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:
14040
Service:
DTV
Call Sign:
KRMA-TV
Channel:
33 (UHF)
File Number:
0000027982
FRN:
0001615582
Date Submitted:
03/27/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

ROCKY MOUNTAIN PUBLIC MEDIA, INC.

Doing Business As: ROCKY MOUNTAIN PUBLIC MEDIA, INC.

DANNA LUO

1089 BANNOCK STREET

DENVER, CO 80204

United States

+1 (303) 892-6666 dannaluo@rmpbs.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

James Schoedler

JB Schoedler Associates LLC

1069 S Downing Street

Denver, CO 80209

United States

+1 (303) 725-9043 jschoedler@usa.net

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 To transition from CH 18 to CH 33 KRMA must replace its antenna, transmission line, and main transmitter. The backup transmitter will be retuned. Installation will take place in 2018 so that testing can begin on 12/1/18 or soon thereafter.

Transmitters

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

Auxiliary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Retune Existing
Use Auxiliary (Backup)
Ownership Owned
Owner 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 Axcera
Model Innovator LX
Year 2009
Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 3 kW

Auxiliary Transmitter

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Retuning Transmitter Costs

Section Question Response
New IOT Tubes Number of Tubes (including accessories) needed N/A
New Mask Filter
Power 3 kW
Other Power N/A
New Exciter Is a new exciter needed? No

Auxiliary 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 No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
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

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

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 Power CD
Year 2009
Type Inductive Output Tube
IOT Power Type Single
Power Capacity 30 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 ULXTE-50
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 31.7 kW
Justification for New Transmitter Refer to attached Transition Plan exhibit.

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) Yes
Power 150 kVA
Rigid Conduit and Wiring Yes
Size 1 inches
Length 1.0 feet
Other Electrical Service Yes
Description Disconnection of existing.
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
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

Site Survey

Engineering visit to specify transmitter installation.

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? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
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-32DSC/VP-R C190
Year 2009

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? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Side 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: 1000.0 kW
Manufacturer
Model TFU-38DSC/VP-R C190
Year 2018
Justification for New Antenna Existing antenna does not cover new channel

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? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 6 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? No

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Transportation to site

Transportation to site on 4-wheel drive road.

Installation

Removal of old antenna and installation of new.

Freight

Shipping from manufacturer to offload point in Denver.

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 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 8 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 379 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 Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 19 3/4 inches
Other Segment Length N/A
Number of parallel runs 1
Length 379 feet per run
Justification for New Transmission Line Existing transmission line is not suitable for new channel

Primary 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 Leased
Is this tower consider Complex? No
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 1023484
Coordinates (NAD83) Latitude (NAD83) 39° 40' 17.4" N-
Longitude (NAD83) 105° 13' 08.0" W-
Overall Structure Height 273.95 feet
Support Structure Height 271.98 feet
Ground Elevation Above Mean Sea Level (AMSL) 7685.60 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Bear Creek Development Corporation
Date Constructed 11/08/1988

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
57219 KCEC DTV
83535 KVOD FM

Other Types of Users

Users
Cellular
2-way radio

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: No 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 500
Explanation Overall project management and coordination of procurement process.
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 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 Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers No
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

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 Yes
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application No
FCC Special Temporary Authority Application No
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

Temporary Antenna Installation

A temporary antenna installation on the tower ice bridge is required during installation of the new antenna.

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 $1,012,490.16 $940,750.16 N/A $217,021.29 N/A
Total for all systems $1,852,293.16 $1,689,962.16 N/A $392,145.06 N/A
Primary Transmitter ULXTE-50 $903,135.16 $901,885.16 $217,021.29
UHF - Liquid Cooled Solid State Transmitter 31.7 kW $868,085.16 $868,085.16 This amount is based on revised proposal obtained from Gates Air. See attached exhibit: Quote G-63421. $217,021.29 N/A
Site Survey $6,500.00 $6,500.00 Site survey is required to determine plan for replacement transmitter installation. N/A N/A
Other Electrical Service: Disconnection of existing. $1,500.00 $1,500.00 N/A N/A N/A
1" Rigid Conduit and Wiring $1,500.00 $1,500.00 N/A N/A N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $24,300.00 N/A N/A N/A
Auxiliary Transmitter Innovator LX $109,355.00 $38,865.00 $0.00
3 kW mask filter $4,155.00 $3,950.00 N/A N/A N/A
UHF and VHF - minor banding issues $105,200.00 $34,915.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF - Liquid Cooled Solid State Transmitter 31.7 kW

Component Description:
Initial payment with order for ULXTE-50 Transmitter System
Amount:
$217,021.29
Site Survey Information not provided.
Other Electrical Service: Disconnection of existing. Information not provided.
1" Rigid Conduit and Wiring Information not provided.
Transformer 3 phase/480v - 150 KVA Information not provided.
3 kW mask filter Information not provided.
UHF and VHF - minor banding issues 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 $450,560.00 $455,080.00 N/A $159,063.12 N/A
Total for all systems $1,852,293.16 $1,689,962.16 N/A $392,145.06 N/A
Primary Antenna TFU-38DSC/VP-R C190 $450,560.00 $455,080.00 $159,063.12
Freight $9,500.00 $9,500.00 Freight Cost to Denver, Colorado provided in Dielectric email dated 6/22/17 (attached to Form). N/A N/A
Transportation to site $0.00 $0.00 Included in antenna installation cost. N/A N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $13,730.00 Estimated cost based on Dielectric quotation. N/A N/A
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, directional,, elliptically or circularly polarized $320,500.00 $320,500.00 This amount was included in the approved Form 399 but inadvertently deleted in a subsequent reimbursement request. This change is to restore the amount to the budget. $159,063.12 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $29,000.00 Custom Mounting Bracket Cost provided in Dielectric Quotation SKM0003 N/A N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $2,500.00 N/A N/A N/A
Installation $79,850.00 $79,850.00 Installation cost determined by Rex Industries proposal 217-301 attached to Form 399. N/A N/A

