Go to the Federal Communications Commission homepage at www.fcc.gov

FCC Form 399: Incentive Auction Relocation Reimbursement Fund System

Approved by OMB 3060-1178
Go to the Federal Communications Commission homepage at www.fcc.gov

(REFERENCE COPY - Not for submission)FCC Form 399: Incentive Auction Relocation Reimbursement Fund System

File Number:
0000026593
FRN:
0003757481
Facility ID:
22591
Repack Channel:
24 (UHF)
Entity:
Broadcaster
Filing Status:
Submitted
Date Submitted:
04/18/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

CITADEL COMMUNICATIONS, LLC

Doing Business As: CITADEL COMMUNICATIONS, LLC

Philip J. Lombardo

117 PONDFIELD ROAD

BRONXVILLE, NY 10708

United States

+1 (914) 793-3400 CITNYLTD@AOL.COM Limited Liability Company

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

David D Burns

Counsel

Pillsbury Winthrop Shaw Pittman LLP

David Burns

1200 Seventeenth Street NW

Washington DC, DC 20036

United States

+1 (202) 663-8007 david.burns@pillsburylaw.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 Purchase transmitter, antenna, combiner, and transmission line. Current transmitter cannot be retuned to the new channel. Installation of interim antenna, transmission line, and combiner on co-located tower while main antenna is replaced.

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  
Ownership Owned
Owner  
Site  
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model Sigma CD
Year 2005
Type Inductive Output Tube
IOT Power Type Two
Description  
Power capacity 40 kw
Solid State Cooling  
Solid State Power Capacity  
Other Transmitter Type  

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Description of Use  
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model Maxiva Series ULXTE-30
Transmitter Type Solid state
IOT Power Type  
Other  
Power capacity  
Solid State Cooling Liquid
Solid State Power Capacity 19.2 kw
Other Transmitter Type  
Justification for New Transmitter Current transmitter cannot be retuned to the new channel. Cost estimate of comparable IOT is significantly more than upgrade to solid state (see attachments). Estimates are from two different vendors because GatesAir does not make IOT transmitters.

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 No
Size
Length
Other Electrical Service Yes
Description Installation of parallel surge suppressor for 3PH WYE, installation of 208-240v pump module.
HVAC Service Does the replacement transmitter require HVAC Service? No
Type
Size
Other Size  
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size
Channel 14 Costs Is an RF Consulting Engineer needed?
Is a channel 14 Mask Filer needed?
Is additional field engineering time needed?
Number of Days  

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Mask Filter System

See GatesAir Proposal Q-60990

Installation and Proof

See GatesAir Proposal Q-60990

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 Leased
Owner WJAR
Site N/A
Is the existing antenna shared with another station or stations? Yes
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side-mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 350.00 kW
Manufacturer
Model RFU-24DSB-R 4C170TC
Year 2005

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

Facility ID Call Sign
50780 WJAR

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? Yes
Ownership Leased
Owner WJAR
Is antenna shared? Yes
Is antenna directional? Yes
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 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: 220.00 kW
Manufacturer
Model TFU-21JCC-R 4C170DC
Year 2017
Justification for New Antenna Present antenna cannot be tuned to new channel 24.

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 upper and lower frequency
Frequency 530.0 MHz - 542.0 MHz
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 6 1/8 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? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

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 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: 350.00 kW
Manufacturer
Model TFU-21JSC-R 04 DC
Year 2018
Justification for New Antenna To keep WLNE on the air when the Primary old antenna is taken down and the new Primary put up. The interim antenna can be used for the new (24)channel or the old channel (50)

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? 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 6 1/8 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? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Interim Antenna

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Other Antenna Cost Not Listed

Name Description

Transmission Line - Other Related

Transmission Line Test 6-75

Rigid Transmission Line

Transmission Line 6-75 EIA Length 15 to 20 Feed Fixed

Transmission Line

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Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? No

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 Move Equipment
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Terrain Constrained
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 1005123
Coordinates (NAD83) Latitude (NAD83) 41° 51' 55.4" N-
Longitude (NAD83) 071° 17' 12.7" W-
Overall Structure Height 922.89 feet
Support Structure Height 872.04 feet
Ground Elevation Above Mean Sea Level (AMSL) 197.83 feet
Structure Type LTOWER - Lattice Tower
Tower Owner WJAR Licensee, LLC
Date Constructed 04/01/2013

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
56092 WSBE-TV DTV
70184 WRIW-CD DTV
50780 WJAR DTV

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Terrain constrained
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

install aux. antenna

install interim antenna so old antenna can be taken down and new one put up

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? No
Number of Hours N/A
Explanation N/A
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 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

