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:
56523
Service:
DTV
Call Sign:
WTTV
Channel:
27 (UHF)
File Number:
0000028158
FRN:
0021781612
Date Submitted:
09/23/2019

Applicant Information

Back to Top

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

TRIBUNE BROADCASTING INDIANAPOLIS, LLC

Doing Business As: TRIBUNE BROADCASTING INDIANAPOLIS, LLC

Steve Zanolini

6910 Network Place

Indianapolis, IN 46278

United States

+1 (317) 632-5900 szanolini@tribunemedia.com Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

Back to Top

Preparer Contact Name and Information

Applicant Address Phone Email

Bill Vanduynhoven , Vanduynhov .

Director of Engineering operations

Tribune broadcasting

Bill VAnduynhoven

2211 Rabbit Hill Cir

Dacula, GA 30019

United States

+1 (404) 312-8693 BillV@Tribunemedia.com

Broadcaster Information and Transition Plan

Back to Top
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 Add antenna above current antenna and replace transmission line. Current Support ple will not meet Rev G structural requirements. Replacement with a Top mount antenna and support was the least costly solution. Replace current transmitters.

Transmitters

Back to Top
Section Question Response
Transmitter Related Expenses Do you have transmitter related expenses? Yes

Auxiliary Transmitter

Back to Top

Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Auxiliary
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 Diamond
Year 2000
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 7.5 kW

Auxiliary Transmitter

Back to Top

New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model ULXTE-10
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 6.2 kW
Justification for New Transmitter Current transmitter is not re-tunable as state by the manufacturer

Auxiliary Transmitter

Back to Top

Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? 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

Auxiliary Transmitter

Back to Top

Other Transmitter Cost Not Listed

Information not provided.

Primary Transmitter

Back to Top

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 Power CD
Year 2004
Type Inductive Output Tube
IOT Power Type Single
Power Capacity 25 kW

Primary Transmitter

Back to Top

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 ULXTE-20
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 12.9 kW
Justification for New Transmitter Upgrade to Solid state transmitter and not re-tune existing. No room in building for additional Tube type RF system. ULXTE-20 Non Epole

Primary Transmitter

Back to Top

Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring Yes
Size 4 inches
Length 400.0 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

Back to Top

Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

Back to Top

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 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: 870.0 kW
Manufacturer
Model TFU-24DSB C260(C
Year 2001

Primary Antenna

Back to Top

New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack 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: 576.0 kW
Manufacturer
Model TFU-30GTH/VP-R C260
Year 2019
Justification for New Antenna Current antenna will not work on assigned channel Support pole will not meet Rev G, Top mount antenna chosen to to save cost of replacing Support pole

Primary Antenna

Back to Top

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

Back to Top

Other Antenna Cost Not Listed

Name Description

Mounting Pole with wedding cake

Support pole, wedding cake to extend antenna to the correct height

Transmission Line

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

Primary Transmission Line

Back to Top

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

Back to Top

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 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
Justification for New Transmission Line Use existing to feed pre transition antenna during construction

Primary Transmission Line

Back to Top

Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

Back to Top

Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1026127
Coordinates (NAD83) Latitude (NAD83) 39° 24' 27.0" N-
Longitude (NAD83) 086° 08' 52.0" W-
Overall Structure Height 1131.88 feet
Support Structure Height 1049.86 feet
Ground Elevation Above Mean Sea Level (AMSL) 869.41 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Tribune Broadcasting Indianapolis, LLC
Date Constructed 01/01/1957

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

Facility ID Call Sign Service
59141 WTTS FM

Primary Tower

Back to Top

Tower Modification Costs

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

Primary Tower

Back to Top

Tower Rigging Costs

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

Primary Tower

Back to Top

Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

Back to Top
Section Question Response
Outside Project Management Services Do you require outside project management services? No
Number of Hours N/A
Explanation N/A
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 2
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 No
For Auxiliary Facility N/A
For Main Facility N/A
Prepare and file Form FCC License to Cover Application No
For Auxiliary Facility N/A
For Main Facility N/A
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 No
Address transition timing and coordination issues w/ other stations and wireless providers No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

Back to Top

Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

Back to Top
Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? No
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

Back to Top

Other Expenses Not Listed

Information not provided.

