTN-410- Existing Primary Tower - Serious Tower Reinforcement /Modifications Amount: $75,000.00
Tower mapping for an undocumented/poorly Component Description: Capital documented tower and Contribution Milton- preparation of Cedar Hill documentation necessary Amount: $1,240.00 for tower load study
Component Description: 10. KDTN-410- Existing Primary Tower - Tower Mapping Amount: $1,240.00
Component Description: KDTN-410- Existing Primary Tower - Tower Study Amount: $2,480.00 Construction project management Tower Component Description: Capital Modification reinforcements Contribution Milton- and facilties Cedar Hill Amount: $9,025.40
Component Description: 16. KDTN-410- Existing Primary Tower - Construction Project Management, Tower and Facilities Amount: $1,875.00
Component Description: KDTN-410- Existing Primary Tower - Construction Project Management, Tower and Facilities Amount: $3,750.00 Tower Load Study
Component Description: Capital Contribution Milton- Cedar Hill Amount: $867.50
Component Description: 11. KDTN-410- Existing Primary Tower - Tower Load Study, Documented Tower Amount: $977.50
Component Description: KDTN-410- Existing Primary Tower - Tower Load Study, Documented Tower Amount: $1,955.00
Tower Permit Drawing package Component Description: 14. KDTN-410- Existing Primary Tower - Tower Permit Drawing Package Amount: $1,175.00
Component Description: KDTN-410- Existing Primary Tower - Tower Permit Drawing Package Amount: $2,350.00 Ground and Building A and E Permit Drawing Package Component Description: 15. KDTN-410- Existing Primary Tower - Ground and Building Permit Drawing Package Amount: $1,175.00
Component Description: KDTN-410- Existing Primary Tower - Ground and Building Permit Drawing Package Amount: $2,350.00 Outside Professional Services Cost Information Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Predetermined Estimated Estimated Cost Actual Cost Description Cost Estimate Cost Justification Actual Cost Justification
Outside $208,600.00 $212,578.50 $117,595.40 Professional Services
Perform $7,360.00 $10,000.00 Please see $10,000.00 N/A engineering KDTN study for new American channel Towers Cost assignment Estimation and and antenna KDTN Main development 75253 Dallas Milton Repack Cost Estimates
Address $2,630.00 $2,500.00 N/A $2,500.00 N/A transition timing and coordination issues w/ other stations and wireless
Project $94,010.00 $118,635.00 see Estimated $83,429.40 invoices management Cost of the transition Justification KDTN-510- Project Management v0
RF System $9,000.00 $9,000.00 Please see $8,800.00 N/A Test KDTN American Towers Cost Estimation and KDTN Main 75253 Dallas Milton Repack Cost Estimates
Site $2,500.00 $2,500.00 See attached $2,000.00 N/A Coordination AMT quote. Meeting Migratory Bird $350.00 $350.00 See attached $262.50 N/A Assessment AMT quote. Permitting if needed
Additional $20,000.00 $20,000.00 N/A $0.00 N/A Field Engineering Service, 10 Days
RF Exposure $21,050.00 $3,000.00 N/A $2,250.00 N/A Measurements
FAA $2,105.00 $2,000.00 N/A $0.00 N/A consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase
ASR $2,105.00 $2,000.00 N/A $0.00 N/A modification (prepare FCC Form 854)
Environmental $10,520.00 $10,000.00 N/A $0.00 N/A Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet
NEPA Section $6,310.00 $1,800.00 N/A $810.00 N/A 106 environmental review, if needed
Attorney Fees $7,360.00 $7,000.00 N/A $1,043.00 N/A - Prepare and File request for Special Temporary Authorization Attorney Fees $4,210.00 $4,000.00 N/A $712.00 N/A - Negotiation of lease and other matters for shared locations
