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:
71127
Service:
DTV
Call Sign:
WAVY-TV
Channel:
19 (UHF)
File Number:
0000028695
FRN:
0009961889
Date Submitted:
08/23/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

NEXSTAR BROADCASTING, INC.

Elizabeth Ryder

545 E. John Carpenter Freeway

Suite 700

Irving, TX 75062

United States

+1 (972) 373-8800 eryder@nexstar.tv 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

Elizabeth Ryder

General Counsel

Nexstar Broadcasting, Inc.

Elizabeth Ryder

545 E. John Carpenter Freeway

Suite 700

Irving, TX 75062

United States

+1 (972) 373-8800 eryder@nexstar.tv

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 the attached transition document.

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 DCX
Year 2001
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? Yes
Manufacturer
Model THU9EVO-48
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 46 kW
Justification for New Transmitter End of life components require transmitter replacement rather than simple conversion of existing transmitter per manufacturer.

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 75.0 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

Name Description

RF SYSTEM CONVERSION

Equipment and labor to convert inside RF system to new combiner/antenna switching.

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 Bottom
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 TFU-30GBH-R 08
Year 2001

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? Yes
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 Bottom
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model TFU-30GBH/VP-R O8
Year 2017
Justification for New Antenna Existing coaxial slot antenna is not designed to operate on repacked channel.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? Yes
Type New
Number of channels supported 4
Frequencies of channels supported RF channel
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? Yes
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

Enter a list of RF channel numbers.

RF Channel Number
31
14
19
21

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Second channel combiner port

WAVY must operate on pre-repack channel as well as post-repack channel into combiner so it needs 2 ports on the combiner.

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? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer DIELECTRIC
Type Rigid
Diameter 8 3/16 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 970 feet per run

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Line extension

30 ft Line extension due to antenna length change and tower mods.

Reducer

Reducer

TL 8-75 Length 5' to 10'

TL 8-75 Length 5' to 10'

Trans Test 8-75

Trans Test 8-75

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? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1018104
Coordinates (NAD83) Latitude (NAD83) 36° 49' 15.0" N-
Longitude (NAD83) 076° 30' 40.0" W-
Overall Structure Height 1026.89 feet
Support Structure Height 889.10 feet
Ground Elevation Above Mean Sea Level (AMSL) 22.97 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner WAVY BROADCASTING INC
Date Constructed 01/01/1957

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
65387 WVBT DTV
71119 WITD-CD DTV
71121 WKTD-CD 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: Serious 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 90
Explanation The engineering, tower rigging, transmitter and combiner suppliers, must all coordinate effectively because WAVY transitions in Phase 9 and the WNLO-CD & WVBT transition in Phase 7. Cost of this activity is shared between WAVY, WVBT, & WNLO-CD.
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 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 No
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

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 $1,554,500.00 $1,098,125.00 N/A $272,862.50 N/A
Total for all systems $3,543,224.00 $2,323,917.00 N/A $832,256.23 N/A
Primary Transmitter THU9EVO-48 $1,554,500.00 $1,098,125.00 $272,862.50
RF SYSTEM CONVERSION $20,000.00 $20,000.00 Equipment and labor to convert inside RF system to new combiner/antenna switching. 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
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW $1,473,000.00 $1,019,450.00 See Rohde& Schwarz quote 195248.1 total cost $1,267,351 less upgrade cost ($247,901) $272,862.50 N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $13,700.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
3" Rigid Conduit and Wiring (Cost per foot) $3,900.00 $3,675.00 N/A N/A N/A

Components

Actual Information Description File Name
RF SYSTEM CONVERSION Information not provided.
Other -- Building Addition Size: 100.0 Information not provided.
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW

