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:
62136
Service:
DTV
Call Sign:
WPBS-DT
Channel:
26 (UHF)
File Number:
0000027455
FRN:
0003432978
Date Submitted:
09/10/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

ST. LAWRENCE VALLEY EDUCATIONAL TV COUNCIL, INC

Doing Business As: ST. LAWRENCE VALLEY EDUCATIONAL TV COUNCIL, INC

LYNN BROWN

1056 ARSENAL STREET

WATERTOWN, NY 13601

United States

+1 (315) 782-3142 lbrown@wpbstv.org 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

Robert Gehman

Consulting Engineer

ST. LAWRENCE VALLEY EDUCATIONAL TV COUNCIL, INC

Robert Gehman

507 NW 60 Street

Suite D

Gainesville, FL 32607

United States

+1 (352) 332-3157 bob@kesslerandgehman.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 transmitter and antenna using existing line. Acquire interim antenna and line for continued operation during construction and duration of the assigned phase. Map and analyze tower; design and implement modifications if required. See attached.

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 Ultimate
Year 2007
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power Capacity 8 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 MPTV-PRLX-U4
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 6.5 kW
Justification for New Transmitter The manufacturer of the existing transmitter advises that the transmitter cannot be re-tuned to the assigned channel. See attachment.

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) Yes
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring Yes
Size 3 inches
Length 100.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Standby Exciter and Switch

Standby Exciter with Automatic Change Over Switch

Additional Interior RF System

Interior RF System Existing Transmitter to Interim Transmission line

Demo and Replacement Parts

Demo and Replacement Parts

Installation

Installation

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 Retune Existing
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 40.0 kW
Manufacturer Dielectric
Model TLP-32 A
Year 2007

Primary Antenna

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Adjustment to Existing Antenna

Section Question Response
Sweep Test of Existing Antenna Do you need a sweep test of existing antenna?

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?
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 40.0 kW
Manufacturer
Model TLP-32 A
Year 2007

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? 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 Top 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: 29.4 kW
Manufacturer
Model TBD
Year 2018
Justification for New Antenna The existing primary antenna is a single channel slotted coaxial which cannot accommodate the assigned channel.

Primary Antenna

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Other Antenna Costs

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

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? 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: 40.0 kW
Manufacturer
Model ALP16L2-HSOC-26
Year 2018
Justification for New Antenna The station is replacing its existing single channel unlicensed but operational standby 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? No

Tower Equipment And Rigging Costs

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Section Question Response
Tower Equipment or Rigging Costs Changes Do you have tower equipment or rigging costs changes? Yes

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership 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? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1016461
Coordinates (NAD83) Latitude (NAD83) 43° 51' 46.0" N-
Longitude (NAD83) 075° 43' 38.0" W-
Overall Structure Height 950.12 feet
Support Structure Height 950.12 feet
Ground Elevation Above Mean Sea Level (AMSL) 1562.97 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner ST LAWRENCE VALLEY ETV COUNCIL INC
Date Constructed 08/01/1971


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

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 50
Explanation It will be necessary to schedule and coordinate multiple vendors, complete progress reports, and update Schedule 399. Station does not have available personnel or personnel trained in project management for such complex projects.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 5
Justification It will be necessary to survey the site, plan the equipment, develop specifications for purchasing, and oversee multiple vendor RF projects. Station does not have available personnel or personnel trained in such services.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Other Legal Services

Legal services related to repack not otherwise included in OPS

Other Engineering Services

Engineering services related to repack not otherwise included in OPS

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? 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

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 $528,324.00 $528,508.00 N/A $298,008.00 N/A
Total for all systems $1,496,316.32 $1,443,255.32 N/A $342,779.57 N/A
Primary Transmitter MPTV-PRLX-U4 $528,324.00 $528,508.00 $298,008.00
Installation $4,234.00 $4,234.00 N/A $4,234.00 N/A
Demo and Replacement Parts $16,640.00 $16,640.00 N/A $16,640.00 N/A
Additional Interior RF System $140,000.00 $140,000.00 N/A N/A N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $24,300.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW $273,500.00 $277,134.00 The actual cost of the transmitter is $260,000, which is less than the predetermined cost, but the total quote amount includes shipping, handling, glycol, and RF switch. $277,134.00 N/A
3" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $4,900.00 N/A N/A N/A
Standby Exciter and Switch $25,000.00 $25,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Installation

