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:
36117
Service:
DTV
Call Sign:
WHME-TV
Channel:
36 (UHF)
File Number:
0000025205
FRN:
0016237976
Date Submitted:
09/06/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

LeSEA Broadcasting of South Bend, Inc.

Doing Business As: LeSEA Broadcasting of South Bend, Inc.

LeSEA Broadcasting of South Bend, Inc.

61300 IRONWOOD ROAD

SOUTH BEND, IN 46614

United States

+1 (574) 291-8200 tagostino@lesea.com Not-for-Profit

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

Joseph C. Chautin III

Hardy, Carey, Chautin & Balkin

1080 West Causeway Approach

Mandeville, LA 70471

United States

+1 (985) 629-0777 jchautin@hardycarey.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. No
Briefly describe transition plan Replace existing channel 48 system with Channel 36

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 Paragon
Year 1995
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 Paralax UHF
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 27.5 kW
Justification for New Transmitter New smaller transmitter is less expensive than a retune of the larger existing unit.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring Yes
Size 1.5 inches
Length 50.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 10 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

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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Add 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 this antenna currently shared with any other stations? No
Is this antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 300.0 kW
Manufacturer
Model TFU-10DSC T160
Year 2005

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: 236.0 kW
Manufacturer
Model TFU 29JTH/VP-R-06
Year 2018
Justification for New Antenna Upgrade for better coverage and to prepare for ATSC3.

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 4 1/16 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

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? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type 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: 87.0 kW
Manufacturer
Model DLP12D
Year 2018
Justification for New Antenna Interim antenna needed to keep WHME signal on air while work proceeds on permanent post-repack antenna.

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? 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? No

Interim Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? Yes

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
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
Type Rigid
Diameter 4 1/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1100 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Type Rigid
Diameter 4 1/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 50 feet per run
Justification for New Transmission Line Jumper to extend the current T/L another 50 feet to new antenna location.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

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? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1060842
Coordinates (NAD83) Latitude (NAD83) 41° 35' 43.0" N-
Longitude (NAD83) 086° 09' 38.0" W-
Overall Structure Height 981.94 feet
Support Structure Height 929.12 feet
Ground Elevation Above Mean Sea Level (AMSL) 850.06 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner LESEA BROADCASTING OF SOUTH BEND, INC.
Date Constructed 06/01/1973


Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: Minor Reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower N/A
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 650
Explanation Insufficient staff at LeSEA to deal with the invoice processing and the FCC rejections.
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 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 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)? No
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? No
Does this relocation require MVPD Notification of a Channel Change? No

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 $1,035,076.75 $848,541.75 N/A $558,696.33 N/A
Total for all systems $1,957,706.75 $1,562,905.28 N/A $1,127,381.13 N/A
Primary Transmitter Paralax UHF $1,035,076.75 $848,541.75 $558,696.33
10 Ton system $38,900.00 $22,670.00 N/A $16,569.58 N/A
1.5" Rigid Conduit and Wiring $23,626.75 $23,626.75 Herman & Goetz, Inc. Quote CF180311-2 $23,626.75 N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $0.00 Need not completely determined yet $0.00 N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $802,245.00 N/A $518,500.00 N/A

Components

Actual Information Description File Name
10 Ton system

Component Description:
Cost as proposed to take out old A/C unit, break out concrete, cut hole in block wall and install overhead door.
Amount:
$16,569.58

Component Description:
remove old A/C units, cut out and frame in four openings in the block wall for the new ducts, and install two five ton A/C units in the
Amount:
$22,670.00
1.5" Rigid Conduit and Wiring

Component Description:
Provided labor and material to rework the Fern Rd tower panels and run pipe and wiring, per customer. Change order was put in to change pipe and wiring to match equipment upon arrival.
Amount:
$23,626.75
Transformer 3 phase/480v - 150 KVA Information not provided.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
transmitter invoice to be reimbursed.
Amount:
$518,500.00

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 $395,200.00 $315,495.75 N/A $285,255.98 N/A
Total for all systems $1,957,706.75 $1,562,905.28 N/A $1,127,381.13 N/A
Interim Antenna DLP12D $89,400.00 $9,522.50 $9,522.50
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized $89,400.00 $9,522.50 Please see attached DTVPros Quote JEHQ1547 and DTVPros Invoice, which includes shipping charges. $9,522.50 N/A
Primary Antenna TFU 29JTH/VP-R-06 $305,800.00 $305,973.25 $275,733.48
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,400.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $289,701.25 Cost from DTV Pros quote JEHQ1342. The antenna amount is $4,442.40 dollars higher due to not including Invoice #148's elbow complex in the correct category before it was reimbursed. $263,903.88 N/A
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed) $9,570.00 $9,872.00 This is the cost quoted on Invoice 148 $5,429.60 N/A

Components

Actual Information Description File Name
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized

Component Description:
UHF - LOW POWER SIDE MOUNT ANT
Amount:
$9,522.50
Sweep test of existing antenna

Component Description:
WHME-210-Primary Antenna - Sweep Test
Amount:
$640.00

Component Description:
Sweep test
Amount:
$2,880.00

Component Description:
Sweep test
Amount:
$2,880.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
UHF-HIGH POWER TOP MOUNT (200-1000KW)
Amount:
$34,586.04