Cost Information

Back to Top

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 $886,550.00 $662,700.00 N/A $457,042.35 N/A
Total for all systems $2,881,085.00 $1,885,185.00 N/A $1,277,304.49 N/A
Primary Transmitter ULXTE-20 $613,050.00 $462,700.00 $312,065.91
4" Rigid Conduit and Wiring (Cost per foot) $40,400.00 $38,400.00 N/A N/A N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $13,700.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $24,300.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $494,500.00 $350,000.00 N/A $312,065.91 N/A
Auxiliary Transmitter ULXTE-10 $273,500.00 $200,000.00 $144,976.44
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW $273,500.00 $200,000.00 N/A $144,976.44 N/A

Components

Actual Information Description File Name
4" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Service entrance 3 phase/800 amp/208 volt Information not provided.
Switchgear - industrial 800 amp Information not provided.
Transformer 3 phase/480v - 150 KVA Information not provided.
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW

Component Description:
site survey
Amount:
$5,294.38

Component Description:
ULXTE-20
Amount:
$92,415.13

Component Description:
2nd payment - ULXTE-20 transmitter
Amount:
$107,178.20

Component Description:
deposit for ULXTE-20 transmitter
Amount:
$107,178.20
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW

Component Description:
2nd payment - ULXTE-10 transmitter
Amount:
$54,662.54

Component Description:
deposit for ULXTE-10
Amount:
$54,662.54

Component Description:
ULXTE-10
Amount:
$35,651.36

Cost Information

Back to Top

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 $446,800.00 $406,400.00 N/A $335,241.22 N/A
Total for all systems $2,881,085.00 $1,885,185.00 N/A $1,277,304.49 N/A
Primary Antenna TFU-30GTH/VP-R C260 $446,800.00 $406,400.00 $335,241.22
Mounting Pole with wedding cake $141,000.00 $141,000.00 N/A $126,020.48 N/A
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed) $9,570.00 $9,000.00 N/A $7,249.50 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $5,760.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $250,000.00 N/A $196,211.24 N/A

Components

Actual Information Description File Name
Mounting Pole with wedding cake

Component Description:
Wedding Cake
Amount:
$63,010.24

Component Description:
Wedding Cake
Amount:
$63,010.24
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)

Component Description:
deposit - elbow complex
Amount:
$3,624.75

Component Description:
deposit - elbow complex
Amount:
$3,624.75

Component Description:
elbow complex - 2nd payment
Amount:
$3,624.75

Component Description:
elbow complex - 2nd payment
Amount:
$3,624.75
Sweep test of existing antenna

Component Description:
SWEEP TEST
Amount:
$2,880.00

Component Description:
2nd payment - sweep test
Amount:
$2,880.00

Component Description:
deposit - sweep test
Amount:
$2,880.00

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

Component Description:
deposit - TFU-30GTH/VP-R C260 CH 27
Amount:
$98,105.62

Component Description:
TFU-30GTH/VP-R C260 CH27
Amount:
$98,105.62

Component Description:
TFU-30GTH/VP-R C260 CH 27 - 2nd payment
Amount:
$98,105.62

Component Description:
TFU-30GTH/VP-R C260 CH 27 - 2nd payment
Amount:
$98,105.62

Cost Information

Back to Top

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 $156,200.00 $101,000.00 N/A $90,168.12 N/A
Total for all systems $2,881,085.00 $1,885,185.00 N/A $1,277,304.49 N/A
Primary Transmission Line $156,200.00 $101,000.00 $90,168.12
Rigid Transmission Line - copper, 4 1/16" $156,200.00 $101,000.00 N/A $90,168.12 N/A

