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:
51101
Service:
DTV
Call Sign:
KOZJ
Channel:
35 (UHF)
File Number:
0000027873
FRN:
0002487056
Date Submitted:
08/06/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

BOARD OF GOVERNORS OF MISSOURI STATE UNIVERSITY

Doing Business As: BOARD OF GOVERNORS OF MISSOURI STATE UNIVERSITY

Tammy Wiley

901 S. NATIONAL AVE.

SPRINGFIELD, MO 65897

United States

+1 (417) 836-5878 TAMMYWILEY@MISSOURISTATE.EDU Government Entity

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

Matthew Anderson Sanderford , Jr. .

President

Marsand, Inc. 211 Pack Saddle Trail Weatherford, TX 76088-8646

Matthew Sanderford

211 Pack Saddle Trail

Weatherford, TX 76088

United States

+1 (817) 783-5566 engineering@marsand.com

Broadcaster Information and Transition Plan

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

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 DHD20P1
Year 2003
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 5.5 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model ULXTE-10
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 6.6 kW
Justification for New Transmitter Existing transmitter manufacturer will not support retuning to new channel and current transmitter does not have sufficient output power.

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 No
Size N/A
Length N/A
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 5 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 0.0 square feet
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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Section Question Response
Antenna Related Expenses Do you have antenna related expenses? Yes

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type 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: 55.0 kW
Manufacturer
Model B16UOM
Year 1984

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Slot
Number of Stations Supported 2
Number of Panels/Bays 16
Lower Limit 500.00 MHz
Upper Limit 626.00 MHz
Design power capacity in use 59.0 %
Other Antenna Type N/A
ERP: 68.0 kW
Manufacturer
Model RD-16RFS(OM)-500626-SL
Year 2017
Justification for New Antenna Existing CH25 antenna will not support CH35. Broadband replacement allows reuse of existing aperture and main transmission line run with no structural modification.

Primary Antenna

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Other Antenna Costs

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

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? 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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Add 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? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1012933
Coordinates (NAD83) Latitude (NAD83) 37° 04' 34.9" N-
Longitude (NAD83) 094° 32' 16.4" W-
Overall Structure Height 981.94 feet
Support Structure Height 980.96 feet
Ground Elevation Above Mean Sea Level (AMSL) 1042.97 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner SpectraSite Communications, LLC. through American Towers, LLC.
Date Constructed 01/01/1965

FM, AM or TV radio broadcasters. Facility ID's, Call Signs and Services of other broadcast stations with whom the tower is shared

Facility ID Call Sign Service
18283 KODE-TV 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 undocumented/poorly 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

Name Description

Antenna Change Out

Cost for removing old antenna and install new antenna

Tower Permit Drawing Package

Tower owner required generation of a construction drawing package

Structural Engineering Tower Load Study

Tower owner required Rigorous Structural analysis

Ground and Building AE Permit Drawing Package

Tower owner required generation of a construction drawing package

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 100
Explanation The station has multiple transmitter sites (2 TV) and operates with minimal staff. It does not have personnel available for any of these tasks, nor is the staff trained to provide any of these services.
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 No
Quantity N/A
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 No
Quantity N/A
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 No
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

Site Survey

Site visit for specifying the final equipment needs and installation planning.

Tower Owner Project Managment

Tower owner required project management.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning No
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application No
FCC Special Temporary Authority Application No
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

Name Description

Required bid advertising

State of Missouri statutes require advertising for projects/equipment with a value of $100,000 or greater.

Receive Equipment to Monitor Signal

Updated receive equipment needed to monitor signal at main studios

Professional Services for Transmitter Building Improvements

Oversight of design development, construction documents, bidding and construction administration.

