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:
25065
Service:
DTV
Call Sign:
WPTO
Channel:
29 (UHF)
File Number:
0000028670
FRN:
0003025004
Date Submitted:
11/18/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

GREATER DAYTON PUBLIC TELEVISION, INC.

Doing Business As: GREATER DAYTON PUBLIC TELEVISION, INC.

DAVID M. FOGARTY

110 SOUTH JEFFERSON STREET

DAYTON, OH 45402

United States

+1 (937) 220-1611 DFOGARTY@THINKTV.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

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 Transition plan

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model CD3140P2
Year 2002
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 140 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 ULXTE-30
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 19.2 kW
Justification for New Transmitter GatesAir technicians tell us our transmitter is obsolete and we will not be able to get parts for repair purposes.

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 4 inches
Length 500.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
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? Yes
Size 750.0 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 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: 400.0 kW
Manufacturer
Model TFU-24DSB-H(C)
Year 2002

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? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type 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: 408.0 kW
Manufacturer
Model VFU-24DSB-H
Year 2019
Justification for New Antenna New antenna necessary to carry new broadcast signal

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? Yes
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: 400.0 kW
Manufacturer
Model TFU-16WB
Year 2019
Justification for New Antenna New interim antenna as specified in transition plan.

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? Yes

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

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Flexible Air
Diameter 4 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 400 feet per run
Justification for New Transmission Line Additional interim antenna necessary while tower crew has installed gin pole on top of tower.

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Rigid
Diameter 6 1/8 inches
Segment Length 19 ¾ '
Other Segment Length
Number of parallel runs 1
Length 820 feet per run
Justification for New Transmission Line See transition plan. Need line for interim antenna. Dielectric now quoting a larger diameter.

Interim 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 No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 39° 07' 19.0" N-
Longitude (NAD83) 084° 32' 52.0" W-
Overall Structure Height 1020.98 feet
Support Structure Height 951.76 feet
Ground Elevation Above Mean Sea Level (AMSL) 728.01 feet
Structure Type LTOWER - Lattice Tower
Tower Owner WXIX, LLC
Date Constructed 01/01/1985

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
39738 WXIX-TV DTV

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: No study needed
Tower Reinforcements Please select whether tower reinforcements are needed: No 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

Interim Antenna

Remove and install new Interim Antenna

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 100
Explanation We do not have staff personnel available for the tasks that Project Management would cover, nor is the staff trained to provide those services.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority 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 No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service Yes
Number of Days 2
Justification Site survey

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Personnel costs

100 hours x $100/hour

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 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 $981,809.00 $944,059.00 N/A $626,808.37 N/A
Total for all systems $2,176,323.04 $1,797,108.29 N/A $1,050,531.97 N/A
Primary Transmitter ULXTE-30 $981,809.00 $944,059.00 $626,808.37
Other -- Building Addition Size: 750.0 $123,059.00 $123,059.00 Transmission line bridge included in this cost as only necessary because of move to new building. Building cost estimate attached. $14,886.00 N/A
10 Ton system $60,500.00 $57,500.00 N/A N/A N/A
4" Rigid Conduit and Wiring (Cost per foot) $50,500.00 $48,000.00 N/A N/A N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $29,200.00 Adjusted to agree with actual proposal from Kraft Electrical Contracting Inc. $29,200.00 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW $684,000.00 $650,000.00 N/A $582,722.37 N/A

Components

Actual Information Description File Name
Other -- Building Addition Size: 750.0

Component Description:
Transmittal room, remove aluminum frame and copper pipe
Amount:
$2,522.00

Component Description:
Transmittal room, openings for lines
Amount:
$12,364.00
10 Ton system Information not provided.
4" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 150 KVA

Component Description:
Final Billing
Amount:
$9,200.00

Component Description:
Second billing towards contract amount.
Amount:
$15,000.00

Component Description:
Partial invoice towards total contract amount.
Amount:
$5,000.00
Switchgear - industrial 800 amp Information not provided.
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW

