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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:
168449
Service:
DCA
Call Sign:
WAZT-CD
Channel:
20 (UHF)
File Number:
0000028253
FRN:
0019682483
Date Submitted:
08/16/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

WMTM, LLC

5670 WILSHIRE BLVD. SUITE 1620

LOS ANGELES, CA 90036

United States

 +1 (323) 904-4090 FORM399@LOOP.COM Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 

Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan The plan is for WAZW is to replace the existing channel 46 system with a new channel 26 antenna and new transmitter.

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 TRU/1000D
Year 1996
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1 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 TMU9-4
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 2.4 kW
Justification for New Transmitter The new transmitter is necessary because the existing transmitter cannot be retuned because the manufacturer is no longer in business. See exhibit for details.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 2 inches
Length 20.0 feet
Other Electrical Service Yes
Description The new main transmitter will require reconfiguration of the electrical service on site. The electrical work cost has been estimated based on verbal guidance from local electrical contractors.
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 200.0 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? 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 Class A
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: 15.0 kW
Manufacturer
Model PSI-LP12AW-46
Year 2011

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 Class A
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: 10.8 kW
Manufacturer
Model ALP4L1-HSH-20
Year 2019
Justification for New Antenna The existing WAZW-CD antenna is not retunable.

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? 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 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? 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 Flexible Air
Diameter 1 5/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 200 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? No
Type Flexible Air
Diameter 1 5/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 200 feet per run
Justification for New Transmission Line The new transmitter is necessary because the existing transmitter cannot be retuned because the manufacturer is no longer in business. See attached exhibit.

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 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 Yes
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? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 38° 57' 36.0" N-
Longitude (NAD83) 078° 19' 52.0" W-
Overall Structure Height 101.70 feet
Support Structure Height 75.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 1082.68 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner WVPY
Date Constructed 01/01/1996

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
66378 WVPY DTV

Other Types of Users

Users
K272FQ

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: Major 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

Structural Analysis

After the tower mapping is complete, a structural analysis will need to be run

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 2000
Explanation WAZW-CD does not have sufficient resource capacity and expertise in house to handle all of the Project Management related tasks necessary to facility on-time completion of the station's build by the Construction Deadline
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 Yes
Environmental Assessment Yes
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service Yes
Number of Days 8
Justification RF Project management of tower and transmitter installs

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 Yes
BLM or NFS Coordination Yes
FCC Construction Permit Minor Change No
FCC License to Cover Application Yes
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? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

Vehicle Rentals

Required for equipment delivery.

Road Repairs

Road improvements required to gain full access to the site.

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 $175,520.00 $122,515.00 N/A $31,633.75 N/A
Total for all systems $1,502,515.00 $1,396,815.00 N/A $78,276.86 N/A
Primary Transmitter TMU9-4 $175,520.00 $122,515.00 $31,633.75
Other -- Building Addition Size: 200.0 $24,000.00 $24,000.00 N/A N/A N/A
Other Electrical Service: The new main transmitter will require reconfiguration of the electrical service on site. The electrical work cost has been estimated based on verbal guidance from local electrical contractors. $25,000.00 $25,000.00 N/A $13,380.00 N/A
2" Rigid Conduit and Wiring (Cost per foot) $520.00 $500.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $73,015.00 N/A $18,253.75 N/A

Components

Actual Information Description File Name
Other -- Building Addition Size: 200.0 Information not provided.
Other Electrical Service: The new main transmitter will require reconfiguration of the electrical service on site. The electrical work cost has been estimated based on verbal guidance from local electrical contractors.

Component Description:
Electrical Installation for New Transmitter
Amount:
$13,380.00
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
25% Down Payment on Transmitter
Amount:
$18,253.75

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 $33,030.00 $31,400.00 N/A $18,744.97 N/A
Total for all systems $1,502,515.00 $1,396,815.00 N/A $78,276.86 N/A
Primary Antenna ALP4L1-HSH-20 $33,030.00 $31,400.00 $18,744.97
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,250.00 N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $25,000.00 N/A $12,494.97 N/A

Components

Actual Information Description File Name
Sweep test of existing antenna

Component Description:
50% payment for Sweep Test
Amount:
$3,125.00

Component Description:
50% Deposit on Sweep Test
Amount:
$3,125.00
UHF - Lower Power Side Mount, Class A One Station antenna -- basic

Component Description:
Mounting pole for antenna (50% deposit).
Amount:
$1,200.00

Component Description:
50% Payment on antenna plus tax and freight.
Amount:
$6,079.02

Component Description:
Mounting pole for antenna (50% final payment plus sales tax).
Amount:
$1,327.20

Component Description:
50% Deposit on Antenna
Amount:
$3,888.75

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 $6,600.00 $6,200.00 N/A $4,711.21 N/A
Total for all systems $1,502,515.00 $1,396,815.00 N/A $78,276.86 N/A
Primary Transmission Line $6,600.00 $6,200.00 $4,711.21
Flexible Air Transmission Line - dielectric, 1 5/8" $6,600.00 $6,200.00 N/A $4,711.21 N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 1 5/8"