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 $710,879.35 $377,323.88 N/A $377,323.88 N/A
Total for all systems $2,288,047.98 $1,210,361.81 N/A $1,036,667.08 N/A
Primary Transmitter ULXTE-10 $710,879.35 $377,323.88 $377,323.88
Other -- Building Addition Size: 0.0 $13,865.00 $13,865.00 Access Door required to allow personnel access between the transmitter room and the new transmitter heat exchanger located outside. Costs exceeded original estimates. See attached documentation for actual costs. $13,865.00 N/A
Other -- HVAC Service Type: H Size:5 (Other) $25,546.00 $25,546.00 Current HVAC requires too much space to locate new transmitter’s outdoor heat exchanger. This space is limited. HVAC to be replaced with smaller outdoor unit to allow sufficient area for transmitter exchanger. Actual costs exceeded original estimates. $25,546.00 N/A
UHF - Liquid Cooled Solid State Transmitter 6.6 kW $176,968.35 $176,968.35 Cost is reflective of actual expenses incurred. See cost component for detailed memo and supporting documentation. $176,968.35 N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $494,500.00 $160,944.53 ***System Notice: Estimate adjusted and locked because line has been superseded.***Final quote not received. Maximum estimate used in its place. $160,944.53 N/A

Components

Actual Information Description File Name
Other -- Building Addition Size: 0.0

Component Description:
Portion of bill for Access Door.
Amount:
$13,865.00
Other -- HVAC Service Type: H Size:5 (Other)

Component Description:
Portion of invoice for HVAC related work.
Amount:
$25,546.00
UHF - Liquid Cooled Solid State Transmitter 6.6 kW

Component Description:
Portion of bill for transmitter installation, proof, and freight.
Amount:
$38,389.34

Component Description:
Costs for transmitter and component parts.
Amount:
$138,579.01
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW

Component Description:
Costs for transmitter components.
Amount:
$1,961.74

Component Description:
Costs for transmitter and component parts.
Amount:
$138,579.01

Component Description:
Costs for transmitter components.
Amount:
$20,403.78

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 $80,587.16 $77,802.46 N/A $66,402.46 N/A
Total for all systems $2,288,047.98 $1,210,361.81 N/A $1,036,667.08 N/A
Primary Antenna RD-16RFS(OM)-500626-SL $80,587.16 $77,802.46 $66,402.46
UHF - High Power, Side Mount, basic slot antenna, 16 bay,, 68 kW input, horizontally polarized $59,257.16 $59,257.16 As final antenna needs were developed, there was some cost variance from initial 399 estimates which relied on FCC catalog pricing. $59,257.16 As final antenna needs were developed, there was some cost variance from initial 399 estimates which relied on FCC catalog pricing.
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
Elbow complex, broadband, at antenna input, per 3 1/8. feedline (if needed) $9,340.00 $7,145.30 As final needs were developed on antenna related components, there was some cost variance from initial 399 estimates which relied on FCC catalog pricing. $7,145.30 As final needs were developed, we saw some cost variance from original estimates for needed components.
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF - High Power, Side Mount, basic slot antenna, 16 bay,, 68 kW input, horizontally polarized

Component Description:
Portion of bill for antenna
Amount:
$59,257.16
Sweep test of existing antenna Information not provided.
Elbow complex, broadband, at antenna input, per 3 1/8. feedline (if needed)

Component Description:
Portion of bill for antenna-related transmission line components.
Amount:
$7,145.30
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) 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 $1,393,650.00 $633,964.00 N/A $540,314.00 N/A
Total for all systems $2,288,047.98 $1,210,361.81 N/A $1,036,667.08 N/A
Primary Tower GTOWER $1,393,650.00 $633,964.00 $540,314.00
Serious tower reinforcement/modifications $1,052,000.00 $512,769.00 Estimated cost has been adjusted to reflect the actual charges incurred when implementing the tower modifications. $512,769.00 N/A
Ground and Building AE Permit Drawing Package $4,700.00 $4,700.00 Cost estimate provided by tower owner. $750.00 N/A
Structural Engineering Tower Load Study $10,450.00 $10,450.00 Cost to KOZJ increased due to the fact that the other tenant on the tower (KODE) decided it will vacate to another tower site. $10,450.00 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $16,345.00 Cost to KOZJ increased due to the fact the other tenant on the tower KODE decided it will vacate to another tower site. $16,345.00 N/A
Antenna Change Out $85,000.00 $85,000.00 Quote attached from PCI N/A N/A
Tower Permit Drawing Package $4,700.00 $4,700.00 Cost estimate provided by tower owner. N/A N/A
Tall Tower (greater than 500') $210,500.00 $0.00 Tower Rigging cost is include in the tower owner's estimate reinforcement / modifications. N/A N/A