Component Description:
Alpine 201304 8204 v190709jgv1
Amount:
$4,234.00
Demo and Replacement Parts

Component Description:
Comark S10416-2B v190816jgv1
Amount:
$16,640.00
Additional Interior RF System Information not provided.
Transformer 3 phase/480v - 150 KVA Information not provided.
Switchgear - industrial 800 amp Information not provided.
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW

Component Description:
Comark S10416-1A v190627jgv1
Amount:
$263,277.30

Component Description:
Comark S10416-2A Final 5 pct v190816jgv1
Amount:
$13,856.70
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Standby Exciter and Switch Information not provided.

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $47,537.00 $49,252.00 N/A $9,525.00 N/A
Total for all systems $1,496,316.32 $1,443,255.32 N/A $342,779.57 N/A
Interim Antenna ALP16L2-HSOC-26 $21,777.00 $21,777.00 $0.00
UHF - High Power, Side Mount, basic slot antenna, 40 kW input, horizontally polarized $21,777.00 $21,777.00 See attached/uploaded file "WPBS Auxiliary Antenna Replacement.pdf" N/A N/A
Primary Antenna TLP-32 A $19,030.00 $17,950.00 $0.00
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $11,700.00 See attached/uploaded file "WPBS Auxiliary Antenna Replacement.pdf" N/A N/A
Sweep test of existing antenna $6,730.00 $6,250.00 See attached/uploaded file "WPBS Auxiliary Antenna Replacement.pdf" N/A N/A
Primary Antenna TBD $6,730.00 $9,525.00 $9,525.00
Sweep test of existing antenna $6,730.00 $9,525.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***Two sweeps have been required. See proposal in attached ERI invoice 50087 and proposal in attached Dielectric invoice 567033. $9,525.00 N/A

Components

Actual Information Description File Name
UHF - High Power, Side Mount, basic slot antenna, 40 kW input, horizontally polarized Information not provided.
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) Information not provided.
Sweep test of existing antenna Information not provided.
Sweep test of existing antenna

Component Description:
Final installment for sweep tests
Amount:
$3,125.00

Component Description:
Installment for Sweep tests
Amount:
$3,125.00

Component Description:
Die 567033 v190809jgv1
Amount:
$6,400.00

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 $657,800.00 $605,000.00 N/A $0.00 N/A
Total for all systems $1,496,316.32 $1,443,255.32 N/A $342,779.57 N/A
Primary Tower TOWER $657,800.00 $605,000.00 $0.00
Tall Tower (greater than 500') $210,500.00 $200,000.00 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 $5,000.00 See attached/uploaded file "WPBS Auxiliary Antenna Replacement.pdf" N/A N/A
Major tower reinforcement/modifications $421,000.00 $400,000.00 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 $189,105.32 $187,495.32 N/A $30,941.57 N/A
Total for all systems $1,496,316.32 $1,443,255.32 N/A $342,779.57 N/A
Outside Professional Services $189,105.32 $187,495.32 $30,941.57
Other Legal Services $22,000.00 $22,000.00 N/A $1,379.25 N/A
Additional Field Engineering Service, 5 Days $3,685.32 $3,685.32 N/A $3,685.32 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
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $960.00 N/A $960.00 N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A $1,500.00 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 $4,500.00 See attached invoices and quotes. $4,500.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $3,500.00 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
Other Engineering Services $35,000.00 $35,000.00 N/A $7,877.00 N/A
Project management of the transition $7,900.00 $7,700.00 N/A $2,310.00 N/A
Prepare and or review reimbursement form $2,630.00 $10,000.00 The Estimated Cost is based on the current invoicing as well as a reasonable estimate for completing submission of the remaining Actual Cost invoices for this Phase 4 station. $3,830.00 N/A
Additional Field Engineering Service, 20 Days $1,400.00 $1,400.00 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $1,400.00 N/A

Components

Actual Information Description File Name
Other Legal Services

Component Description:
GSB 723577 v190906jgv1
Amount:
$720.00

Component Description:
GSB 720582 v190815jgv1
Amount:
$150.00

Component Description:
GSB 720210 v190815jgv1
Amount:
$300.00

Component Description:
Other Legal Services related to quarterly progress report
Amount:
$209.25
Additional Field Engineering Service, 5 Days