Component Description:
Second installment of ULXTE-30 transmitter purchase.
Amount:
$204,779.46

Component Description:
Balance due ULXTE-30 transmitter purchase
Amount:
$193,641.40

Component Description:
30% down payment
Amount:
$184,301.51

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 $427,910.00 $252,345.00 N/A $102,894.30 N/A
Total for all systems $2,176,323.04 $1,797,108.29 N/A $1,050,531.97 N/A
Interim Antenna TFU-16WB $196,230.00 $121,520.00 $75,122.10
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized $189,500.00 $115,120.00 quote attached $75,122.10 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 Per signed quote $0.00 N/A
Primary Antenna VFU-24DSB-H $231,680.00 $130,825.00 $27,772.20
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $14,160.00 This was omitted from original estimated cost and not included in antenna base cost per invoice. $12,744.00 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $10,298.00 This was not included in the original estimated cost plan. $9,268.20 N/A
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized $189,500.00 $99,967.00 Cost per Dielectric quotation attached N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $5,760.00 N/A

Components

Actual Information Description File Name
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized

Component Description:
2nd 45% prior to ship. Repackvpol not included in request.
Amount:
$37,561.05

Component Description:
1st 45% of Antenna cost
Amount:
$37,561.05
Sweep test of existing antenna

Component Description:
Sweep
Amount:
$6,400.00
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
2nd 45% prior to ship. Repackvpol not included in request.
Amount:
$6,372.00

Component Description:
1st 45% of cost per invoice.
Amount:
$6,372.00
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
2nd 45% prior to ship. Repackvpol not included in request.
Amount:
$4,634.10

Component Description:
1st 45% of cost per invoice.
Amount:
$4,634.10
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized Information not provided.
Sweep test of existing antenna

Component Description:
2nd 45% prior to ship. Repackvpol not included in request.
Amount:
$2,880.00

Component Description:
Invoice amount
Amount:
$3,992.00

Component Description:
1st 45% of cost per invoice.
Amount:
$2,880.00

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 $195,240.00 $149,989.75 N/A $146,826.85 N/A
Total for all systems $2,176,323.04 $1,797,108.29 N/A $1,050,531.97 N/A
Interim Transmission Line $29,600.00 $26,728.00 $26,728.00
Flexible Air Transmission Line - dielectric, 4" $29,600.00 $26,728.00 Per quote as provided by Dielectric $26,728.00 N/A
Interim Transmission Line $165,640.00 $123,261.75 $120,098.85
Rigid Transmission Line - copper, 6 1/8" $165,640.00 $123,261.75 Actual cost as provided by Dielectric on quote 700186CMZ-3 for line and flanges. $120,098.85 N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 4"

Component Description:
As per invoice
Amount:
$26,728.00
Rigid Transmission Line - copper, 6 1/8"

Component Description:
2nd 45% prior to ship. Repackvpol not included in request.
Amount:
$55,467.79

Component Description:
Balance due on final completion
Amount:
$9,163.27

Component Description:
1st 45% of cost per invoice.
Amount:
$55,467.79

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 $343,500.00 $231,590.00 N/A $139,645.00 N/A
Total for all systems $2,176,323.04 $1,797,108.29 N/A $1,050,531.97 N/A
Primary Tower LTOWER $343,500.00 $231,590.00 $139,645.00
Interim Antenna $133,000.00 $133,000.00 Tower rigging as per bid received from Dielectric $74,325.00 N/A
Tall Tower (greater than 500') $210,500.00 $98,590.00 Antenna installation as per Dielectric quotation. $65,320.00 N/A

Components

Actual Information Description File Name
Interim Antenna

Component Description:
Interim antenna rigging
Amount:
$74,325.00
Tall Tower (greater than 500')

Component Description:
Additional mobilization and rigging for antenna replacement
Amount:
$43,420.00