Component Description:
New Primary Antenna - H Pol Only
Amount:
$112,437.72

Component Description:
down payment on antenna
Amount:
$116,880.12

Component Description:
please see attachment for new procedure that documentation be uploaded in one multi page document
Amount:
N/A
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)

Component Description:
WHME-210-Primary Antenna - Elbow Complex, 4 1/16"
Amount:
$987.20

Component Description:
Elbow Complex
Amount:
$4,442.40

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 $7,100.00 $12,171.34 N/A $12,171.34 N/A
Total for all systems $1,957,706.75 $1,562,905.28 N/A $1,127,381.13 N/A
Primary Transmission Line $7,100.00 $12,171.34 $12,171.34
Rigid Transmission Line - copper, 4 1/16" $7,100.00 $12,171.34 Per Estimated Cost Justification WHME-310-Primary Transmission Line- Rigid v0 $12,171.34 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 4 1/16"

Component Description:
WHME-310-Primary Transmission Line - Rigid, 4 1/16"
Amount:
$6,749.52

Component Description:
New primary transmission line
Amount:
$2,710.91

Component Description:
New primary transmission line
Amount:
$2,710.91

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $381,100.00 $261,946.44 N/A $237,146.38 N/A
Total for all systems $1,957,706.75 $1,562,905.28 N/A $1,127,381.13 N/A
Primary Tower TOWER $381,100.00 $261,946.44 $237,146.38
Tall Tower (greater than 500') $210,500.00 $145,750.00 GTI America Quote Q17-06-038 $133,249.94 a
Minor tower reinforcement/modifications $158,000.00 $103,896.44 Additional costs per Quote Q18-06-034b $103,896.44 Additional costs per Quote Q18-06-034b
Structural engineering tower load study for well documented tower $12,600.00 $12,300.00 N/A $0.00 N/A

Components

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

Component Description:
deposit on tower work to be done
Amount:
$27,562.50

Component Description:
CHANNEL 46 TOWER ANTENNA REPLACEMENT PRICING
Amount:
$4,000.00

Component Description:
Tower Rigging Services - Tall Tower (500')
Amount:
$55,125.00

Component Description:
Tower Rigging Services - Tall Tower (500')
Amount:
$46,562.44
Minor tower reinforcement/modifications

Component Description:
Tower rigging services - tall tower
Amount:
$46,562.44

Component Description:
Cost to enlarge tower base as to your drawing.
Amount:
$22,500.00

Component Description:
STNLSA STNL Materials, Engineering Labor Hours, Drafting Labor Hours-Final 50%
Amount:
$17,417.00

Component Description:
STNLSA STNL Materials only
Amount:
$17,417.00
Structural engineering tower load study for well documented tower Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $127,680.00 $121,250.00 N/A $30,836.10 N/A
Total for all systems $1,957,706.75 $1,562,905.28 N/A $1,127,381.13 N/A
Outside Professional Services $127,680.00 $121,250.00 $30,836.10
Project management of the transition $102,700.00 $97,500.00 See attached quote for Project Management / Strategic Support and additional hours on DTVPros invoices $29,836.10 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $1,000.00 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
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Project Management
Amount:
$3,822.55

Component Description:
Project management
Amount:
$3,240.00

Component Description:
Project Management
Amount:
$2,329.80

Component Description:
Project Management
Amount:
$1,601.30

Component Description:
Project Management
Amount:
$2,503.05

Component Description:
Project Management
Amount:
$1,560.05

Component Description:
Project Management
Amount:
$2,135.20

Component Description:
Project Management
Amount:
$1,714.00

Component Description:
Cost Reconciliation
Amount:
$1,921.70

Component Description:
Project Management
Amount:
$2,547.35

Component Description:
Project Management
Amount:
$2,288.65

Component Description:
Project Management
Amount:
$4,448.35

Component Description:
Project Management
Amount:
$1,969.35

Component Description:
Project Management
Amount:
$2,509.65

Component Description:
Project Management
Amount:
$2,307.65
Perform engineering study for new channel assignment and antenna development

Component Description:
Determine pre-transition ERP for WHME-TV, on post-transition channel 36, that would protect WFFT-TV, Ft. Wayne and WJYS, both on pre-transition channel 36.
Amount:
$1,000.00
Prepare and or review reimbursement form Information not provided.
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare engineering section of 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.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application 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 $11,550.00 $3,500.00 N/A $3,275.00 N/A
Total for all systems $1,957,706.75 $1,562,905.28 N/A $1,127,381.13 N/A
Other Expenses $11,550.00 $3,500.00 $3,275.00
DTV Medical Facility Notification $11,550.00 $3,500.00 N/A $3,275.00 N/A

Components

Actual Information Description File Name
DTV Medical Facility Notification

Component Description:
DTV Notification Service - Notification of Medical Facilities - Transmitter Medical Facility Notification per proposal
Amount:
$3,275.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,957,706.75 $1,562,905.28 $1,127,381.13

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.

tony agostino

CFO


09/06/2019

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.

tony agostino

CFO


09/06/2019

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