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:
73319
Service:
DTV
Call Sign:
WQAD-TV
Channel:
31 (UHF)
File Number:
0000028252
FRN:
0028358455
Date Submitted:
02/20/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

TEGNA Broadcast Holdings, LLC

Denise A. Branson, Sr. Paralegal

8350 BROAD STREET

SUITE 2000

TYSONS, VA 22102

United States

+1 (703) 873-6606 DBRANSON@TEGNA.COM Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan Replace Antenna and Transmission line Replace transmitter Install Interim antenna to operate on during construction

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 SigmaCD-P2
Year 2001
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 60 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-72
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 47 kW
Justification for New Transmitter Current transmitter has be state not Re-Tunable by the manufacturer. ULXTE-72 Non Epole equivalent for reimbursement.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 2 inches
Length 300.0 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

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? 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: 1000.0 kW
Manufacturer
Model TFU-30GTH
Year 2003

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 868.0 kW
Manufacturer
Model TFU-31JTH/VP-R 06
Year 2020
Justification for New Antenna Current antenna will not operate on 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 7 3/16 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
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 Broadband Slot
Number of Stations Supported 1
Number of Panels/Bays 16
Lower Limit 470.00 MHz
Upper Limit 700.00 MHz
Design power capacity in use 90.0 %
Other Antenna Type N/A
ERP: 200.0 kW
Manufacturer
Model TFU-WB16
Year 2020
Justification for New Antenna Temporary operation during tower work

Interim Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? B
Feed Line Size 6 1/8 inches
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

Name Description

Tower Rental

American Tower rental of tower space for antenna

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1100 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 7 3/16 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 Current line section length is not compatible with assigned channel

Primary 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 Broadband
Other Segment Length
Number of parallel runs 1
Length 1080 feet per run
Justification for New Transmission Line Transmission line to connect to interim antenna

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? Candelabra
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? Yes
ASR Number 1225582
Coordinates (NAD83) Latitude (NAD83) 41° 18' 44.5" N-
Longitude (NAD83) 090° 22' 46.2" W-
Overall Structure Height 1096.12 feet
Support Structure Height 1096.12 feet
Ground Elevation Above Mean Sea Level (AMSL) 752.94 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers, LLC.
Date Constructed 08/30/2001

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
81946 WMWC-TV DTV
73319 WQAD-TV DTV
54011 KLJB DTV
5468 WQPT-TV DTV
5471 KQIN DTV
6885 KWQC-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: Study needed for undocumented/poorly documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: Minor Reinforcements needed

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Weather Day

Weather Day

Tower Permit Drawing Package

Tower Permit Drawing Package

Structural engineering tower load study for a documented tower with candelabra

Rigorous Structural analysis to access the structural capacity and modifications needed to accommodate the repacked equipment.

Pedestal

Replace current pedestal to support new antenna

Capital Contribution to Am Twr

Capital Contribution to Am Twr

Obtain building permits from local zoning authorities

Obtain building permits from local zoning authorities

Interim Install

Separate trip for Interim system install

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 300
Explanation Landlord Management of project
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

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Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application No
FCC Special Temporary Authority Application No
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? No
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? 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 $1,533,400.00 $1,388,592.00 N/A $1,269,881.71 N/A
Total for all systems $3,785,308.75 $3,712,024.06 N/A $2,572,779.74 N/A
Primary Transmitter ULXTE-72 $1,533,400.00 $1,388,592.00 $1,269,881.71
Service entrance 3 phase/800 amp/208 volt $14,400.00 $44,792.00 See attached / uploaded PDF files titled "Tri-City Elec 225824 v200211pmv1" and "Tri-City Elec 228083 v200211pmv1" $44,792.00 N/A
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW $1,473,000.00 $1,300,000.00 N/A $1,225,089.71 N/A
2" Rigid Conduit and Wiring (Cost per foot) $7,800.00 $7,500.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A

Components

Actual Information Description File Name
Service entrance 3 phase/800 amp/208 volt

Component Description:
Tri-City Elec 225824 v200211pmv1
Amount:
$33,594.00

Component Description:
Tri-City Elec 228083 v200211pmv1
Amount:
$11,198.00
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW

