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:
65247
Service:
DTV
Call Sign:
WAWV-TV
Channel:
18 (UHF)
File Number:
0000028336
FRN:
0004284899
Date Submitted:
08/14/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

MISSION BROADCASTING, INC.

30400 DETROIT ROAD

SUITE 304

WESTLAKE, OH 44145

United States

+1 (440) 526-2227 missionbroadcasting@gmail.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

Greg Best

Consulting Engineer

Greg Best Consulting, Inc.

16100 Outlook Avenue

Stilwell, KS 66085

United States

+1 (816) 792-2913 gbconsulting54@gmail.com

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan See attached document.

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 Purchase New
Use Auxiliary (Backup)
Description of Use Backup
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 UNKNOWN
Year 2007
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 5 kW

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model UAXTE-12
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 5 kW
Justification for New Transmitter Existing transmitter cannot be converted to repacked channel per manufacturer.

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) Yes
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 2 inches
Length 50.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 5 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

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 UNKNOWN
Year 2009
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 50 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-90
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 50 kW
Justification for New Transmitter Existing transmitter cannot be converted to repacked channel per manufacturer and manufacturer is no longer in business.

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 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 100.0 square feet
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

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? Yes
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 Broadband Panel
Number of Stations Supported 2
Number of Panels 64
Design power capacity in use 75.0 %
Lower Limit 600.00 MHz
Upper Limit 630.00 MHz
Other Antenna Type N/A
ERP: 2000.0 kW
Manufacturer
Model 9551516
Year 2007

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

Facility ID Call Sign
20426 wtwo

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? Yes
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 Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 2
Number of Panels/Bays 64
Lower Limit 470.00 MHz
Upper Limit 630.00 MHz
Design power capacity in use 75.0 %
Other Antenna Type N/A
ERP: 3000.0 kW
Manufacturer
Model TUA-16/64H-1-R-T
Year 2017
Justification for New Antenna Existing broadband panel has VSWR problem at repacked channel. Manufacturer is no longer in business and no product support is available. It is known that antenna was modified earlier and could have reduced original operating range.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? Yes
Type New
Number of channels supported 2
Frequencies of channels supported RF channel
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? No
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Broadband
Feed Line Size 7 3/16 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Enter a list of RF channel numbers.

RF Channel Number
35
18

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
Ownership Owned
Owner N/A
Is antenna shared? Yes
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 2
Number of Panels/Bays 16
Lower Limit 470.00 MHz
Upper Limit 630.00 MHz
Design power capacity in use 50.0 %
Other Antenna Type N/A
ERP: 500.0 kW
Manufacturer
Model TUA-O4-04/16
Year 2017
Justification for New Antenna Station has no way to remain on the air except to acquire/use an interim antenna.

Interim Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? Yes
Type New
Number of channels supported 2
Frequencies of channels supported RF channel
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? No
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? B
Feed Line Size 3 1/8 inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for an antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Enter a list of RF channel numbers.

RF Channel Number
35
18

Interim 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? Yes
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer Dielectric
Type Rigid
Diameter 7 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 910 feet per run

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

Facility ID Call Sign
20426 WTWO

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

T Line extension

Add 180 feet of 7" line to existing run to mate with antenna location.

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? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
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 1027196
Coordinates (NAD83) Latitude (NAD83) 39° 14' 33.0" N-
Longitude (NAD83) 087° 23' 29.0" W-
Overall Structure Height 999.00 feet
Support Structure Height 892.38 feet
Ground Elevation Above Mean Sea Level (AMSL) 549.86 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Nexstar Broadcasting, Inc.
Date Constructed 07/01/1965

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
20426 WTWO DTV

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for 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 80
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 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 2
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 2
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 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 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? No
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

