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:
81503
Service:
DTV
Call Sign:
WMOW
Channel:
13 (High VHF)
File Number:
0000027497
FRN:
0030884985
Date Submitted:
03/30/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WAOW-WYOW LICENSE, LLC

Doing Business As: WAOW-WYOW LICENSE, LLC

P.O. BOX 909

QUINCY, IL 62306

United States

+1 (217) 223-5100 bdreasler@quincyinc.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

Tony zumMallen

QCommunications

Tony zumMallen

705B SE Melody LN #314

Lees Summit, MO 64063

United States

+1 (816) 729-1177 tony@qcom1.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 Transition from ch12 to ch13 and will require a new antenna as show by system analysis. A new transmitter and systems will also be required along with interim systems for use in the transition.

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 Platinum
Year 1990
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 4 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 VAXTE-2R44
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 4.0 kW
Justification for New Transmitter Existing transmitter is not tunable per transmitter manufacturer, GatesAir.

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 300 kVA
Rigid Conduit and Wiring Yes
Size 2 inches
Length 200.0 feet
Other Electrical Service No
Description N/A
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

Sales Tax

Sales tax collected by vendors as part of the repack

Site Survey - TX

Site survey and report are required to be performed before the new transmitter and components installation plan can be finalized.

Disconnect existing Transmitter

Disconnect transmitter and components from existing configuration and move within building to make way for new facilities.

Transmitter- Training

Transmitter training - offsite - 1 week in duration at mfg site.

Securirty - Site

This site requires security once the new transmission line and equipment arrive on site to be installed. Estimated length of 4-6 weeks.

Interim Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Interim
Description of Use N/A
Change Type Purchase
Manufacturer
Model VAXTE-1-R-44
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.1 kW
Justification for New Transmitter Interim facility is required to avoid prolonged period of station silence during transition, and station currently has no aux facility to use for interim operation. Extended silent period during transition to new channel is unreasonable.

Interim 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 Yes
Size 2 inches
Length 200.0 feet
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? Yes
Size 220.0 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
Inside RF System Is an additional interior RF system required to support this interim transmitter? Yes

Interim Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

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? 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 Other
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type Panel
ERP: 4.0 kW
Manufacturer
Model DRV-3-4-HO
Year 2011

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? No
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 Broadband Panel
Number of Stations Supported 1
Number of Panels/Bays 12
Lower Limit 470.00 MHz
Upper Limit 698.00 MHz
Design power capacity in use 80.0 %
Other Antenna Type N/A
ERP: 3.2 kW
Manufacturer
Model DRV-3-4-HO
Year 2017
Justification for New Antenna Channel reassignment requires new antenna.

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? Broadband
Feed Line Size 3 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? 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 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 Flexible Foam
Diameter 1 5/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 260 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 Flexible Foam
Diameter 1 5/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 275 feet per run
Justification for New Transmission Line Required for new channel assignment operations.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Coax Switch

provide antenna switching from main to interim transmitter during cut-over.

Disconnect existing Interior RF components

Disconnect interior RF transmission line and filters from existing configuration and move within the building to make way for new facilities.

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) No
Others Types of Users Yes
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? Yes
ASR Number 1051793
Coordinates (NAD83) Latitude (NAD83) 45° 34' 23.4" N-
Longitude (NAD83) 088° 52' 58.7" W-
Overall Structure Height 299.87 feet
Support Structure Height 279.85 feet
Ground Elevation Above Mean Sea Level (AMSL) 1823.14 feet
Structure Type LTOWER - Lattice Tower
Tower Owner Global Tower, LLC. through American Towers, LLC
Date Constructed 06/08/1998


Other Types of Users

Users
Cellular

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 394
Explanation Scope & significance of project (QMI has multiple stations repacked) require outside management services to augment existing internal personnel to assist turnkey management of and ensure timely and safe execution of channel relocation.
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 4
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 4
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 Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
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

Quarterly reporting

Preparation and submittal of the FCC required quarterly report 387 by PM and attorney.

Vendor Travel Expenses

Reimbursable Vendor Travel expenses for working in the field on behalf of the station for the Repack project - see quote for estimated expenses.

