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:
53819
Service:
DTV
Call Sign:
WMOR-TV
Channel:
18 (UHF)
File Number:
0000026813
FRN:
0002538445
Date Submitted:
10/06/2017

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

HEARST PROPERTIES INC.

C/O BROOKS, PIERCE ET AL.

P.O. BOX 1800

RALEIGH, NC 27602

United States

+1 (919) 839-0300 shartzell@brookspierce.com Corporation

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

The Preparer is same as the reimbursement contact.

 

 

 

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 see attached transition plan

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 Sigma CD3300P3
Year 2001
Type Inductive Output Tube
IOT Power Type Three
Power Capacity 62.8 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 ULXTE-100
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 62.9 kW
Justification for New Transmitter Existing IOT transmitter cannot be converted to post-transition channel, see GatesAir EOL and HTV IOT to Solid-State Justification statements. An IOT replacement is more expensive than proposed SS transmitter. See attached Comark IOT Transmitter quote.

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) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service Yes
Description Transmitter installation electrical service
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 15 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 3200.0 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

RF Accessories

Additional RF components required for transmitter operation

Shipping

Transmitter shipping

Electrical Accessories

Manufacturer required surge protection

Sales Tax

transmitter sales tax

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 Lease New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
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 Bottom
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model TFU-30GBH 08
Year 2002

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 Lease New
Is this a request for upgraded equipment? No
Ownership Leased
Owner American Tower Corp.
Is antenna shared? Yes
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 3
Number of Panels/Bays 56
Lower Limit 470.00 MHz
Upper Limit 680.00 MHz
Design power capacity in use 60.0 %
Other Antenna Type N/A
ERP: 940.0 kW
Manufacturer
Model RFS PEPL56D VPT
Year 2018
Justification for New Antenna Current antenna is channel specific and cannot be used on post-transition channel. Antenna must be replaced.

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
19
18
27

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Combiner Installation

WMOR portion of combiner installation per attached ATC documentation

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Lease New
Ownership Leased
Owner American Tower Corp.
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 Elliptical
Type Broadband Panel
Number of Stations Supported 2
Number of Panels/Bays 24
Lower Limit 470.00 MHz
Upper Limit 860.00 MHz
Design power capacity in use 41.0 %
Other Antenna Type N/A
ERP: 940.0 kW
Manufacturer
Model IRTE 8 - 8 - 8 I230EH
Year 2018
Justification for New Antenna interim antenna required while main antenna is replaced.

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? Yes
Type New
Number of channels supported 2
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? B
Feed Line Size 6 1/8 inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for an 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
29
18

Interim Antenna

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Other Antenna Cost Not Listed

Name Description

Combiner Installation

WMOR portion of combiner installation per attached ATC documentation

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 Lease New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1770 feet per run

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 Lease 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 1770 feet per run
Justification for New Transmission Line ATC is replacing WMOR and WXPX antenna stack with a BBA. The entries are based on information from ATC.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Lease New
Type Rigid
Diameter 6 1/8 inches
Segment Length Broadband
Other Segment Length
Number of parallel runs 2
Length 1440 feet per run
Justification for New Transmission Line required for interim antenna

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Additional RF components

install of 6 1/8" line with up to 6 tunable elbows from combiner to WMOR transmitter.

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 No
Is tower documented for structural analysis? No
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1057473
Coordinates (NAD83) Latitude (NAD83) 27° 49' 10.8" N-
Longitude (NAD83) 082° 15' 38.0" W-
Overall Structure Height 1592.83 feet
Support Structure Height 1443.88 feet
Ground Elevation Above Mean Sea Level (AMSL) 75.13 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers, LLC.
Date Constructed 09/07/2011

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
11290 WTSP DTV
6601 WXPX-TV DTV
23078 WMTX FM
16788 WVEA-TV DTV
11125 WCLF DTV

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: Minor 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

Tower permit drawing package

Project Management

(15) hours on Modification project management, (10) hours allotted for civil installation management and one-hundred (25) hours for RF installation project management for a total of twenty (25) days,

Grounds and Building

The generation of a construction drawing package for one (1) broadcasters/customers.

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 210
Explanation Additional RF experience needed in planning and execution and ATC tower project management
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 No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
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 No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
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) No
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
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 all frequencies are tuned for optimal patterns.