Sales Tax

Sales and Use Tax for goods and services

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 $1,831,050.00 $1,741,700.00 N/A $755,081.00 N/A
Total for all systems $3,506,030.00 $3,276,275.00 N/A $1,212,109.54 N/A
Primary Transmitter ULXTE-90 $1,535,800.00 $1,459,900.00 $736,810.00
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW $1,473,000.00 $1,400,000.00 N/A $736,810.00 N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $13,700.00 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
Other -- Building Addition Size: 100.0 $5,000.00 $5,000.00 Need to move walls, plumbing, electrical wiring, lighting fixtures, etc. N/A N/A
Auxiliary Transmitter UAXTE-12 $295,250.00 $281,800.00 $18,271.00
Other -- HVAC Service Type: H Size:5 (Other) $19,250.00 $19,250.00 N/A $18,271.00 N/A
UHF - Air Cooled Solid State Transmitter 4 - 6 kW $236,500.00 $225,000.00 N/A $0.00 N/A
2" Rigid Conduit and Wiring (Cost per foot) $1,300.00 $1,250.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A

Components

Actual Information Description File Name
Switchgear - industrial 800 amp Information not provided.
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW

Component Description:
75% Balance due on Transmitter system. See also sales tax 51,576.70.
Amount:
$550,518.75

Component Description:
25% Down payment on Transmitter System
Amount:
$186,291.25
Service entrance 3 phase/800 amp/208 volt Information not provided.
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Other -- Building Addition Size: 100.0 Information not provided.
Other -- HVAC Service Type: H Size:5 (Other)

Component Description:
HVAC per quote, shared cost with WTWO 20426. See also sales tax.
Amount:
$18,271.00
UHF - Air Cooled Solid State Transmitter 4 - 6 kW Information not provided.
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Switchgear - industrial 800 amp 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 $955,050.00 $837,680.00 N/A $231,654.36 N/A
Total for all systems $3,506,030.00 $3,276,275.00 N/A $1,212,109.54 N/A
Interim Antenna TUA-O4-04/16 $300,270.00 $215,280.00 $0.00
UHF – Broadband Panel, Side Mount Auxiliary/Interim, 500 horizontally polarized $200,000.00 $200,000.00 Use shorter antenna and fewer number of bays than full power panel. N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
New combiner, cost per channel (without antenna) $84,200.00 $0.00 Use same combiner as purchased for new primary antenna. 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
Primary Antenna TUA-16/64H-1-R-T $654,780.00 $622,400.00 $231,654.36
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $2,880.00 N/A
Elbow complex, broadband, at antenna input, per 7 3/16. feedline (if needed) $16,850.00 $16,000.00 N/A $11,613.36 N/A
UHF - High Power Top Mount (200-1000 kW), Two Station broadband panel antenna, horizontally polarized $547,000.00 $520,000.00 N/A $217,161.00 N/A
New combiner, cost per channel (without antenna) $84,200.00 $80,000.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF – Broadband Panel, Side Mount Auxiliary/Interim, 500 horizontally polarized Information not provided.
Sweep test of existing antenna Information not provided.
New combiner, cost per channel (without antenna) Information not provided.
Elbow complex, broadband, at antenna input, per 3 1/8. feedline (if needed) Information not provided.
Sweep test of existing antenna

Component Description:
Line 5 of invoice, shared cost with WTWO 20426.
Amount:
$1,440.00

Component Description:
Line 5 of invoice, shared cost with WTWO 20426.
Amount:
$1,440.00
Elbow complex, broadband, at antenna input, per 7 3/16. feedline (if needed)

Component Description:
Other component, line 4 of invoice, shared cost with WTWO 20426.
Amount:
$1,078.31

Component Description:
Elbow component, line 2 of invoice, shared cost with WTWO 20426.
Amount:
$3,219.75

Component Description:
Other component, line 3 of invoice, shared cost with WTWO 20426.
Amount:
$1,508.62

Component Description:
Other component, line 4 of invoice, shared cost with WTWO 20426.
Amount:
$1,078.31

Component Description:
Other component, line 3 of invoice, shared cost with WTWO 20426.
Amount:
$1,508.62

Component Description:
Elbow component, line 2 of invoice, shared cost with WTWO 20426.
Amount:
$3,219.75
UHF - High Power Top Mount (200-1000 kW), Two Station broadband panel antenna, horizontally polarized

Component Description:
Antenna component, line 1 of invoice, cost share with WTWO 20426.
Amount:
$108,580.50