Component Description:
50% payment for Transmission Line
Amount:
$2,355.60

Component Description:
50% deposit on Transmission Line
Amount:
$2,355.61

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 $543,500.00 $517,000.00 N/A $0.00 N/A
Total for all systems $1,502,515.00 $1,396,815.00 N/A $78,276.86 N/A
Primary Tower TOWER $543,500.00 $517,000.00 $0.00
Structural Analysis $12,000.00 $12,000.00 N/A N/A N/A
Short Tower (less than 500') $84,200.00 $80,000.00 N/A N/A N/A
Major tower reinforcement/modifications $421,000.00 $400,000.00 N/A N/A N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $25,000.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate 		Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $487,480.00 $463,875.00 N/A $21,583.10 N/A
Total for all systems $1,502,515.00 $1,396,815.00 N/A $78,276.86 N/A
Outside Professional Services $487,480.00 $463,875.00 $21,583.10
Additional Field Engineering Service, 8 Days $16,000.00 $16,000.00 N/A N/A N/A
RF Exposure Measurements $21,050.00 $20,000.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A N/A N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $10,000.00 N/A N/A N/A
NEPA Section 106 environmental review, if needed $6,310.00 $6,000.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 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
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $0.00 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 $3,125.00 The form prep cost slightly more than we anticipated. $3,125.00 See Smith and Fisher invoice 6675.
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $0.00 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
Project management of the transition $316,000.00 $300,000.00 N/A $17,350.40 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $1,107.70 N/A

Components

Actual Information Description File Name
Additional Field Engineering Service, 8 Days Information not provided.
RF Exposure Measurements Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
ASR modification (prepare FCC Form 854) Information not provided.
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet Information not provided.
NEPA Section 106 environmental review, if needed Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations 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 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:
Interference study / Preparation of Construction Permit
Amount:
$2,400.00

Component Description:
RF Eng - CP Application - Main
Amount:
$75.00

Component Description:
Disregard
Amount:
N/A

Component Description:
Prepare engineering section of FCC Form 2100 (main), CP Application.
Amount:
$650.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Interference study of repack Channel 26
Amount:
$650.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Project management of the transition

Component Description:
Technical , Consultation and Planning Services. Attended a Conference on 3/6/2017 at Rohde and Schwartz concerning the 399 re-pack documentation.
Amount:
$75.00

Component Description:
Project management / Tower site coordination.
Amount:
$2,500.00

Component Description:
Project Management
Amount:
$1,450.85

Component Description:
Project Management
Amount:
$1,109.85

Component Description:
Project Management
Amount:
$557.75

Component Description:
Project Management
Amount:
$1,833.60

Component Description:
Project Management
Amount:
$1,664.55

Component Description:
Technical, Consultation and Planning Services.
Amount:
$136.50

Component Description:
Technical, Consultation and Planning Services.
Amount:
$54.60

Component Description:
Technical, Consultation and Planning Services.
Amount:
$54.60

Component Description:
Technical, Consultation and Planning Services.
Amount:
$54.60

Component Description:
Project Management
Amount:
$760.70

Component Description:
Project Management
Amount:
$1,768.55

Component Description:
Project Management
Amount:
$1,300.30

Component Description:
Technical , Consultation and Planning Services. Review and answering technical questions through a telephone conference call for the follow up report for the Re-pack.
Amount:
$75.00

Component Description:
Re-pack consulting and updating.
Amount:
$75.00

Component Description:
Project Management
Amount:
$684.20

Component Description:
Technical, Consultation and Planning Services.
Amount:
$54.60

Component Description:
Project Management / Planning
Amount:
$75.00

Component Description:
Project Management
Amount:
$1,301.65

Component Description:
Project Management
Amount:
$2,118.40

Component Description:
Please Disregard. Revised Invoice Supersedes This One.
Amount:
N/A
Prepare and or review reimbursement form

Component Description:
Budget Review/Form Prep
Amount:
$612.85

Component Description:
Budget Review/Form Prep
Amount:
$384.60

Component Description:
Budget Review/Form Prep
Amount:
$110.25

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 $256,385.00 $255,825.00 N/A $1,603.83 N/A
Total for all systems $1,502,515.00 $1,396,815.00 N/A $78,276.86 N/A
Other Expenses $256,385.00 $255,825.00 $1,603.83
Road Repairs $150,000.00 $150,000.00 N/A N/A N/A
Vehicle Rentals $5,000.00 $5,000.00 N/A N/A N/A
MVPD Notification of Channel Change $2,000.00 $2,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $15,000.00 $15,000.00 N/A N/A N/A
Equipment Storage $10,000.00 $10,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $15,000.00 $15,000.00 N/A $1,603.83 N/A
BLM or NFS Coordination $30,000.00 $30,000.00 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
Local Zoning $5,000.00 $5,000.00 N/A N/A N/A
Non-zoning permits $2,500.00 $2,500.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $10,000.00 $10,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Road Repairs Information not provided.
Vehicle Rentals Information not provided.
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges

Component Description:
Transmitter Delivery Charges
Amount:
$1,603.83
BLM or NFS Coordination Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
Local Zoning Information not provided.
Non-zoning permits Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
DTV Medical Facility Notification Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate 		Estimated Cost Actual Cost
Total for all systems $1,502,515.00 $1,396,815.00 $78,276.86

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. No
Construction of final facilities or all necessary modifications are complete. No
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator. No

Certification

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Section Question Response
Submission of Estimated Expenses Statements

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.

  1. The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.

  2. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

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

  4. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).

  5. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.

  6. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.

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

  8. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Andy Wilcoxson

General Manager


08/16/2019

Attachments

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