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:
31870
Service:
DTV
Call Sign:
KYAZ
Channel:
25 (UHF)
File Number:
0000028371
FRN:
0019682483
Date Submitted:
07/12/2017

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

NORTHSTAR HOUSTON LICENSE, LLC.

Doing Business As: NORTHSTAR HOUSTON LICENSE, LLC.

Jack Goodman

1701 N. MARKET STREET

SUITE 500

DALLAS, TX 75202

United States

+1 (214) 754-7008 jack@jackngoodman.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

Jack Goodman

Northstar Media, LLC

Jack Goodman

1701 N. Market St.

Suite 500

Dallas, TX 75202

United States

+1 (214) 754-7008 jack@jackngoodman.com

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 Site owner will install an interim antenna for shared use by two stations currently sharing an antenna to continue operation while the shared Main antenna atop the tower is replaced and configured to support three stations.

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)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model HP60TDP
Year 2008
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 40 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model THU9EVO-20
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 31 kW
Justification for New Transmitter The existing IOT transmitter is no longer supported by the manufacturer and cannot be retuned to the new channel. A solid state transmitter costs less than the only available IOT transmitter.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring Yes
Size 2 inches
Length 1100.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 10 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 1500.0 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

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Electrical sub panels

New HVAC electrical subpanels for new AC units required for the repack combiner area fed from the existing 480 VAC main panel. This equipment is required to provide existing power to new HVAC units.

Ice shield for HVAC equipment.

Ice protection for new outdoor HVAC equipment outside the combiner room. The total estimated area is 300 sq. ft.

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)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? Yes
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Other
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type Cavity Slot
ERP: 1000.0 kW
Manufacturer
Model RD32A-4255EDS65
Year 2008

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
28324 KTBU

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? Yes
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 645.0 kW
Manufacturer
Model PEPL42C
Year 2018
Justification for New Antenna Current shared antenna will not work for the new assigned channels. New 14 bay Broadband antenna, with 56 elements total, required to accommodate the new repack frequencies. This antenna will be a four-sided assembly mast.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? Yes
Type New
Number of channels supported 3
Frequencies of channels supported RF channel
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? No
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
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? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Enter a list of RF channel numbers.

RF Channel Number
33
21
25

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
Ownership Leased
Owner American Tower Corporation
Is antenna shared? Yes
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model TFU-24WB-C160
Year 2018
Justification for New Antenna The main antenna on top needs to be replaced; due to the complexity of the work, an interim antenna will need to be installed to keep the station on the air.

Interim Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? B
Feed Line Size 7 3/16 inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for an antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Interim Antenna

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Other Antenna Cost Not Listed

Name Description

Combiner Installation

Combiner installation cost for three 3 or 6 modules, 2 per channel constant impedance waveguide modules and three directional filter modules, for 3 repacked frequency transmitters.

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)
Description of Use N/A
Ownership Leased
Owner KTBU-TV
Site N/A
Is the existing transmission line shared with another station or stations? Yes
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 7 3/16 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 20 feet per run

Facility ID's and Call Signs of all stations with whom the transmission line is shared.

Facility ID Call Sign
28324 KTBU

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 7 3/16 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 2
Length 2100 feet per run
Justification for New Transmission Line New broadband transmission line is required to run multiple shared channels for a master antenna.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Interim Antenna Connection to New Transmitter

Temporary connection to interim antenna with new transmitter is required to remove current equipment and make space for second transmitter on shared space.

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)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Candelabra
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users Yes
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 1059622
Coordinates (NAD83) Latitude (NAD83) 29° 33' 45.2" N-
Longitude (NAD83) 095° 30' 35.9" W-
Overall Structure Height 1974.06 feet
Support Structure Height 1844.14 feet
Ground Elevation Above Mean Sea Level (AMSL) 74.15 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers, LLC.
Date Constructed 08/30/2000

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
51569 KTXH DTV
28324 KTBU DTV
69531 KZJL DTV
53847 KXLN-DT DTV
22204 KRIV DTV
11971 KMJQ FM
13200 KUVM-CD DTV
9625 KQBT FM
11969 KBXX FM

Other Types of Users

Users
Wireless
LPTV
FM translator

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for tower with candelabra
Tower Reinforcements Please select whether tower reinforcements are needed: Major Reinforcements needed

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Tower permit drawing package

Basic drawing package for municipality permitting.

Construction project management

17.5 hours on modification project management and 42.5 hours for RF installation project management.

Ground, Building A and E Permit Drawing Package.

Basic drawing package for municipality permitting.

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 245
Explanation Project management fee for the transition of broadcasters. Scheduling and management of the timelines and schedules occurring during the repack. Overseeing all work carried out in KYAZ space in the transmitter building.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review Yes
Environmental Assessment Yes
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

RF System test

Testing of the combiner to ensure that each channel in use by a station is tuned for optimal performance.

Migratory Bird Assessment Permitting, if needed

Migratory Bird Assessment Permitting, if needed.

Site Coordination Meeting

Site coordination meetings with all broadcasters, contractors and vendors involved with site deliveries and construction. This cost is for travel and logistics expenses accrued.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning 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 Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

Site Security

Site security for installation and storage of Transmission line and materials for 12 hours per day for 30 days. The materials are at a high risk of theft due to the material makeup, such as copper, brass and aluminum.

ATC one time tower rental during market repack period.

ATC has 5 customers at the Missouri City site being repacked, with 3 repacked broadcasters on top of the candelabra. The interim Main side mount antenna will allow broadcasters to minimize their OTA disruption while maintaining their coverage contours.