Components

Actual Information Description File Name
Serious tower reinforcement/modifications

Component Description:
Final true-up payment for construction/modification costs.
Amount:
$146,304.75

Component Description:
Second payment for structural modifications.
Amount:
$244,309.50

Component Description:
First Payment for construction/modification costs
Amount:
$122,154.75
Ground and Building AE Permit Drawing Package

Component Description:
Building Permit for modifications of ATC owned tower.
Amount:
$750.00
Structural Engineering Tower Load Study

Component Description:
Charges for structural engineering tower load study
Amount:
$10,450.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Charges for required tower mapping
Amount:
$16,345.00
Antenna Change Out Information not provided.
Tower Permit Drawing Package Information not provided.
Tall Tower (greater than 500') 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 $61,840.00 $80,730.00 N/A $34,086.52 N/A
Total for all systems $2,288,047.98 $1,210,361.81 N/A $1,036,667.08 N/A
Outside Professional Services $61,840.00 $80,730.00 $34,086.52
Tower Owner Project Managment $9,480.00 $9,480.00 Cost provided by tower owner $9,480.00 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $25,000.00 After consultation with legal counsel, the station is estimating lease negotiation costs of $25,000 for amending the current site lease with ATC and for negotiating a Master Agreement with ATC relating to the overall tower changes necessary for the station’s repack. $3,871.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $1,005.50 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $580.00 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 $2,250.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $6,161.27 N/A
Project management of the transition $15,800.00 $15,000.00 N/A $9,399.25 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $1,339.50 N/A
Site Survey $10,000.00 $10,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Tower Owner Project Managment

Component Description:
Tower Owner Project Management Services
Amount:
$9,480.00
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
Review of Tower Master Services Agreement
Amount:
$242.50

Component Description:
Review of shared site issues.
Amount:
$436.50

Component Description:
Portion of bill for review of shared site issues.
Amount:
$1,455.00

Component Description:
Review of shared site issues.
Amount:
$339.50

Component Description:
Review of shared site issues
Amount:
$242.50

Component Description:
Review of Tower Master Services Agreement
Amount:
$864.00

Component Description:
Review of shared site issues.
Amount:
$291.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Legal fees associated with the License to Cover Application
Amount:
$1,005.50
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Legal Fees for Construction Permit application
Amount:
$580.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Portion of bill for engineering section of CP application. Invoice updated per FCC inquiry.
Amount:
$2,250.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Engineering Services for channel assignment and antenna development . Requested amount updated per FCC inquiries.
Amount:
$1,661.27

Component Description:
Portion of bill for Engineering Study. Invoice date entry corrected per FCC inquiry.
Amount:
$4,500.00
Project management of the transition

Component Description:
Legal Fees for Project Management
Amount:
$388.00

Component Description:
Legal Fees for Project Management
Amount:
$423.00

Component Description:
Portion of bill for Project Management-KOZJ
Amount:
$237.50

Component Description:
Project management services.
Amount:
$145.50

Component Description:
Project Management Costs
Amount:
$194.00

Component Description:
Legal fees for Project Management
Amount:
$5,222.00

Component Description:
Portion of the bill for KOZJ Project Management
Amount:
$54.00

Component Description:
Portion of bill for Preliminary Project Management. Invoice updated per FCC inquiries.
Amount:
$2,500.00

Component Description:
Legal Fees for Project Management
Amount:
$630.50

Component Description:
Portion of bill for project management.
Amount:
$48.50

Component Description:
Project Management Services.
Amount:
$523.00

Component Description:
Legal Fees for Project Management.
Amount:
$1,811.00

Component Description:
Legal Project Management Fees
Amount:
$409.50

Component Description:
Portion of the bill for legal project management fees.
Amount:
$145.50

