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:
17433
Service:
DTV
Call Sign:
KAZD
Channel:
31 (UHF)
File Number:
0000028491
FRN:
0026907345
Date Submitted:
04/10/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

HC2 STATION GROUP, INC.

Doing Business As: HC2 STATION GROUP, INC.

RENEE ILHARDT

450 PARK AVENUE

30TH FLOOR

NEW YORK, NY 10022

United States

+1 (212) 339-5832 rilhardt@hc2broadcasting.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

The Preparer is same as the reimbursement contact.

 

 

 

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 Purchase interim antenna for temporary operation during installation and testing of new top-mount Main antenna plus transmitter for the repacked channel (31).

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 HP90TDP
Year 2007
Type Inductive Output Tube
IOT Power Type Three
Power Capacity 60 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? Yes
Manufacturer
Model TH9EVO-48
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 73.5 kW
Justification for New Transmitter The present transmitter manufacturer no longer supports the equipment nor makes channel changes. A solid state transmitter costs less than the only available IOT transmitter.

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) No
Power N/A
Rigid Conduit and Wiring Yes
Size 2 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? 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

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 Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model ATW28HS3-HTO-39H
Year 2007

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 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 Top 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: 852.0 kW
Manufacturer
Model SAA30-O4B-E301-ET5R-31
Year 2019
Justification for New Antenna Slotted coaxial antennas work only on one channel or adjacent channels. Existing antenna was manufactured to work on Channel 39 and will not work on Channel 31.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 6 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

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? No
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 Horizontal
Type Broadband Slot
Number of Stations Supported 1
Number of Panels/Bays 6
Lower Limit 470.00 MHz
Upper Limit 700.00 MHz
Design power capacity in use 100.0 %
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model SBB-24
Year 2019
Justification for New Antenna The existing antenna cannot be retuned so it needs to be replaced. In order to keep the station on the air, an interim antenna is required.

Interim Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for an 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

Information not provided.

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 Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? No
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1048127
Coordinates (NAD83) Latitude (NAD83) 32° 35' 15.0" N-
Longitude (NAD83) 096° 58' 00.0" W-
Overall Structure Height 1536.73 feet
Support Structure Height 1457.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 811.67 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner American Tower, LLC
Date Constructed 11/01/1989

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
71201 KSCS FM

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 undocumented/poorly 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

Name Description

Construction project management Tower Modification reinforcements and facilities.

80 hours for tower modification project management.

Tower Permit Drawing Package

The generation of a construction drawing package for one broadcaster

Ground and Building A and E Permit Drawing Package

The generation of a construction drawing package for one broadcaster.

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 260
Explanation Project management fee for the transition of one broadcaster for the tower and transmitter sub-projects. Scheduling and management of the timelines and schedules occurring during the repack.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study 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

Site Coordination Meetings

Site coordination meetings with all broadcasters, contractors and vendors involved with the site deliveries and construction. This cost is for travel and logistics expenses accrued.

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 Yes
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

Name Description

Obtain Building Permit from local zoning authorities.

The cost of preparation and submission of the needed forms for permits, on behalf of one broadcaster for jurisdictional permits, required for electrical, building and other required tasks associated with installation of the equipment in the transmitter.

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 $2,001,600.00 $1,948,500.00 N/A $391,904.69 N/A
Total for all systems $3,150,146.98 $2,896,539.48 N/A $648,932.86 N/A
Primary Transmitter TH9EVO-48 $2,001,600.00 $1,948,500.00 $391,904.69
UHF - Liquid Cooled Solid State Transmitter 68.5 - 75 kW $1,999,000.00 $1,946,000.00 N/A $391,904.69 N/A
2" Rigid Conduit and Wiring (Cost per foot) $2,600.00 $2,500.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF - Liquid Cooled Solid State Transmitter 68.5 - 75 kW

Component Description:
Transmitter 25% downpayment. #9500086777
Amount:
$390,957.50

Component Description:
Transmitter related cost. #9500092931
Amount:
$947.19
2" Rigid Conduit and Wiring (Cost per foot) 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 $502,521.98 $392,006.98 N/A $210,771.66 N/A
Total for all systems $3,150,146.98 $2,896,539.48 N/A $648,932.86 N/A
Interim Antenna SBB-24 $193,991.98 $185,606.98 $170,606.98
UHF - High Power, Side Mount, basic slot antenna, 6 bay,, 1000 kW input, directional,, horizontally polarized $164,111.98 $164,111.98 N/A $164,111.98 N/A
Sweep test of existing antenna $6,730.00 $6,495.00 N/A $6,495.00 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $15,000.00 N/A N/A N/A
Primary Antenna SAA30-O4B-E301-ET5R-31 $308,530.00 $206,400.00 $40,164.68
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $190,000.00 N/A $40,164.68 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $10,000.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF - High Power, Side Mount, basic slot antenna, 6 bay,, 1000 kW input, directional,, horizontally polarized

