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:
71645
Service:
DTV
Call Sign:
WLJT-DT
Channel:
27 (UHF)
File Number:
0000028599
FRN:
0001773761
Date Submitted:
02/28/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WEST TENNESSEE PUBLIC TV COUNCIL, INC

MONICA REESE

P.O. BOX 966

MARTIN, TN 38237

United States

+1 (731) 881-7561 MREESE@WLJT.ORG Not-for-Profit

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

Roy P Stype , III .

Consulting Engineer

Carl E. Smith Consulting Engineers

PO Box 807

Bath, OH 44210

United States

+1 (330) 659-4440 rstype@aol.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. No
Briefly describe transition plan Build Ch 14 repack transmitter in adjacent room. Transition current Ch 47 transmitter into spare sidemount Ch 47 antenna, build new Ch 14 top mount antenna out to patch, transition to new Ch 14 antenna.

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 DHD45P2
Year 2002
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 5.5 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? No
Manufacturer
Model UAXTE-24
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 14.4 kW
Justification for New Transmitter The manufacturer of the existing transmitter advises that the transmitter cannot be re-tuned to the assigned channel. Limited parts availability.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 3 inches
Length 100.0 feet
Other Electrical Service Yes
Description Electrical to HVAC.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 25 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

HVAC Ice Shield

Protects HVAC from falling ice

Antennas

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

Auxiliary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Auxiliary (Backup)
Description of Use Auxiliary
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? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 195.0 kW
Manufacturer
Model JA/MS-AL-16
Year 2008

Auxiliary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Auxiliary (Backup)
Description of Use Backup replacement of ch 47 sidemount
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 142.0 kW
Manufacturer
Model JA/MS-16/14 THO
Year 2017
Justification for New Antenna Replaces sidemount CH 47 backup antenna with sidemount CH 14

Auxiliary 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? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? 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

Auxiliary Antenna

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Other Antenna Cost Not Listed

Information not provided.

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? 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? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 285.0 kW
Manufacturer
Model JA/MS-32/47 THO
Year 2013

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? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top 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: 142.0 kW
Manufacturer
Model JA/MS-20/14
Year 2019
Justification for New Antenna Cannot be retuned from RF 47 to Rf 14

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

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

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 Utilize Existing
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 Dielectric
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 510 feet per run

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Auxiliary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Utilize Existing
Use Auxiliary (Backup)
Description of Use Auxiliary
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 Andrew
Type Flexible Air
Diameter 3 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 480 feet per run

Auxiliary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

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 Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 35° 42' 12.0" N-
Longitude (NAD83) 088° 36' 10.0" W-
Overall Structure Height 499.01 feet
Support Structure Height 432.74 feet
Ground Elevation Above Mean Sea Level (AMSL) 667.97 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner WEST TENNESSEE PUBLIC TV COUNCIL INC
Date Constructed 01/01/1966


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 documented tower
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 N/A
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 95
Explanation It will be necessary to schedule and coordinate multiple vendors, complete progress reports, and update Schedule 399. Station does not have available personnel or personnel trained in project management for such complex projects.
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 No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
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 No
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 10
Justification It will be necessary to survey the site, plan the equipment, develop specifications for purchasing, and oversee multiple vendor RF projects. Station does not have available personnel or personnel trained in such services.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

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 No
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? No
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

Information not provided.

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 $864,486.00 $847,326.00 N/A $237,317.50 N/A
Total for all systems $1,555,451.00 $1,315,126.00 N/A $338,853.83 N/A
Primary Transmitter UAXTE-24 $864,486.00 $847,326.00 $237,317.50
HVAC Ice Shield $13,000.00 $13,000.00 N/A N/A N/A
Channel 14 Mask Filter $189,500.00 $180,000.00 N/A $16,997.50 N/A
RF Consulting Engineer $5,260.00 $5,000.00 N/A N/A N/A
25 Ton system $91,500.00 $87,000.00 N/A $57,985.00 N/A
Other Electrical Service: Electrical to HVAC. $45,000.00 $45,000.00 N/A N/A N/A
3" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $4,900.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 14.4 kW $462,426.00 $462,426.00 N/A $155,436.40 N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $13,700.00 N/A $6,898.60 N/A

Components

Actual Information Description File Name
HVAC Ice Shield Information not provided.
Channel 14 Mask Filter

Component Description:
1/2 payment on mask filter
Amount:
$16,997.50
RF Consulting Engineer Information not provided.
25 Ton system

Component Description:
cooling/adders for transmitter
Amount:
$57,985.00
Other Electrical Service: Electrical to HVAC. Information not provided.
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Switchgear - industrial 800 amp Information not provided.
UHF - Air Cooled Solid State Transmitter 14.4 kW

Component Description:
1/3 down payment on transmitter
Amount:
$155,436.40
Service entrance 3 phase/800 amp/208 volt