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)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

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 $619,579.86 $593,979.86 N/A $39,533.63 N/A
Total for all systems $1,395,323.86 $1,342,131.86 N/A $64,791.12 N/A
Interim Transmitter VAXTE-1-R-44 $271,600.00 $260,000.00 $6,074.33
VHF inside RF system including switching $78,900.00 $75,000.00 N/A $0.00 N/A
High VHF - Air Cooled Solid State Transmitter 1.1 . 4.4 kW $152,500.00 $145,000.00 N/A N/A N/A
2" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $5,000.00 N/A N/A N/A
Other -- Building Addition Size: 220.0 $35,000.00 $35,000.00 Existing TX room is 10x10 building. Since this site is a leased site for WMOW to facilitate the interim requires a temporary solution. The solution that Gates Air offers is a transmitter trailer to hold the interim TX. $6,074.33 N/A
Primary Transmitter VAXTE-2R44 $347,979.86 $333,979.86 $33,459.30
Securirty - Site $17,500.00 $17,500.00 This site requires security once the new transmission line and equipment arrive on site to be installed. Estimated length of 4-6 weeks. N/A N/A
Transmitter- Training $3,300.00 $3,300.00 Transmitter training - offsite - 1 week in duration at mfg site. N/A N/A
Disconnect existing Transmitter $20,000.00 $20,000.00 Disconnect transmitter and components from existing configuration and move within building to make way for new facilities. N/A N/A
High VHF - Air Cooled Solid State Transmitter 1.1 . 4.4 kW $152,500.00 $145,000.00 N/A $27,386.16 N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $35,000.00 N/A $4,013.19 N/A
Site Survey - TX $15,000.00 $15,000.00 Site survey and report are required to be performed before the new transmitter and components installation plan can be finalized. N/A N/A
2" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $5,000.00 N/A N/A N/A
25 Ton system $91,500.00 $87,000.00 N/A N/A N/A
Sales Tax $6,179.86 $6,179.86 est sales tax per Gates INV TE10004487-1 $2,059.95 N/A

Components

Actual Information Description File Name
VHF inside RF system including switching Information not provided.
High VHF - Air Cooled Solid State Transmitter 1.1 . 4.4 kW Information not provided.
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Other -- Building Addition Size: 220.0

Component Description:
WMOW-GATES-MAIN-TEMP SHELTER-INV-TE10004487-1 Q-73722 ITEM F
Amount:
$6,074.33
Securirty - Site Information not provided.
Transmitter- Training Information not provided.
Disconnect existing Transmitter Information not provided.
High VHF - Air Cooled Solid State Transmitter 1.1 . 4.4 kW

Component Description:
WMOW-GATES-MAIN-TX- INV TE10004487-1 ITEM A,B, AND E
Amount:
$27,386.16
Transformer 3 phase/480v - 300 KVA

Component Description:
WMOW-GATES-MAIN- INV TE10004487-1 - ITEM C AND D
Amount:
$4,013.19
Site Survey - TX Information not provided.
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
25 Ton system Information not provided.
Sales Tax