Component Description:
Transmitter, installment #1, less upgrade cost
Amount:
$272,862.50
Service entrance 3 phase/800 amp/208 volt Information not provided.
Switchgear - industrial 800 amp Information not provided.
3" 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 $598,730.00 $627,810.00 N/A $450,083.80 N/A
Total for all systems $3,543,224.00 $2,323,917.00 N/A $832,256.23 N/A
Primary Antenna TFU-30GBH/VP-R O8 $598,730.00 $627,810.00 $450,083.80
Second channel combiner port $80,000.00 $80,000.00 To operate on pre-repack and post-repack channels, WAVY needs 2 ports on input combiner. $68,524.80 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $10,710.00 See Dielectric quote DMS188-3 $9,639.00 N/A
Combiner output splitting/switching for dual feed lines, if applicable $126,000.00 $120,000.00 This combiner switching system is used to directly the RF output to the combined WNLO antenna (see WAVY transition plan document) or the WAVY antenna. N/A N/A
New combiner, cost per channel (without antenna) $84,200.00 $0.00 See Second Channel Combiner Port N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $2,290.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $410,700.00 See Dielectric quote DMS188-3 total cost $441,450 less vpol ($30750) $369,630.00 N/A

Components

Actual Information Description File Name
Second channel combiner port

Component Description:
Combiner, installment #2, shared cost with WVBT and WNLO-CD
Amount:
$34,262.40

Component Description:
Combiner, installment #1, shared cost with WVBT and WNLO-CD
Amount:
$34,262.40
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Elbow complex, installment #2
Amount:
$4,819.50

Component Description:
Elbow complex, installment #1
Amount:
$4,819.50
Combiner output splitting/switching for dual feed lines, if applicable Information not provided.
New combiner, cost per channel (without antenna) Information not provided.
Sweep test of existing antenna

Component Description:
Sweep test, 50% of invoice cost shared with WVBT FAC ID 65387.
Amount:
$2,290.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Antenna, installment #2
Amount:
$184,815.00

Component Description:
Antenna, installment #1
Amount:
$184,815.00

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 $20,634.00 $20,634.00 N/A $8,337.60 N/A
Total for all systems $3,543,224.00 $2,323,917.00 N/A $832,256.23 N/A
Primary Transmission Line $20,634.00 $20,634.00 $8,337.60
Trans Test 8-75 $4,742.25 $4,742.25 See Dielectric quote DMS188-3 and change order $4,268.02 N/A
TL 8-75 Length 5' to 10' $2,103.75 $2,103.75 See Dielectric quote DMS188-3 and change order $1,893.38 N/A
Line extension $11,370.00 $11,370.00 30 ft of 8" BB line extension. N/A N/A
Reducer $2,418.00 $2,418.00 See Dielectric quote DMS188-3 and change order $2,176.20 N/A

Components

Actual Information Description File Name
Trans Test 8-75

Component Description:
Trans test, installment #2
Amount:
$2,134.01

Component Description:
Trans test, installment #1
Amount:
$2,134.01
TL 8-75 Length 5' to 10'

Component Description:
Transmission line piece, installment #2
Amount:
$946.69

Component Description:
Transmission line piece, installment #1
Amount:
$946.69
Line extension Information not provided.
Reducer

Component Description:
Reducer, installment #2
Amount:
$1,088.10

Component Description:
Reducer, installment #1
Amount:
$1,088.10

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 $1,275,100.00 $491,333.00 N/A $63,760.33 N/A
Total for all systems $3,543,224.00 $2,323,917.00 N/A $832,256.23 N/A
Primary Tower TOWER $1,275,100.00 $491,333.00 $63,760.33
Tall Tower (greater than 500') $210,500.00 $154,000.00 See Coast to Coast proposal 05211901T; shared cost with WVBT and WLNO-CD $53,760.33 N/A
Structural engineering tower load study for well documented tower $12,600.00 $4,000.00 Cost of this activity is shared between WAVY, WVBT, & WNLO-CD. This is only the cost for WAVY. N/A N/A
Serious tower reinforcement/modifications $1,052,000.00 $333,333.00 Cost of this activity is shared between WAVY, WVBT, & WNLO-CD. $10,000.00 N/A

Components

Actual Information Description File Name
Tall Tower (greater than 500')