Component Description:
Tower services
Amount:
$21,900.00

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 $182,340.00 $174,150.50 N/A $27,302.45 N/A
Total for all systems $2,176,323.04 $1,797,108.29 N/A $1,050,531.97 N/A
Outside Professional Services $182,340.00 $174,150.50 $27,302.45
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $702.50 N/A
Personnel costs $10,000.00 $10,000.00 N/A N/A N/A
Additional Field Engineering Service, 2 Days $16,370.00 $16,370.00 N/A $18,402.45 The cost of the sweep came in at a cost in excess of estimated cost.
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
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A $2,045.00 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 $1,520.00 N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 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
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $1,725.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,530.50 Actual invoices received has exceeded original estimate. $2,480.00 The amount of actual invoices received has exceeded original estimate.
Project management of the transition $15,800.00 $15,000.00 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 $427.50 N/A

Components

Actual Information Description File Name
Perform engineering study for new channel assignment and antenna development

Component Description:
Linked station set
Amount:
$195.00

Component Description:
Antenna study
Amount:
$300.00

Component Description:
Channel study
Amount:
$207.50

Component Description:
Investigate tower move
Amount:
$900.00

Component Description:
Antenna study.
Amount:
$825.00
Personnel costs Information not provided.
Additional Field Engineering Service, 2 Days

Component Description:
Total invoice
Amount:
$18,402.45
RF Exposure Measurements Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
STA
Amount:
$2,045.00
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

Component Description:
CP
Amount:
$234.00

Component Description:
CP
Amount:
$714.00

Component Description:
CP
Amount:
$101.00

Component Description:
CP
Amount:
$276.00

Component Description:
CP
Amount:
$195.00

Component Description:
CP
Amount:
$390.00

Component Description:
CP
Amount:
$351.00
Prepare request for Special Temporary Authorization 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:
CP
Amount:
$675.00

Component Description:
CP
Amount:
$900.00

Component Description:
CP
Amount:
$150.00
Prepare and or review reimbursement form

Component Description:
Quarterly
Amount:
$50.50

Component Description:
Quarterly
Amount:
$50.50

Component Description:
Quarterly
Amount:
$202.00

Component Description:
Quarterly
Amount:
$50.50

Component Description:
Form 1876
Amount:
$392.00

Component Description:
Form 399
Amount:
$1,295.00

Component Description:
Quarterly
Amount:
$39.00

Component Description:
Quarterly
Amount:
$350.00

Component Description:
Quarterly
Amount:
$50.50
Project management of the transition Information not provided.
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Chart dependencies.
Amount:
$140.00

Component Description:
Transition timing
Amount:
$151.50

Component Description:
Linked station set
Amount:
$136.00

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 $45,524.04 $44,974.04 N/A $7,055.00 N/A
Total for all systems $2,176,323.04 $1,797,108.29 N/A $1,050,531.97 N/A
Other Expenses $45,524.04 $44,974.04 $7,055.00
MVPD Notification of Channel Change $500.00 $500.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $1,000.00 $1,000.00 N/A N/A N/A
Equipment Storage $4,000.00 $4,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $22,474.04 $22,474.04 Additional freight and shipping billed by Dielectric $3,780.00 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $5,000.00 $5,000.00 N/A N/A N/A
Local Zoning $1,000.00 $1,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $3,275.00 N/A

Components

Actual Information Description File Name
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:
2nd 45% prior to ship. Repackvpol not included in request.
Amount:
$1,890.00

Component Description:
Freight and shipping billed
Amount:
$13,474.04

Component Description:
1st 45% of cost per invoice.
Amount:
$1,890.00
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Local Zoning Information not provided.
DTV Medical Facility Notification

Component Description:
Invoice received
Amount:
$3,275.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,176,323.04 $1,797,108.29 $1,050,531.97

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.

Lee Weinel

CFO


11/18/2019

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.

Lee Weinel

CFO


11/18/2019

Attachments

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