Attorney Fees - $2,365.00 $2,250.00 N/A N/A N/A Prepare and File FCC Form 2100 (main), License to Cover Application
Attorney Fees $5,260.00 $5,000.00 N/A N/A N/A - Prepare and File FCC Form 2100 (main), Construction Permit Application
Prepare $4,100.00 $3,000.00 N/A $0.00 N/A request for Special Temporary Authorization
Prepare $1,580.00 $1,500.00 N/A $745.00 N/A engineering section of FCC Form 2100 (main), License to Cover Application
Prepare $3,155.00 $3,000.00 N/A N/A N/A engineering section of FCC Form 2100 (main), Construction Permit Application Prepare and $2,630.00 $5,043.50 Estimated Cost $5,043.50 N/A or review Justification reimbursement KDTN-590- form Prepare and_or Review Reimbursement v0
Sub-total $208,600.00 $212,578.50 N/A $117,595.40 N/A
Total for all $5,720,482.17 $2,645,514.33 N/A $2,379,058.53 N/A systems
Components
Actual Information Description File Name
Perform engineering study for new channel Component Description: Capital assignment and antenna Contribution Milton- development Cedar Hill Amount: $1,250.00
Component Description: 19. KDTN-530-RF Eng - Engineering Study for New Channel Assignment Amount: $1,250.00
Component Description: KDTN-530-RF Eng - Engineering Study for New Channel Assignment Amount: $2,500.00
Component Description: KDTN-530-RF Eng - Engineering Study for New Channel Assignment Amount: $5,000.00 Address transition timing and coordination issues w/ Component Description: Capital other stations and wireless Contribution Milton- Cedar Hill Amount: $625.00
Component Description: 18. KDTN-590- Transition Timing and Coordination Amount: $625.00
Component Description: KDTN-590- Transition Timing and Coordination Amount: $1,250.00
Project management of the transition Component Description: Capital Contribution Milton- Cedar Hill Amount: $2,370.00
Component Description: 17. KDTN-510- Project Management Amount: $2,370.00
Component Description: Project Management Amount: $3,385.70
Component Description: Project Management Amount: $6,804.60
Component Description: Project Management Amount: $1,803.40 Component Description: Project Management Amount: $3,518.70
Component Description: KDTN-510-Project Management Amount: $4,740.00
Component Description: Project Management Amount: $4,937.95
Component Description: Project Management Amount: $1,528.75
Component Description: Project Management Amount: $9,673.50
Component Description: Project Management Amount: $6,433.70
Component Description: Project Management Amount: $93.90
Component Description: Project Management Amount: $4,724.35
Component Description: Project Management Amount: $10,323.90 Component Description: Project Management Amount: $1,620.15
Component Description: KDTN-510-Project Management Amount: $9,480.00
Component Description: Project Management Amount: $1,514.90
Component Description: Project Management Amount: $2,543.65
Component Description: Project Management Amount: $1,519.30
Component Description: Project Management Amount: $4,042.95 RF System Test
Component Description: Capital Contribution Milton- Cedar Hill Amount: $800.00
Component Description: 24. KDTN-580- Field Engineering Service - RF System Test Amount: $1,000.00
Component Description: KDTN-580-Field Engineering Service - RF System Test Amount: $2,000.00
Component Description: KDTN-580-Field Engineering Service - RF System Test Amount: $5,000.00
Site Coordination Meeting
Component Description: Capital Contribution Milton- Cedar Hill Amount: $125.00
Component Description: 22. KDTN-590-Site Coordination Meeting Amount: $625.00
Component Description: KDTN-590-Site Coordination Meeting Amount: $1,250.00 Migratory Bird Assessment Permitting if needed Component Description: 23. KDTN-590- Migratory Bird Assessment and Permitting Amount: $87.50