Component Description:
Antenna installation, installment #1, shared cost with WVBT and WNLO-CD
Amount:
$53,760.33
Structural engineering tower load study for well documented tower Information not provided.
Serious tower reinforcement/modifications

Component Description:
Deposit as agreed per Nexstar Commitment Letter and Coast to Coast Tower Service
Amount:
$10,000.00

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $44,930.00 $42,250.00 N/A $12,212.00 N/A
Total for all systems $3,543,224.00 $2,323,917.00 N/A $832,256.23 N/A
Outside Professional Services $44,930.00 $42,250.00 $12,212.00
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 - 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 $2,050.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A N/A N/A
Project management of the transition $14,220.00 $13,500.00 This is a complex project with three stations on a single tower with multiple phase assignments. We have estimated WAVY's portion of the total project management cost to be 90 hours each at a rate of $150/hr. $6,874.50 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 $5,337.50 N/A

Components

Actual Information Description File Name
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.
Project management of the transition

Component Description:
Project management services 6.1.19 through 6.28.19
Amount:
$600.00

Component Description:
Project management services 1.1.19 through 1.31.19
Amount:
$600.00

Component Description:
Project management services February 2019
Amount:
$123.50

Component Description:
Project management services May 2019
Amount:
$70.00

Component Description:
Project management services 9.29.18 through 10.26.18
Amount:
$150.00

Component Description:
Professional management services 10.27.18 through 12.31.18
Amount:
$275.00

Component Description:
Project management of the transition professional services from September 20, 2017 through May 25, 2018 including services provided by consultants Kessler and Gehman Associates, Inc.
Amount:
$3,491.00

Component Description:
Project management services 2.1.19 through 3.1.19
Amount:
$600.00

Component Description:
Project management services 3.30.19 through 4.26.19
Amount:
$450.00

Component Description:
Project management of the transition professional services from May 26, 2018 through June 29, 2018 including services provided by consultants Kessler and Gehman Associates, Inc.
Amount:
$450.00

Component Description:
Project management services January 2019
Amount:
$65.00
Prepare and or review reimbursement form Information not provided.
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
Repack engineering services. Evaluation of expansion options for WAVY for 2nd priority window application. Creation of exhibit to support Legal STA for WAVY to transition earlier than assigned.
Amount:
$1,137.50

Component Description:
Information gathering, creation of transition plan with definition of initial equipment and service needs.
Amount:
$350.00

Component Description:
Creation of initial repacked versus licensed map comparison. Information gathering for all station transmission facilities and creation of repack plan for each station . WAVY RPU license mod to address narrow banding and use of digital emissions.
Amount:
$2,100.00

Component Description:
Revise storyboard, interference study, create CP and recalculate ERP if COR changed, transition plan document, create 399, coverage maps, & upload draft documents to ASANA.
Amount:
$1,225.00

Component Description:
Revise and update 399 form
Amount:
$612.50

Component Description:
Repack plan and revision, 399 form info
Amount:
$1,050.00

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 $49,330.00 $43,765.00 N/A $25,000.00 N/A
Total for all systems $3,543,224.00 $2,323,917.00 N/A $832,256.23 N/A
Other Expenses $49,330.00 $43,765.00 $25,000.00
MVPD Notification of Channel Change $5,750.00 $5,750.00 See attached quote for notification of all relevant MVPD entities. N/A N/A
Develop and air announcement of upcoming channel change $3,500.00 $3,500.00 Develop and produce crawls and spots for viewer notification. N/A N/A
Equipment Storage $2,000.00 $2,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $25,000.00 $25,000.00 See USA Commercial quote 22 attached. $25,000.00 N/A
Local Zoning $1,000.00 $1,000.00 Building permits and fees. N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $6,000.00 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

Components

Actual Information Description File Name
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Disposal costs
Amount:
$25,000.00
Local Zoning Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
DTV Medical Facility Notification Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,543,224.00 $2,323,917.00 $832,256.23

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.

Elizabeth Ryder

General Counsel


08/23/2019

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.

Elizabeth Ryder

General Counsel


08/23/2019

Attachments

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