Compund Fencing

Facilitating construction operations in the compound area will require removal, reinstallation, and sometimes replacement of fencing to provide necessary access to heavy machinery.

Grading

Due to the very soft soil at the site and the need for movement of heavy equipment, grading is required to avoid having the equipment sink into the soil

Access Road Upgrades

The access road to the site will undergo many stresses from delivery of heavy equipment and reconfiguration of utilities at the site. Initial upgrades will reduce the need for repairs and maintain traffic flow.

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 $1,131,250.00 $952,471.71 N/A $0.00 N/A
Total for all systems $4,353,652.24 $2,281,011.95 N/A $0.00 N/A
Primary Transmitter THU9EVO-20 $1,131,250.00 $952,471.71 $0.00
2" Rigid Conduit and Wiring (Cost per foot) $28,600.00 $8,000.00 N/A N/A N/A
10 Ton system $38,900.00 $25,000.00 N/A N/A N/A
Other -- Building Addition Size: 1500.0 $25,000.00 $25,000.00 N/A N/A N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $20,000.00 N/A N/A N/A
Ice shield for HVAC equipment. $8,000.00 $8,000.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $15,000.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $831,471.71 N/A N/A N/A
Electrical sub panels $20,000.00 $20,000.00 N/A N/A N/A

Components

Information not provided.

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 $521,343.00 $338,653.00 N/A $0.00 N/A
Total for all systems $4,353,652.24 $2,281,011.95 N/A $0.00 N/A
Interim Antenna TFU-24WB-C160 $124,063.00 $118,733.00 $0.00
Elbow complex, broadband, at antenna input, per 7 3/16. feedline (if needed) $16,850.00 $15,000.00 N/A N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $20,000.00 N/A N/A N/A
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, directional,, horizontally polarized $69,000.00 $69,000.00 N/A N/A N/A
Combiner Installation $8,333.00 $8,333.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
Primary Antenna PEPL42C $397,280.00 $219,920.00 $0.00
New combiner, cost per channel (without antenna) $84,200.00 $54,000.00 N/A N/A N/A
Elbow complex, broadband, at antenna input, per 7 3/16. feedline (if needed) $16,850.00 $9,600.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $149,920.00 N/A N/A N/A

Components

Information not provided.

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 $1,466,951.24 $458,351.24 N/A $0.00 N/A
Total for all systems $4,353,652.24 $2,281,011.95 N/A $0.00 N/A
Primary Transmission Line $1,466,951.24 $458,351.24 $0.00
Rigid Transmission Line - copper, 7 3/16" broadband $1,398,600.00 $390,000.00 N/A N/A N/A
Interim Antenna Connection to New Transmitter $68,351.24 $68,351.24 N/A N/A N/A

Components

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 $878,900.00 $217,988.00 N/A $0.00 N/A
Total for all systems $4,353,652.24 $2,281,011.95 N/A $0.00 N/A
Primary Tower GTOWER $878,900.00 $217,988.00 $0.00
Structural engineering tower load study for a documented tower with candelabra $20,000.00 $11,088.00 N/A N/A N/A
Major tower reinforcement/modifications $421,000.00 $90,000.00 N/A N/A N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $100,000.00 N/A N/A N/A
Tower permit drawing package $4,700.00 $4,700.00 N/A N/A N/A
Construction project management $7,500.00 $7,500.00 N/A N/A N/A
Ground, Building A and E Permit Drawing Package. $4,700.00 $4,700.00 N/A N/A N/A

Components

Information not provided.

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 $210,293.00 $175,988.00 N/A $0.00 N/A
Total for all systems $4,353,652.24 $2,281,011.95 N/A $0.00 N/A
Outside Professional Services $210,293.00 $175,988.00 $0.00
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A N/A N/A
RF System test $5,000.00 $5,000.00 N/A N/A N/A
Migratory Bird Assessment Permitting, if needed $438.00 $438.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $4,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A N/A N/A
NEPA Section 106 environmental review, if needed $6,310.00 $1,350.00 N/A N/A N/A
Project management of the transition $38,710.00 $24,500.00 N/A N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $2,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A N/A N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $5,000.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,105.00 $200.00 N/A N/A N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A N/A N/A
RF Exposure Measurements $21,050.00 $20,000.00 N/A N/A N/A
Site Coordination Meeting $1,250.00 $1,250.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A N/A N/A

Components

Information not provided.

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 $144,915.00 $137,560.00 N/A $0.00 N/A
Total for all systems $4,353,652.24 $2,281,011.95 N/A $0.00 N/A
Other Expenses $144,915.00 $137,560.00 $0.00
Local Zoning $750.00 $750.00 N/A N/A N/A
Access Road Upgrades $2,500.00 $2,500.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $4,250.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
Non-zoning permits $1,000.00 $1,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $1,000.00 $1,000.00 N/A N/A N/A
ATC one time tower rental during market repack period. $57,600.00 $57,600.00 N/A N/A N/A
Compund Fencing $1,875.00 $1,875.00 N/A N/A N/A
Equipment Delivery and Handling Charges $7,000.00 $7,000.00 N/A N/A N/A
Equipment Storage $2,000.00 $2,000.00 N/A N/A N/A
MVPD Notification of Channel Change $1,000.00 $1,000.00 N/A N/A N/A
Grading $1,000.00 $1,000.00 N/A N/A N/A
Site Security $6,000.00 $6,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $50,000.00 $50,000.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $4,353,652.24 $2,281,011.95 $0.00

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. No
Construction of final facilities or all necessary modifications are complete. No
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. No

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.

Michael Jahrmarkt

Managing Member of Sole Member


07/12/2017

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