Component Description: KDTN-590- Migratory Bird Assessment and Permitting Amount: $175.00
Additional Field Information not provided. Engineering Service, 10 Days
RF Exposure Measurements Component Description: 21. KDTN-580- Field Engineering Service - RF Exposure Measurements Amount: $750.00
Component Description: KDTN-580-Field Engineering Service - RF Exposure Measurements Amount: $1,500.00
FAA consultant, including Information not provided. cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase
ASR modification (prepare Information not provided. FCC Form 854) Environmental Information not provided. Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet
NEPA Section 106 environmental review, if Component Description: 20. KDTN-590- needed NEPA Section 106 Review Amount: $270.00
Component Description: KDTN-590-NEPA Section 106 Review Amount: $540.00
Attorney Fees - Prepare and File request for Special Component Description: Total Professional Temporary Authorization Services Amount: $1,043.00 Attorney Fees - Negotiation of lease and other matters Component Description: Total Professional for shared locations Services Amount: $69.50
Component Description: Total Professional Services Amount: $74.50
Component Description: Total Professional Services Amount: $223.50
Component Description: Total Professional Services Amount: $131.00
Component Description: Total Professional Services Amount: $69.50
Component Description: Total Professional Services Amount: $69.50
Component Description: Total Professional Services Amount: $74.50
Attorney Fees -Prepare Information not provided. and File FCC Form 2100 (main), License to Cover Application
Attorney Fees - Prepare Information not provided. and File FCC Form 2100 (main), Construction Permit Application Prepare request for Special Information not provided. Temporary Authorization
Prepare engineering section of FCC Form 2100 Component Description: Total Professional (main), License to Cover Services Application Amount: $745.00
Prepare engineering Information not provided. section of FCC Form 2100 (main), Construction Permit Application
Prepare and or review reimbursement form Component Description: Total Professional Services Amount: $786.00
Component Description: Total Professional Services Amount: $4,257.50 Other Expenses Cost Information Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Estimated Predetermined Estimated Cost Actual Cost Description Cost Estimate Cost Justification Actual Cost Justification
Other $103,695.50 $101,330.50 $81,974.94 Expenses
Disposal $5,000.00 $5,000.00 N/A $4,279.75 N/A Costs (for equipment and other waste, net of any salvage value)
Local Zoning $4,700.00 $4,700.00 See attached $3,541.20 N/A AMT quote.
Leasing $2,500.00 $2,500.00 Please see $2,500.00 N/A Application ATC Fees Customer Project Cost Estimation
Tree Clearing $1,600.00 $1,600.00 See attached $1,200.00 N/A Tag Alley AMT quote.
Transmission $36,241.50 $36,241.50 see $36,241.50 N/A Line Bridge Estimated Cost Justification KDTN-610- Transmission Line Bridge v0
Site Secuirty $8,500.00 $8,500.00 See attached $6,412.50 N/A Company AMT quote. during construction for theft prevention and vandalism Cost of $10,000.00 $10,000.00 See attached $7,500.00 N/A Construction AMT quote. and Electrical permits
MVPD $2,964.00 $2,964.00 see $2,964.00 N/A Notification of Estimated Channel Cost Change Justification KDTN-610- MVPD Notifications v0
Develop and $500.00 $500.00 N/A N/A N/A air announcement of upcoming channel change
Equipment $3,500.00 $3,500.00 See attached $3,422.50 N/A Storage AMT quote.