Component Description:
pole installation & primary run-service entrance, transmitter site
Amount:
$6,898.60

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 $349,860.00 $144,800.00 N/A $88,032.50 N/A
Total for all systems $1,555,451.00 $1,315,126.00 N/A $338,853.83 N/A
Primary Antenna JA/MS-20/14 $253,730.00 $103,000.00 $69,212.50
UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized $247,000.00 $96,600.00 N/A $69,212.50 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
Auxiliary Antenna JA/MS-16/14 THO $96,130.00 $41,800.00 $18,820.00
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized $89,400.00 $35,400.00 N/A $18,820.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized

Component Description:
1/2 payment on main antenna
Amount:
$69,212.50
Sweep test of existing antenna Information not provided.
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized

Component Description:
1/2 payment for auxilary antenna
Amount:
$18,820.00
Sweep test of existing antenna 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 $0.00 $0.00 N/A $0.00 N/A
Total for all systems $1,555,451.00 $1,315,126.00 N/A $338,853.83 N/A
Primary Transmission Line $0.00 $0.00 $0.00
Auxiliary Transmission Line $0.00 $0.00 $0.00

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 $254,800.00 $242,000.00 N/A $5,500.00 N/A
Total for all systems $1,555,451.00 $1,315,126.00 N/A $338,853.83 N/A
Primary Tower TOWER $254,800.00 $242,000.00 $5,500.00
Structural engineering tower load study for well documented tower $12,600.00 $12,000.00 N/A $5,500.00 N/A
Short Tower (less than 500') $84,200.00 $80,000.00 N/A N/A N/A
Minor tower reinforcement/modifications $158,000.00 $150,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Structural engineering tower load study for well documented tower

Component Description:
Structural Study on WLJT-TV tower for proposed new antenna/transmission line alterations as required per FCC Repack Directive
Amount:
$5,500.00
Short Tower (less than 500') Information not provided.
Minor tower reinforcement/modifications 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 $68,615.00 $65,500.00 N/A $7,793.83 N/A
Total for all systems $1,555,451.00 $1,315,126.00 N/A $338,853.83 N/A
Outside Professional Services $68,615.00 $65,500.00 $7,793.83
Additional Field Engineering Service, 10 Days $15,000.00 $15,000.00 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 -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 - 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), Construction Permit Application $5,260.00 $5,000.00 N/A $390.00 N/A
Prepare request for Special Temporary Authorization $2,050.00 $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 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, Construction Permit Application $2,105.00 $2,000.00 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 $7,000.00 N/A $3,340.58 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A $630.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $3,302.00 Due to issues with filing the form 399 and reimbursement issues, talking with the FCC reimbursement department to work out issues, working with the lawyer to make sure filed properly
Project management of the transition $15,010.00 $14,250.00 N/A $131.25 N/A

Components

Actual Information Description File Name
Additional Field Engineering Service, 10 Days Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
review and proposal for revision of draft Schedule A repack construction permit application
Amount:
$390.00
Prepare request for Special Temporary Authorization Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
Preparation of app for construction permit, provide assistance with form 399 and phone/email liaison in regards to above
Amount:
$3,340.58
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
change to phase 0 from 8
Amount:
$630.00
Prepare and or review reimbursement form

Component Description:
reimbursement/transition progress report
Amount:
$129.00

Component Description:
Review of Schedule 399 and telephone call
Amount:
$240.00

Component Description:
memo regarding initial reimbursement allocation and permissible documentation of cost
Amount:
$78.00

Component Description:
Amendment of WLJT Form 399 filing to add additional documentation which was requested by the FCC staff in regards to HVAC modifications.
Amount:
$1,475.00

Component Description:
possible repack arrangement with T-Mobile consultation
Amount:
$90.00

Component Description:
calls regarding form 399, item entries, LMS, breakdown, help desk problems, reimbursement issues
Amount:
$1,290.00
Project management of the transition

Component Description:
Transition progress report review, filing, certification
Amount:
$131.25

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 $17,690.00 $15,500.00 N/A $210.00 N/A
Total for all systems $1,555,451.00 $1,315,126.00 N/A $338,853.83 N/A
Other Expenses $17,690.00 $15,500.00 $210.00
MVPD Notification of Channel Change $1,000.00 $1,000.00 N/A $210.00 N/A
Develop and air announcement of upcoming channel change $1,000.00 $1,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $2,500.00 $2,500.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $0.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $0.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $0.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A N/A N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change

Component Description:
research and report on channel assignment, memo regarding 2nd filing window for alternate channel
Amount:
$210.00
Develop and air announcement of upcoming channel change Information not provided.
Equipment Delivery and Handling Charges Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
DTV Medical Facility Notification Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,555,451.00 $1,315,126.00 $338,853.83

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.

Monica Reese

General Manager & CEO


02/28/2018

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