Migratory Birds

Migratory Birds Assessment

Site Coordination

Site Coordination Meeting

Transmitter Site Survey

Transmitter planning survey & transmitter building drawings

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

Other Expenses

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Other Expenses Not Listed

Name Description

Compound Fencing

The replacement of existing fencing in the compound area where the construction and additional equipment is being installed, some of the fencing will require reconfiguration once all repack construction is completed.

Road Upgrades

cost of repairing the road - See ATC documentation

Security

Site security for installatiion and storage of Transmission line and materials for 15 days X 12 hours. These materials are a high risk of theft due to the material makeup such as copper, brass and aluminum.

One-time tower rental

ATC one-time tower rental during market repack period per attached ATC documentation

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 $2,185,846.00 $2,151,246.00 N/A $523,869.19 N/A
Total for all systems $5,337,111.00 $3,304,893.00 N/A $523,869.19 N/A
Primary Transmitter ULXTE-100 $2,185,846.00 $2,151,246.00 $523,869.19
Sales Tax $129,176.00 $129,176.00 transmitter sales tax per attached GatesAir quote N/A N/A
Electrical Accessories $7,500.00 $7,500.00 third party surge protection - quote attached. N/A N/A
Shipping $17,300.00 $17,300.00 transmitter shipping per attached GatesAir quote N/A N/A
RF Accessories $77,737.00 $77,737.00 Additional RF components required for transmitter operation and integration into current RF environment per GatesAir quote. N/A N/A
Other -- Building Addition Size: 3200.0 $76,000.00 $76,000.00 This cost is to provide a building expansion for a 2 story building. See ATC documentation for full explanation. N/A N/A
15 Ton system $55,800.00 $21,200.00 N/A N/A N/A
Other Electrical Service: Transmitter installation electrical service $94,000.00 $94,000.00 main transmitter installation electrical service see attached quote N/A N/A
UHF - Liquid Cooled Solid State Transmitter 62.9 kW $1,728,333.00 $1,728,333.00 GatesAir quote sections A, B & E. This is the transmitter, mask filter, installation and proof per the FCC "transmitter" definition. $523,869.19 N/A

Components

Actual Information Description File Name
Sales Tax Information not provided.
Electrical Accessories Information not provided.
Shipping Information not provided.
RF Accessories Information not provided.
Other -- Building Addition Size: 3200.0 Information not provided.
15 Ton system Information not provided.
Other Electrical Service: Transmitter installation electrical service Information not provided.
UHF - Liquid Cooled Solid State Transmitter 62.9 kW