Component Description:
Antenna costs. #16487658
Amount:
$164,111.98
Sweep test of existing antenna

Component Description:
Antenna related cost. #16488509
Amount:
$6,495.00
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
Sweep test of existing antenna Information not provided.
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Antenna related cost. #16495111
Amount:
$40,164.68
Elbow complex, single channel, 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 $430,200.00 $362,285.00 N/A $26,885.00 N/A
Total for all systems $3,150,146.98 $2,896,539.48 N/A $648,932.86 N/A
Primary Tower TOWER $430,200.00 $362,285.00 $26,885.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $26,885.00 Updated cost of estimated amount per FCC requirement. $26,885.00 N/A
Ground and Building A and E Permit Drawing Package $4,700.00 $4,700.00 N/A N/A N/A
Tower Permit Drawing Package $4,700.00 $4,700.00 N/A N/A N/A
Construction project management Tower Modification reinforcements and facilities. $26,000.00 $26,000.00 N/A N/A N/A
Tall Tower (greater than 500') $210,500.00 $200,000.00 N/A N/A N/A
Minor tower reinforcement/modifications $158,000.00 $100,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Tower related cost. #460207440
Amount:
$16,435.00

Component Description:
Tower related cost. #460207439
Amount:
$10,450.00
Ground and Building A and E Permit Drawing Package Information not provided.
Tower Permit Drawing Package Information not provided.
Construction project management Tower Modification reinforcements and facilities. Information not provided.
Tall Tower (greater than 500') Information not provided.
Minor tower reinforcement/modifications Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $166,385.00 $144,912.50 N/A $15,121.51 N/A
Total for all systems $3,150,146.98 $2,896,539.48 N/A $648,932.86 N/A
Outside Professional Services $166,385.00 $144,912.50 $15,121.51
Prepare request for Special Temporary Authorization $2,050.00 $2,662.50 Updated cost of estimated amount per FCC requirement. $2,662.50 N/A
Site Coordination Meetings $2,500.00 $2,500.00 N/A $2,500.00 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $4,000.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A 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 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
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $2,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Project management of the transition $41,080.00 $25,000.00 N/A $9,959.01 N/A

Components

Actual Information Description File Name
Prepare request for Special Temporary Authorization

Component Description:
Consulting engineering cost. #0002-010-0001
Amount:
$2,662.50
Site Coordination Meetings

Component Description:
Site coordination. #460209590
Amount:
$2,500.00
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application 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 Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application Information not provided.
Project management of the transition

Component Description:
Construction project management. #460209590
Amount:
$2,500.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1118
Amount:
$1,609.03

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1112
Amount:
$521.40

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1104
Amount:
$1,359.73

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #471659
Amount:
$713.16

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1104
Amount:
$644.80

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1112
Amount:
$1,881.13

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1116
Amount:
$1,254.03

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #472568
Amount:
$1,235.06

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1096
Amount:
$714.93

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #472232
Amount:
$766.60

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 $49,440.00 $48,835.00 N/A $4,250.00 N/A
Total for all systems $3,150,146.98 $2,896,539.48 N/A $648,932.86 N/A
Other Expenses $49,440.00 $48,835.00 $4,250.00
Obtain Building Permit from local zoning authorities. $750.00 $750.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 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 - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $4,250.00 N/A
Local Zoning $1,000.00 $1,000.00 N/A N/A N/A
Non-zoning permits $1,000.00 $1,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $25,000.00 $25,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $2,500.00 $2,500.00 N/A N/A N/A
Equipment Storage $1,500.00 $1,500.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $2,000.00 $2,000.00 N/A N/A N/A
MVPD Notification of Channel Change $2,500.00 $2,500.00 N/A N/A N/A

Components

Actual Information Description File Name
Obtain Building Permit from local zoning authorities. Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
DTV Medical Facility Notification

Component Description:
Medical notification service. #1125
Amount:
$4,250.00
Local Zoning Information not provided.
Non-zoning permits Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Equipment Delivery and Handling Charges 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.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,150,146.98 $2,896,539.48 $648,932.86

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.

Les Levi

Chief Operating Officer


04/10/2019

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.

Les Levi

Chief Operating Officer


04/10/2019

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