Equipment $5,000.00 $5,000.00 See attached $4,876.49 N/A Delivery and AMT quote. Handling Charges
Non-zoning $10,000.00 $10,000.00 N/A N/A N/A permits
FCC Filing $195.00 $190.00 N/A N/A N/A Fees - Special Temporary Authorization request
FCC Filing $335.00 $335.00 see $335.00 N/A Fees - Form Estimated 2100 license Cost to cover Justification application KDTN-610- FCC Filing Fees - License to Cover Application v0 FCC Filing $1,110.00 $1,070.00 N/A N/A N/A Fees - Form 2100 minor change CP application
DTV Medical $11,550.00 $9,230.00 N/A $8,702.00 N/A Facility Notification
Sub-total $103,695.50 $101,330.50 N/A $81,974.94 N/A
Total for all $5,720,482.17 $2,645,514.33 N/A $2,379,058.53 N/A systems
Components
Actual Information Description File Name
Disposal Costs (for equipment and other waste, Component Description: Capital net of any salvage value) Contribution Milton- Cedar Hill Amount: $4,279.75
Local Zoning
Component Description: Capital Contribution Milton- Cedar Hill Amount: $16.20
Component Description: 25. KDTN-610- Local Zoning Amount: $1,175.00
Component Description: KDTN-610-Local Zoning Amount: $2,350.00 Leasing Application Fees
Component Description: Capital Contribution Milton- Cedar Hill Amount: $2,500.00
Tree Clearing Tag Alley
Component Description: 29. KDTN-610- Tree Clearing Tag Alley Amount: $400.00
Component Description: KDTN-610-Tree Clearing Tag Alley Amount: $800.00
Transmission Line Bridge
Component Description: Capital Contribution Milton- Cedar Hill Amount: $19,366.50
Component Description: 9. KDTN-610- Transmission Line Bridge Amount: $5,625.00
Component Description: KDTN-610- Transmission Line Bridge Amount: $11,250.00 Site Secuirty Company during construction for theft Component Description: 27. KDTN-610- prevention and vandalism Site Security Amount: $2,137.50
Component Description: KDTN-610-Site Security Amount: $4,275.00
Cost of Construction and Electrical permits Component Description: 28. KDTN-610- Construction and Electrical Permits Amount: $2,500.00
Component Description: KDTN-610- Construction and Electrical Permits Amount: $5,000.00
MVPD Notification of Channel Change Component Description: MVPD Notification Services Amount: $2,964.00
Develop and air Information not provided. announcement of upcoming channel change
Equipment Storage
Component Description: Capital Contribution Milton- Cedar Hill Amount: $3,422.50 Equipment Delivery and Handling Charges Component Description: 26. KDTN-610- Equipment Delivery and Handling Amount: $1,250.00
Component Description: 30' Single Manlift Push-Type Amount: $431.78
Component Description: 5500LB 19' Shooting Boom Forklift Amount: $694.71
Component Description: KDTN-610- Equipment Delivery and Handling Amount: $2,500.00
Non-zoning permits Information not provided.
FCC Filing Fees - Special Information not provided. Temporary Authorization request
FCC Filing Fees - Form 2100 license to cover Component Description: KDTN-610-FCC application Filing Fee - License to Cover Application Amount: $335.00
FCC Filing Fees - Form Information not provided. 2100 minor change CP application DTV Medical Facility Notification Component Description: DTV Notification Service Amount: $8,702.00 Grand Total Cost Information Predetermined Cost Estimate Estimated Cost Actual Cost
Total for all systems $5,720,482.17 $2,645,514.33 $2,379,058.53
ReimbursementQuestion Response Status The facility has ceased operating on its pre- Yes auction channel.
Construction of final facilities or all Yes necessary modifications are complete.
All receipts for reimbursement have been No 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. Certification Section Question Response
Submission of Estimated WILLFUL FALSE STATEMENTS ON THIS Expenses Statements 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 Arnold an authorized representative of the above- Torres named applicant for the Authorization(s) Business specified above. Administrator
08/07/2020 Certification Section Question Response
Submission of Actual WILLFUL FALSE, FRAUDULENT, OR Cost Documentation FICTITIOUS STATEMENTS ON THIS Statements 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).
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.
2. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct.
3. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. 4. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
5. 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) .
6. 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.
7. The above-named entity certifies that the cost information /documents submitted reflect costs actually incurred. 8. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
9. 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 Arnold an authorized representative of the above- Torres named applicant for the Authorization(s) Business specified above. Administrator
08/07/2020 Certification Section Question Response
Submission of Final WILLFUL FALSE STATEMENTS ON THIS Allocation or Accounting FORM ARE PUNISHABLE BY FINE AND Information Statements /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 Arnold an authorized representative of the above- Torres named applicant for the Authorization(s) Business specified above. Administrator
08/07/2020 Attachments