Component Description:
Legal Fees for Project Management
Amount:
$2,900.00

Component Description:
Portion of bill for KOZJ Project Management
Amount:
$97.00

Component Description:
Legal fees for Project Management
Amount:
$194.00

Component Description:
Legal Project Management Fees
Amount:
$48.50

Component Description:
Legal Project Management Fees
Amount:
$436.50

Component Description:
Portion of the bill for KOZJ Project Management
Amount:
$24.25
Prepare and or review reimbursement form

Component Description:
Prepare or review reimbursement form. Invoice attachment provides additional support per FCC inquiry.
Amount:
$588.50

Component Description:
Prepare or review reimbursement form.
Amount:
$654.00

Component Description:
Prepare or review reimbursement form.
Amount:
$97.00
Site Survey Information not provided.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $41,091.47 $40,541.47 N/A $18,540.22 N/A
Total for all systems $2,288,047.98 $1,210,361.81 N/A $1,036,667.08 N/A
Other Expenses $41,091.47 $40,541.47 $18,540.22
Professional Services for Transmitter Building Improvements $12,800.00 $12,800.00 N/A $12,000.00 N/A
Receive Equipment to Monitor Signal $1,241.47 $1,241.47 N/A $1,241.47 N/A
Required bid advertising $1,500.00 $1,500.00 State of Missouri statutes require advertising for projects/equipment with a value of $100,000 or greater. $1,347.95 N/A
MVPD Notification of Channel Change $11,000.00 $11,000.00 Send notification to cable companies, MVPD locations, follow up on signal reception after repack switch. $1,430.55 N/A
Develop and air announcement of upcoming channel change $1,000.00 $1,000.00 Spot creation, talent, production. N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,000.00 $2,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $2,520.25 N/A

Components

Actual Information Description File Name
Professional Services for Transmitter Building Improvements

Component Description:
Professional Services for Transmitter Building Improvements
Amount:
$6,460.00

Component Description:
Professional Services for Transmitter Building Improvements
Amount:
$3,840.00

Component Description:
Professional Services for Transmitter Building Improvements
Amount:
$1,410.00

Component Description:
Professional Services for Transmitter Building Improvements
Amount:
$290.00
Receive Equipment to Monitor Signal

Component Description:
Receive Equipment for Monitoring KOZJ Signal
Amount:
$202.00

Component Description:
Receive Equipment to Monitor KOZJ Signal
Amount:
$1,039.47
Required bid advertising

Component Description:
KOZJ portion of ads for bid process for transmitter purchases.
Amount:
$165.02

Component Description:
KOZJ portion of ads for bid process for transmitter purchases.
Amount:
$165.02

Component Description:
KOZJ portion of ads for bid process for transmitter purchases.
Amount:
$14.50

Component Description:
KOZJ portion of ads for bid process for transmitter purchases.
Amount:
$165.02

Component Description:
KOZJ portion of ads for bid process for transmitter purchases.
Amount:
$236.25

Component Description:
KOZJ portion of ads for bid process for transmitter purchases.
Amount:
$587.64

Component Description:
KOZJ portion of ads for bid process for transmitter purchases.
Amount:
$14.50
MVPD Notification of Channel Change

Component Description:
Required MVPD Notifications
Amount:
$1,430.55
Develop and air announcement of upcoming channel change Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
DTV Medical Facility Notification

Component Description:
Required Medical Facility Notifications
Amount:
$2,520.25

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,288,047.98 $1,210,361.81 $1,036,667.08

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. Yes
Construction of final facilities or all necessary modifications are complete. Yes
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.

James Baker , Dr. .

VP, Missouri State University


08/06/2019

Certification

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Section Question Response
Submission of Final Allocation or Accounting Information 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 representations.

  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 all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.

  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 acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  6. 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.

James Baker , Dr. .

VP, Missouri State University


08/06/2019

Attachments

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