Component Description:
Transmitter 2nd deposit
Amount:
$338,551.86

Component Description:
Transmitter 1st deposit
Amount:
$185,317.33

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 $399,332.00 $310,589.00 N/A $0.00 N/A
Total for all systems $5,337,111.00 $3,304,893.00 N/A $523,869.19 N/A
Interim Antenna IRTE 8 - 8 - 8 I230EH $148,227.00 $84,597.00 $0.00
UHF - High Power, Side Mount, broadband panel, 24 bay,, 940 kW input, directional,, elliptically or circularly polarized $40,097.00 $40,097.00 WMOR portion of interim antenna cost per attached ATC documentation N/A N/A
Sweep test of existing antenna $6,730.00 $3,000.00 N/A N/A N/A
New combiner, cost per channel (without antenna) $84,200.00 $33,000.00 per attached ATC documentation $0.00 N/A
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,700.00 $5,000.00 per attached ATC documentation N/A N/A
Combiner Installation $3,500.00 $3,500.00 WMOR portion of combiner installation cost per attached ATC documentation N/A N/A
Primary Antenna RFS PEPL56D VPT $251,105.00 $225,992.00 $0.00
UHF - High Power Top Mount Three Station broadband panel antenna elliptically or circularly polarized $136,325.00 $136,325.00 WMOR portion of main antenna cost per attached ATC documentation N/A N/A
Sweep test of existing antenna $6,730.00 $6,000.00 N/A N/A N/A
New combiner, cost per channel (without antenna) $84,200.00 $66,000.00 WMOR portion of combiner cost per attached ATC documentation N/A N/A
Elbow complex, broadband, at antenna input, per 7 3/16. feedline (if needed) $16,850.00 $10,667.00 WMOR portion of elbow complex cost per attached ATC documentation N/A N/A
Combiner Installation $7,000.00 $7,000.00 WMOR portion of combiner installation cost per attached ATC documentation. 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 $1,890,380.00 $447,050.00 N/A $0.00 N/A
Total for all systems $5,337,111.00 $3,304,893.00 N/A $523,869.19 N/A
Interim Transmission Line $711,560.00 $165,800.00 $0.00
Additional RF components $43,400.00 $43,400.00 ATC charge for transmission line from WMOR transmitter to ATC combiner. See attached ATC documentation. N/A N/A
Rigid Transmission Line - copper, 6 1/8" broadband $668,160.00 $122,400.00 WMOR portion of interim transmission line. See attached ATC documentation. N/A N/A
Primary Transmission Line $1,178,820.00 $281,250.00 $0.00
Rigid Transmission Line - copper, 7 3/16" broadband $1,178,820.00 $281,250.00 WMOR portion of transmission line. See attached ATC documentation. 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 $614,650.00 $197,488.00 N/A $0.00 N/A
Total for all systems $5,337,111.00 $3,304,893.00 N/A $523,869.19 N/A
Primary Tower GTOWER $614,650.00 $197,488.00 $0.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $120,750.00 per ATC documentation N/A N/A
Structural engineering tower load study for a documented tower with candelabra $20,000.00 $11,088.00 per ATC documentation N/A N/A
Minor tower reinforcement/modifications $158,000.00 $50,000.00 per ATC documentation N/A N/A
Project Management $6,250.00 $6,250.00 per ATC documentation N/A N/A
Tower Permit $4,700.00 $4,700.00 per ATC documentation N/A N/A
Grounds and Building $4,700.00 $4,700.00 per ATC documentation 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 $135,623.00 $88,805.00 N/A $0.00 N/A
Total for all systems $5,337,111.00 $3,304,893.00 N/A $523,869.19 N/A
Outside Professional Services $135,623.00 $88,805.00 $0.00
Transmitter Site Survey $20,600.00 $20,600.00 transmitter site survey per attached quote Transmitter planning survey & transmitter building drawings N/A N/A
Migratory Birds $438.00 $438.00 per ATC documentation N/A N/A
RF System Test $5,000.00 $5,000.00 per ATC documentation N/A N/A
RF Exposure Measurements $21,050.00 $3,750.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,105.00 $167.00 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 $1,250.00 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
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $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 FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 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
Perform engineering study for new channel assignment and antenna development $7,360.00 $5,000.00 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
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A
Project management of the transition $33,180.00 $24,000.00 N/A N/A N/A
Site Coordination $1,500.00 $1,500.00 per ATC documentation 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 $111,280.00 $109,715.00 N/A $0.00 N/A
Total for all systems $5,337,111.00 $3,304,893.00 N/A $523,869.19 N/A
Other Expenses $111,280.00 $109,715.00 $0.00
Security $2,250.00 $2,250.00 per ATC documentation N/A N/A
Road Upgrades $3,750.00 $3,750.00 per ATC documentation N/A N/A
Compound Fencing $2,500.00 $2,500.00 per ATC documentation N/A N/A
MVPD Notification of Channel Change $2,500.00 $2,500.00 Attorney assistance in coordinating MVPD notification N/A N/A
Develop and air announcement of upcoming channel change $2,500.00 $2,500.00 Attorney review to ensure FCC compliance N/A N/A
Equipment Delivery and Handling Charges $6,250.00 $6,250.00 per ATC documentation N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $21,100.00 $21,100.00 Tansmitter removal required to make space for replacement transmitter. See attached quote. N/A N/A
Local Zoning $750.00 $750.00 per ATC documentation N/A N/A
DTV Medical Facility Notification $11,550.00 $10,000.00 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
One-time tower rental $57,600.00 $57,600.00 ATC one-time tower rental during market repack period per attached ATC documentation. 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 $5,337,111.00 $3,304,893.00 $523,869.19

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.

Susan Triana

Sr. Accounting Manager, Projects


10/06/2017

Certification

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Section Question Response
Submission of Actual Cost Documentation Statements

WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733).

  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 an authorized representative of the above-named applicant for the Authorization(s) specified above.

Susan Triana

Sr. Accounting Manager, Projects


10/06/2017

Attachments

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