Component Description:
Antenna component, line 1 of invoice, shared cost with WTWO 20426.
Amount:
$108,580.50
New combiner, cost per channel (without 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 $57,060.00 $57,060.00 N/A $0.00 N/A
Total for all systems $3,506,030.00 $3,276,275.00 N/A $1,212,109.54 N/A
Primary Transmission Line $57,060.00 $57,060.00 $0.00
T Line extension $57,060.00 $57,060.00 180 feet of 7" BB T-Line. 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 $381,100.00 $362,000.00 N/A $164,400.00 N/A
Total for all systems $3,506,030.00 $3,276,275.00 N/A $1,212,109.54 N/A
Primary Tower TOWER $381,100.00 $362,000.00 $164,400.00
Minor tower reinforcement/modifications $158,000.00 $150,000.00 N/A $82,100.00 N/A
Tall Tower (greater than 500') $210,500.00 $200,000.00 N/A $82,300.00 N/A
Structural engineering tower load study for well documented tower $12,600.00 $12,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Minor tower reinforcement/modifications

Component Description:
Amount due on proposal acceptance for Tower Modifications. See also sales tax $5,747.00.
Amount:
$82,100.00
Tall Tower (greater than 500')

Component Description:
Main antenna replacement installment #1; see also sales tax.
Amount:
$27,400.00

Component Description:
Main antenna replacement balance due on completion
Amount:
$27,500.00

Component Description:
Main antenna replacement installment #2
Amount:
$27,400.00
Structural engineering tower load study for well documented tower 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 $49,080.00 $45,750.00 N/A $2,750.00 N/A
Total for all systems $3,506,030.00 $3,276,275.00 N/A $1,212,109.54 N/A
Outside Professional Services $49,080.00 $45,750.00 $2,750.00
Project management of the transition $12,640.00 $12,000.00 N/A $825.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $1,925.00 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 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 N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Project management services and consultant with supporting invoice
Amount:
$675.00

Component Description:
Project management services 1.1.18 through 1.26.18
Amount:
$75.00

Component Description:
Project management services 10.27.17 through 12.31.17
Amount:
$75.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Services through end of April 2017. Information gathering, creation of transition plan with definition of initial equipment and service needs.
Amount:
$525.00

Component Description:
Services through 7/14/17. Revise storyboard if necessary, interference study, create CP and recalculate ERP if COR changed, transition plan document, create 399, coverage maps and upload draft docs.
Amount:
$700.00

Component Description:
Repack plan and revision, 399 form info, MCI Panel analysis
Amount:
$700.00
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 - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
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 Information not provided.
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form 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 $232,690.00 $232,085.00 N/A $58,224.18 N/A
Total for all systems $3,506,030.00 $3,276,275.00 N/A $1,212,109.54 N/A
Other Expenses $232,690.00 $232,085.00 $58,224.18
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
Local Zoning $500.00 $500.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $3,000.00 $3,000.00 N/A N/A N/A
Equipment Storage $1,000.00 $1,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $1,500.00 $1,500.00 Costs to develop and produce spots and crawls for viewer notification N/A N/A
MVPD Notification of Channel Change $3,500.00 $3,500.00 N/A N/A N/A
Sales Tax $210,000.00 $210,000.00 Sales and use tax for goods and services based on IN state rates. $58,224.18 N/A

Components

Actual Information Description File Name
DTV Medical Facility Notification Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
Local Zoning Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Equipment Storage Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
MVPD Notification of Channel Change Information not provided.
Sales Tax

Component Description:
Sales tax on invoice for Transmitter
Amount:
$51,576.70

Component Description:
Sales tax on Tower Modifications.
Amount:
$5,747.00

Component Description:
Sales tax on materials included on invoice
Amount:
$153.51

Component Description:
Sales tax on HVAC, shared cost with WTWO 20426.
Amount:
$746.97

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,506,030.00 $3,276,275.00 $1,212,109.54

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.

Dennis P. Thatcher

President


08/14/2018

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.

Dennis P. Thatcher

President


08/14/2018

Attachments

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