Component Description:
KGA 954-11 v190626jgv1
Amount:
$3,685.32
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.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Legal services for Form 2100 (main) CP application
Amount:
$960.00
Prepare request for Special Temporary Authorization

Component Description:
KGA 954-30 v190809jgv1
Amount:
$1,500.00
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:
Engineering for CP application, Main facility WPBS
Amount:
$2,000.00

Component Description:
KGA 954-27 v190626jgv1
Amount:
$2,500.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Engineering for new channel and Antenna development for main facility WPBS
Amount:
$3,500.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Other Engineering Services

Component Description:
KGA 954-25 v190626jgv1
Amount:
$1,150.00

Component Description:
KGA 954-12 v190906jgv2
Amount:
$397.50

Component Description:
Repack Specifications for Purchase of equipment
Amount:
$1,350.00

Component Description:
KGA 954-20 v190626jgv1
Amount:
$125.00

Component Description:
KGA 954-13 v190906jgv2
Amount:
$79.50

Component Description:
KGA 954-16 v190626jgv1
Amount:
$1,350.00

Component Description:
KGA 954-19 v190906jgv2
Amount:
$600.00

Component Description:
KGA 954-31 v190906jgv1
Amount:
$1,250.00

Component Description:
KGA 954-15 v190626jgv1
Amount:
$1,275.00

Component Description:
KGA 954-23 v190626jgv1
Amount:
$200.00

Component Description:
KGA 954-32 v190906jgv1
Amount:
$1,450.00

Component Description:
RF Calculations
Amount:
$1,275.00
Project management of the transition

Component Description:
KGA 954-24 v190626jgv1
Amount:
$300.00

Component Description:
Prepare and file Form 387 4Q2017 WPBS
Amount:
$225.00

Component Description:
Prepare and file Form 387 3Q2017 WPBS
Amount:
$300.00

Component Description:
Legal review of Form 387 3Q2017 WPBS
Amount:
$209.25

Component Description:
Form 387 4Q18 Progress Report
Amount:
$150.00

Component Description:
KGA 954-21 v190626jgv1
Amount:
$150.00

Component Description:
KGA 954-14 v190626jgv1
Amount:
$150.00

Component Description:
Prepare and file Form 399 invoices for reimbursement
Amount:
$615.00

Component Description:
KGA 954-10 v190626jgv1b
Amount:
$150.00

Component Description:
Review of original Form 399 WPBS
Amount:
$420.00
Prepare and or review reimbursement form

Component Description:
KGA 954-33 v190906jgv1
Amount:
$825.00

Component Description:
Prepare Form 399 budget for reimbursement for WPBS
Amount:
$2,500.00

Component Description:
KGA 954-22 v190626jgv1
Amount:
$475.00

Component Description:
KGA 954-26 v190626jgv1
Amount:
$30.00
Additional Field Engineering Service, 20 Days

Component Description:
Additional Field service, RF system design, for WPBS
Amount:
$1,400.00

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $73,550.00 $73,000.00 N/A $4,305.00 N/A
Total for all systems $1,496,316.32 $1,443,255.32 N/A $342,779.57 N/A
Other Expenses $73,550.00 $73,000.00 $4,305.00
Develop and air announcement of upcoming channel change $0.00 $0.00 N/A N/A N/A
Equipment Storage $10,000.00 $10,000.00 N/A N/A N/A
MVPD Notification of Channel Change $2,000.00 $2,000.00 N/A $1,580.00 N/A
Equipment Delivery and Handling Charges $40,000.00 $40,000.00 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 $2,725.00 N/A

Components

Actual Information Description File Name
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
MVPD Notification of Channel Change

Component Description:
KGA 954-18 v190626jgv1
Amount:
$1,580.00
Equipment Delivery and Handling Charges Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
DTV Medical Facility Notification

Component Description:
KGA 954-17 v190626jgv1
Amount:
$2,725.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,496,316.32 $1,443,255.32 $342,779.57

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. 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.

Jeffrey C Gehman

Engineering Associate


09/10/2019

Attachments

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