Components

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

Component Description:
transmission line 4-1/16 50 OHM 1,100 feet
Amount:
$43,543.71

Component Description:
deposit - TLSCR's
Amount:
$1,540.35

Component Description:
deposit - transmission line 4-1/16 50 OHM 1,100 feet
Amount:
$43,543.71

Component Description:
2nd payment - transmission line 4-1/16 50 OHM 1,100 feet
Amount:
$43,543.71

Component Description:
deposit - transmission line 4-1/16 50 OHM 1,100 feet
Amount:
$43,543.71

Component Description:
2nd payment - TLSCR'S
Amount:
$1,540.35

Component Description:
2nd payment - TLSCR'S
Amount:
$1,540.35

Component Description:
deposit - TLSCR's
Amount:
$1,540.35

Cost Information

Back to Top

Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,275,100.00 $612,000.00 N/A $391,102.80 N/A
Total for all systems $2,881,085.00 $1,885,185.00 N/A $1,277,304.49 N/A
Primary Tower TOWER $1,275,100.00 $612,000.00 $391,102.80
Tall Tower (greater than 500') $210,500.00 $300,000.00 see attached quotes and invoices $267,143.40 N/A
Serious tower reinforcement/modifications $1,052,000.00 $300,000.00 N/A $117,059.40 N/A
Structural engineering tower load study for well documented tower $12,600.00 $12,000.00 N/A $6,900.00 N/A

Components

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

Component Description:
mobilization
Amount:
$118,730.40

Component Description:
down payment
Amount:
$148,413.00

Component Description:
Deposit
Amount:
N/A

Component Description:
Mobilization
Amount:
N/A

Component Description:
Weather days
Amount:
N/A

Component Description:
Final payment
Amount:
N/A
Serious tower reinforcement/modifications

Component Description:
down payment
Amount:
$53,915.00

Component Description:
in progress billing
Amount:
$47,823.40

Component Description:
weather days
Amount:
$5,850.00

Component Description:
Deposit
Amount:
N/A

Component Description:
Mobilization
Amount:
N/A

Component Description:
final payment
Amount:
$9,471.00
Structural engineering tower load study for well documented tower

Component Description:
ADDITIONAL LOADING CONFIGURATION
Amount:
$1,000.00

Component Description:
STRUCTURAL ANALYSIS AND REPORT
Amount:
$5,900.00

Cost Information

Back to Top

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 $37,245.00 $24,500.00 N/A $0.00 N/A
Total for all systems $2,881,085.00 $1,885,185.00 N/A $1,277,304.49 N/A
Outside Professional Services $37,245.00 $24,500.00 $0.00
RF Exposure Measurements $21,050.00 $10,000.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A 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

Components

Information not provided.

Cost Information

Back to Top

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 $79,190.00 $78,585.00 N/A $3,750.00 N/A
Total for all systems $2,881,085.00 $1,885,185.00 N/A $1,277,304.49 N/A
Other Expenses $79,190.00 $78,585.00 $3,750.00
MVPD Notification of Channel Change $11,000.00 $11,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $15,000.00 $15,000.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 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
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $3,750.00 N/A
Equipment Storage $25,000.00 $25,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $0.00 $0.00 N/A N/A N/A
Local Zoning $15,000.00 $15,000.00 N/A N/A N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change Information not provided.
Equipment Delivery and Handling Charges Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
DTV Medical Facility Notification

Component Description:
Medical Notification
Amount:
$3,750.00
Equipment Storage Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Local Zoning Information not provided.

Cost Information

Back to Top

Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,881,085.00 $1,885,185.00 $1,277,304.49

Reimbursement Status

Back to Top
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

Back to Top
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.

Teri Ann Guillory

Broadcasting Operations


09/23/2019

Certification

Back to Top
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.

Teri Ann Guillory

Broadcasting Operations


09/23/2019

Attachments

Back to Top