Component Description:
WMOW-GATES-SALES TAX -INV TE10004487-1
Amount:
$2,059.95

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 $224,480.00 $222,280.00 N/A $0.00 N/A
Total for all systems $1,395,323.86 $1,342,131.86 N/A $64,791.12 N/A
Primary Antenna DRV-3-4-HO $224,480.00 $222,280.00 $0.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 N/A N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 N/A N/A N/A
Elbow complex, broadband, at antenna input, per 3 1/8. feedline (if needed) $9,340.00 $8,880.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
High VHF - High Power Side Mount Broadband Panel antenna --One Station horizontally polarized $180,000.00 $180,000.00 Entered Catalog of Costs dollar amount. The form stated $0.00 in the Predetermined block for the replacement of the Primary antenna. Not sure why. We tried many options to alleviate the situation and only adding the Catalog cost to the EST column worked. 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 $22,100.00 $21,825.00 N/A $0.00 N/A
Total for all systems $1,395,323.86 $1,342,131.86 N/A $64,791.12 N/A
Primary Transmission Line $22,100.00 $21,825.00 $0.00
Flexible Foam Transmission Line - dielectric, 1 5/8" $6,600.00 $6,325.00 N/A N/A N/A
Coax Switch $3,000.00 $3,000.00 switch from main to interim transmitter. N/A N/A
Disconnect existing Interior RF components $12,500.00 $12,500.00 Disconnect interior RF transmission line and filters from existing configuration and move within the building to make way for new facilities. 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 $254,800.00 $242,000.00 N/A $0.00 N/A
Total for all systems $1,395,323.86 $1,342,131.86 N/A $64,791.12 N/A
Primary Tower LTOWER $254,800.00 $242,000.00 $0.00
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
Structural engineering tower load study for well documented tower $12,600.00 $12,000.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $213,174.00 $201,462.00 N/A $25,257.49 N/A
Total for all systems $1,395,323.86 $1,342,131.86 N/A $64,791.12 N/A
Outside Professional Services $213,174.00 $201,462.00 $25,257.49
Quarterly reporting $5,000.00 $5,000.00 Preparation and submittal of the FCC required quarterly report 387 by PM and attorney. N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $14,720.00 $14,000.00 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 $3,459.50 N/A
Prepare request for Special Temporary Authorization $8,200.00 $6,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $1,650.00 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $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 $2,100.00 N/A
Vendor Travel Expenses $9,612.00 $9,612.00 Reimbursable Vendor Travel expenses for working in the field on behalf of the station for the Repack project - see quote for estimated expenses. QC-17005 $4,885.49 N/A
Project management of the transition $62,252.00 $59,100.00 N/A $13,162.50 N/A

Components

Actual Information Description File Name
Quarterly reporting 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:
ATTY FEE-INV AUG17 WMOW
Amount:
$235.00

Component Description:
ATTY-INV APRIL17 WMOW
Amount:
$470.00

Component Description:
ATTY FEE-WMOW-MAY17
Amount:
$547.00

Component Description:
ATTY INV- SEPT17 WMOW
Amount:
$141.00

Component Description:
ATTY FEE - WMOW- JUNE17
Amount:
$359.00

Component Description:
ATTY FEE CP-JULY17 WMOW
Amount:
$1,658.00

Component Description:
WMOW-BROOKS-LEGAL-INV- 3949057 -JAN18
Amount:
$49.50
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:
ENGR- CP APPLICATION-WMOW INV
Amount:
$1,650.00
Comprehensive coverage verification via field study, if needed Information not provided.
Prepare and or review reimbursement form Information not provided.
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
WMOW-NEW CHANNEL ENGR INV
Amount:
$2,100.00
Vendor Travel Expenses

Component Description:
WMOW-QCOMM-PM-TRAVEL EXP-INV QC17-146 ITEMS 1010-1015
Amount:
$4,885.49
Project management of the transition

Component Description:
WMOW-QCOMM-PM - INV QC17-146 ITEM 4004 - MARCH-AUGUST 2017
Amount:
$13,162.50

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 $61,190.00 $60,585.00 N/A $0.00 N/A
Total for all systems $1,395,323.86 $1,342,131.86 N/A $64,791.12 N/A
Other Expenses $61,190.00 $60,585.00 $0.00
MVPD Notification of Channel Change $5,000.00 $5,000.00 Required FCC notification. N/A N/A
Develop and air announcement of upcoming channel change $15,000.00 $15,000.00 Required FCC announcements and good will public relations must we upheld. The production airing and disseminating of these announcements are fundamental to our operations. N/A N/A
Equipment Storage $10,000.00 $10,000.00 Expecting multiple staggered equipment deliveries from different vendors and need to store and stage new equipment prior to installation date. Anticipate from 6-24 months of storage time. N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $10,000.00 $10,000.00 Rent 40 yard dumpster with multiple pickups. Estimated 6- months on site. Potential hazardous waste management issues. N/A N/A
Equipment Delivery and Handling Charges $8,000.00 $8,000.00 Transport, forklift rental and handling fees from staging area to transmitter site. 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 $1,395,323.86 $1,342,131.86 $64,791.12

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.

BRADY DREASLER

CORPORATE DIRECTOR OF ENGINEERING


03/30/2018

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.

BRADY DREASLER

CORPORATE DIRECTOR OF ENGINEERING


03/30/2018

Attachments

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