Name Description

Additional Repack Legal Services Not Otherwise Specified in Form 399

6-2017 Pillsbury Invoice Breakout

Additional Repack Legal Services Not Otherwise Specified in Form 399

4-2017 Pillsbury Invoice Breakout

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? Yes
Is Remediation needed? Yes
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 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? No
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $759,688.27 $743,088.27 N/A $156,509.96 N/A
Total for all systems $1,899,030.27 $1,186,463.77 N/A $252,383.41 N/A
Primary Transmitter Maxiva Series ULXTE-30 $759,688.27 $743,088.27 $156,509.96
Transformer 3 phase/480v - 150 KVA $24,900.00 $24,300.00 N/A N/A N/A
Installation and Proof $30,395.25 $30,395.25 N/A $10,131.75 N/A
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW $666,000.00 $650,000.00 N/A $135,477.52 N/A
Other Electrical Service: Installation of parallel surge suppressor for 3PH WYE, installation of 208-240v pump module. $10,000.00 $10,000.00 N/A $1,436.34 N/A
Mask Filter System $28,393.02 $28,393.02 N/A $9,464.35 N/A

Components

Actual Information Description File Name
Transformer 3 phase/480v - 150 KVA Information not provided.
Installation and Proof

Component Description:
Installation and Proof
Amount:
$10,131.75
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW

Component Description:
ULXTE-30 Transmitter
Amount:
$135,477.52
Other Electrical Service: Installation of parallel surge suppressor for 3PH WYE, installation of 208-240v pump module.

Component Description:
Electrical
Amount:
$1,436.34
Mask Filter System

Component Description:
Mask Filter System
Amount:
$9,464.35

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 $610,637.00 $326,406.00 N/A $83,916.45 N/A
Total for all systems $1,899,030.27 $1,186,463.77 N/A $252,383.41 N/A
Interim Antenna TFU-21JSC-R 04 DC $267,237.00 $205,006.00 $83,916.45
UHF - Lower Power Side Mount, One station antenna -- 200-500 kW, elliptically or circularly polarized $221,000.00 $166,374.00 N/A $66,532.05 N/A
Sweep test of existing antenna $6,550.00 $6,400.00 N/A $2,880.00 N/A
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,300.00 $11,970.00 N/A $5,386.50 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $22,550.00 $16,425.00 N/A $7,391.25 N/A
Rigid Transmission Line $1,719.00 $1,719.00 N/A $773.55 N/A
Transmission Line - Other Related $2,118.00 $2,118.00 N/A $953.10 N/A
Primary Antenna TFU-21JCC-R 4C170DC $343,400.00 $121,400.00 $0.00
Side mount brackets for high power antennas (if not included in antenna base cost) $22,550.00 $22,000.00 N/A N/A N/A
UHF - Lower Power Side Mount, One station antenna -- 200-500 kW, elliptically or circularly polarized $221,000.00 $0.00 N/A N/A N/A
Sweep test of existing antenna $6,550.00 $6,400.00 N/A N/A N/A
New combiner, cost per channel (without antenna) $80,000.00 $80,000.00 N/A N/A N/A
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,300.00 $13,000.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF - Lower Power Side Mount, One station antenna -- 200-500 kW, elliptically or circularly polarized

Component Description:
Side Mount Antenna - VPOL included towards antenna price
Amount:
$66,532.05
Sweep test of existing antenna

Component Description:
Sweep Test
Amount:
$2,880.00
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Elbow Complex Kit
Amount:
$5,386.50
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
Side Mount Brackets
Amount:
$7,391.25
Rigid Transmission Line

Component Description:
Rigid Transmission Line
Amount:
$773.55
Transmission Line - Other Related

Component Description:
Transmission Line Test 6-75
Amount:
$953.10
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
UHF - Lower Power Side Mount, One station antenna -- 200-500 kW, elliptically or circularly 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 6 1/8. feedline (if needed) Information not provided.