Components

Actual Information Description File Name
Freight Information not provided.
Transportation to site Information not provided.
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) Information not provided.
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, directional,, elliptically or circularly polarized

Component Description:
Initial payment with order for TFU-38DSC/VP-R high power antenna.
Amount:
$159,063.12
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Installation 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 $76,558.00 $73,887.00 N/A $0.00 N/A
Total for all systems $1,852,293.16 $1,689,962.16 N/A $392,145.06 N/A
Primary Transmission Line $76,558.00 $73,887.00 $0.00
Rigid Transmission Line - copper, 6 1/8" $76,558.00 $73,887.00 Estimated cost is based on Dielectric cost proposal. 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 $96,800.00 $12,000.00 N/A $4,339.90 N/A
Total for all systems $1,852,293.16 $1,689,962.16 N/A $392,145.06 N/A
Primary Tower TOWER $96,800.00 $12,000.00 $4,339.90
Short Tower (less than 500') $84,200.00 $0.00 N/A $0.00 N/A
Structural engineering tower load study for well documented tower $12,600.00 $12,000.00 N/A $4,339.90 N/A

Components

Actual Information Description File Name
Short Tower (less than 500') Information not provided.
Structural engineering tower load study for well documented tower

Component Description:
Tower Analysis - Main Tower - Labor for December 2017 - Includes PO #22547
Amount:
$1,064.90

Component Description:
Tower Analysis - Main Tower - January Labor - Includes PO #22547
Amount:
$3,275.00

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $132,340.00 $125,250.00 N/A $11,720.75 N/A
Total for all systems $1,852,293.16 $1,689,962.16 N/A $392,145.06 N/A
Outside Professional Services $132,340.00 $125,250.00 $11,720.75
RF Exposure Measurements $21,050.00 $20,000.00 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 - 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 $4,952.00 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 $600.00 N/A
Project management of the transition $79,000.00 $75,000.00 N/A $6,168.75 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $0.00 N/A

Components

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

Component Description:
Legal Fees
Amount:
$139.00

Component Description:
Legal Fees
Amount:
$600.00

Component Description:
Legal Fees
Amount:
$878.00

Component Description:
Legal Fees
Amount:
$2,418.00

Component Description:
Legal Fees
Amount:
$917.00
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Engineering Fees for Preparation of CP Application - line items for 6/26 and 6/27/17.
Amount:
$450.00

Component Description:
Engineering Fees for CP Application - line item for 7/6 only
Amount:
$150.00
Project management of the transition

Component Description:
Legal advice related to management of project - line items for 2/6 and 2/14 only
Amount:
$300.00

Component Description:
Project Management Fees - November 2017
Amount:
$300.00

Component Description:
Project Management Fees - August 2017
Amount:
$150.00

Component Description:
Project Management Fees - May 2017
Amount:
$1,125.00

Component Description:
Project Management Fees - June 2017 (includes all line items except 6/26 and 6/27).
Amount:
$1,275.00

Component Description:
Project Management Fees for April 2017.
Amount:
$600.00

Component Description:
Project Management Fees - October 2017
Amount:
$225.00

Component Description:
Legal Advice related to management of project
Amount:
$50.00

Component Description:
Project Management Fees - July 2017 (all line items except 7/6/17)
Amount:
$656.25

Component Description:
Project Management Fees for the month of December 2017
Amount:
$937.50

Component Description:
Project Management Fees - September 2017
Amount:
$450.00

Component Description:
Legal advice related to management of project
Amount:
$150.00
Prepare and or review reimbursement form Information not provided.
Perform engineering study for new channel assignment and antenna development 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 $83,545.00 $82,995.00 N/A $0.00 N/A
Total for all systems $1,852,293.16 $1,689,962.16 N/A $392,145.06 N/A
Other Expenses $83,545.00 $82,995.00 $0.00
Develop and air announcement of upcoming channel change $1,500.00 $1,500.00 N/A N/A N/A
Equipment Delivery and Handling Charges $4,500.00 $4,500.00 Cost based on local towing company 4WD vehicle to transport transmitter(s) to/from site. Three days @ $1500 per day. N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $48,495.00 $48,495.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A N/A N/A
Local Zoning $5,000.00 $5,000.00 N/A N/A N/A
Temporary Antenna Installation $10,000.00 $10,000.00 See Rex Industries email dated 6/30/17 attached to Form 399. N/A N/A
MVPD Notification of Channel Change $2,500.00 $2,500.00 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 $1,852,293.16 $1,689,962.16 $392,145.06

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.

Danna Luo

Chief Financial Officer


03/27/2018

Attachments

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