Cost Information

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Transmission Line

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 $409,500.00 $0.00 N/A $0.00 N/A
Total for all systems $1,899,030.27 $1,186,463.77 N/A $252,383.41 N/A
Primary Tower LTOWER $409,500.00 $0.00 $0.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $409,500.00 $0.00 This is a shared site, and all costs are to be borne by WJAR (Fac. ID No. 50780). Please see WJAR's Form 399 to ensure consistency. N/A N/A
install aux. antenna $0.00 $0.00 This is a shared site, and all costs are to be borne by WJAR (Fac. ID No. 50780). Please see WJAR's Form 399 to ensure consistency. 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 $67,480.00 $66,179.50 N/A $11,957.00 N/A
Total for all systems $1,899,030.27 $1,186,463.77 N/A $252,383.41 N/A
Outside Professional Services $67,480.00 $66,179.50 $11,957.00
Additional Repack Legal Services Not Otherwise Specified in Form 399 $15,000.00 $15,000.00 NON-CATALOG LEGAL SERVICES SUCH AS REVIEW OF QUARTERLY TRANSITION STATUS REPORTS AND OTHER MISCELLANEOUS NON-CATALOG LEGAL FEES. $356.00 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,585.00 $3,500.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,095.00 $4,000.00 N/A $0.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,305.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,120.00 $5,000.00 N/A $0.00 N/A
Prepare request for Special Temporary Authorization $1,535.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,535.00 $1,500.00 N/A $0.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,070.00 $3,000.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,170.00 $7,000.00 N/A $3,000.00 N/A
Prepare and or review reimbursement form $2,560.00 $15,000.00 Additional expenses were incurred as indicated in the attached invoices. $2,671.50 Placeholder
Address transition timing and coordination issues w/ other stations and wireless $2,560.00 $2,500.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,095.00 $923.00 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $923.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,120.00 $4,029.50 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $4,029.50 N/A
Perform engineering study for new channel assignment and antenna development $7,170.00 $125.00 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $125.00 N/A
Prepare and or review reimbursement form $2,560.00 $852.00 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $852.00 N/A

Components

Actual Information Description File Name
Additional Repack Legal Services Not Otherwise Specified in Form 399

Component Description:
FCC Rules regarding repack; review coverage maps; FCC correspondence
Amount:
$1,708.39

Component Description:
Non-Catalog Legal Services such as review of quarterly transition status reports and other miscellaneous non-catalog legal fees
Amount:
$44.50

Component Description:
Non-Catalog Legal Services such as review of quarterly transition status reports and other miscellaneous non-catalog legal fees
Amount:
$133.50

Component Description:
June Invoice from Pillsbury revised 5-9-18
Amount:
$7,617.27

Component Description:
Non-Catalog Legal Services such as review of quarterly transition status reports and other miscellaneous non-catalog legal fees
Amount:
$178.00
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
Leased antenna and line on Rehoboth Tower
Amount:
$923.00
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:
Review WLNE Construction Permit
Amount:
$255.06

Component Description:
form 2100 and schedule 399
Amount:
$4,029.50
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 Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
Engineering Study for New Channel Assignment and Antenna Development
Amount:
$500.00

Component Description:
WLNE updated application to specify elliptical polarization
Amount:
$250.00

Component Description:
Engineering study for new channel assignment and antenna development
Amount:
$2,500.00

Component Description:
du Treil, Lundin, Rackley 4-30-17 invoice
Amount:
$125.00
Prepare and or review reimbursement form

Component Description:
Reimbursement Questions
Amount:
$1,044.12

Component Description:
Prepare and or review reimbursement form
Amount:
$532.70

Component Description:
Prepare and or review reimbursement form
Amount:
$496.00

Component Description:
Prepare and or review reimbursement form
Amount:
$719.30

Component Description:
Form 399 Construction Permit
Amount:
$852.00

Component Description:
Modification of Form 399
Amount:
$745.50

Component Description:
Prepare and or review reimbursement form
Amount:
$178.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
leased antenna and line on Rehoboth tower
Amount:
$923.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
form 2100 and schedule 399
Amount:
$4,029.50
Perform engineering study for new channel assignment and antenna development

Component Description:
du Triel, Lundin, Rackley 4-30-17 invoice
Amount:
$125.00
Prepare and or review reimbursement form

Component Description:
form 399 construction permit
Amount:
$852.00

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 $51,725.00 $50,790.00 N/A $0.00 N/A
Total for all systems $1,899,030.27 $1,186,463.77 N/A $252,383.41 N/A
Other Expenses $51,725.00 $50,790.00 $0.00
AM Pattern Disturbance -- Impact study $7,680.00 $7,500.00 N/A N/A N/A
AM Pattern Disturbance -- Remedy $20,500.00 $20,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,250.00 $11,000.00 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 $1,000.00 $1,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $10,000.00 $10,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $1,000.00 $1,000.00 N/A N/A N/A
MVPD Notification of Channel Change $100.00 $100.00 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 $1,899,030.27 $1,186,463.77 $252,383.41

Construction Status

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Question Response
Is construction complete? 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.

Daniel D. Ackerman

Vice President of Engineering


04/18/2019

Certification

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Section Question Response
Submission of Actual Cost Documentation 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 and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material.

  2. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  3. 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).

  4. 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.

  5. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.

  6. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  7. 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.

Daniel D. Ackerman

Vice President of Engineering


04/18/2019

Attachments

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