Component Description:
2nd payment for ULXTE-72
Amount:
$381,531.67

Component Description:
Gates US0333447 v200131jgv1
Amount:
$86,685.83

Component Description:
ULXTE-72 Deposit
Amount:
$377,974.52

Component Description:
Gates US0331041 v191129jgv1
Amount:
$378,897.69
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Switchgear - industrial 800 amp 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 $545,060.00 $425,918.31 N/A $230,062.95 N/A
Total for all systems $3,785,308.75 $3,712,024.06 N/A $2,572,779.74 N/A
Interim Antenna TFU-WB16 $234,930.00 $156,518.31 $124,942.50
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $5,760.00 N/A
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized $189,500.00 $110,000.00 N/A $104,064.19 N/A
Tower Rental $25,000.00 $25,000.00 Tower interim antenna space rental N/A N/A
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,700.00 $15,118.31 See attached / uploaded PDF files titled "Die 666044 v200210pmv1.pdf" and "Die ST666044 v200210pmv1.pdf" $15,118.31 N/A
Primary Antenna TFU-31JTH/VP-R 06 $310,130.00 $269,400.00 $105,120.45
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $2,880.00 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 $96,668.10 N/A
Elbow complex, single channel, at antenna input, per 7 3/16. feedline (if needed) $13,900.00 $13,000.00 N/A $5,572.35 N/A

Components

Actual Information Description File Name
Sweep test of existing antenna

Component Description:
1st payment Sweep test
Amount:
$2,880.00

Component Description:
2nd payment Sweep Test
Amount:
$2,880.00
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized

Component Description:
1st payment TFU-16WB-R
Amount:
$45,866.25

Component Description:
Die ST611006 v200211pmv1
Amount:
$7,899.19

Component Description:
2nd payment TFU-16WB-R
Amount:
$45,866.25

Component Description:
Die 611006 v200211pmv1
Amount:
$4,432.50
Tower Rental Information not provided.
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Die ST666044 v200210pmv1
Amount:
$889.31

Component Description:
Die 666044 v200210pmv1
Amount:
$14,229.00
Sweep test of existing antenna

Component Description:
1st payment Sweep Test
Amount:
$2,880.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
1st payment TFU-31JTH/VP-R
Amount:
$96,668.10
Elbow complex, single channel, at antenna input, per 7 3/16. feedline (if needed)

Component Description:
1st payment Elbow Complex
Amount:
$5,572.35

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 $569,560.00 $450,000.00 N/A $269,324.12 N/A
Total for all systems $3,785,308.75 $3,712,024.06 N/A $2,572,779.74 N/A
Interim Transmission Line $250,560.00 $210,000.00 $169,710.66
Rigid Transmission Line - copper, 6 1/8" broadband $250,560.00 $210,000.00 N/A $169,710.66 N/A
Primary Transmission Line $319,000.00 $240,000.00 $99,613.46
Rigid Transmission Line - copper, 7 3/16" $319,000.00 $240,000.00 N/A $99,613.46 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 6 1/8" broadband

Component Description:
Die ST611006 v200211pmv1
Amount:
$11,784.43

Component Description:
2nd payment RTLSCR's
Amount:
$2,485.69

Component Description:
2nd payment transmission line
Amount:
$68,425.76

Component Description:
Die 611006 v200211pmv1
Amount:
$10,234.35

Component Description:
Die ST670005 v200220pmv1
Amount:
$345.23

Component Description:
1st payment RTLSCR's
Amount:
$2,485.69

Component Description:
1st payment transmission line
Amount:
$68,425.76

Component Description:
Die 670005 v200220pmv1b
Amount:
$4,971.38

Component Description:
Die 670005 v200220pmv1b
Amount:
$552.37
Rigid Transmission Line - copper, 7 3/16"

Component Description:
1st payment Transmission Line
Amount:
$94,919.96

Component Description:
1st payment RTLSCR's
Amount:
$4,693.50

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 $981,093.75 $1,306,013.75 N/A $768,458.75 N/A
Total for all systems $3,785,308.75 $3,712,024.06 N/A $2,572,779.74 N/A
Primary Tower GTOWER $981,093.75 $1,306,013.75 $768,458.75
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $24,800.00 N/A $24,800.00 N/A
Minor tower reinforcement/modifications $158,000.00 $0.00 N/A N/A N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $905,420.00 Complete quote for services including modifications and new pedestal $452,710.00 N/A
Obtain building permits from local zoning authorities $1,000.00 $1,000.00 See attached / uploaded PDF file titled "Am Twr 370433 v200130jgv1.pdf" $1,000.00 N/A
Pedestal $0.00 $0.00 Included in Quote N/A N/A
Capital Contribution to Am Twr $5,000.00 $5,000.00 See attached/uploaded PDF file titled "Am Twr 460220503 v191129jgv1.pdf" $5,000.00 N/A
Interim Install $339,380.00 $339,380.00 N/A $254,535.00 N/A
Structural engineering tower load study for a documented tower with candelabra $19,000.00 $19,000.00 N/A $19,000.00 N/A
Tower Permit Drawing Package $4,700.00 $4,700.00 See attached / uploaded PDF file titled "Am Twr 370433 v200130jgv1.pdf" $4,700.00 N/A
Weather Day $6,713.75 $6,713.75 See attached / uploaded PDF file titled "TCI 8980 v200208pmv1" $6,713.75 N/A

Components

Actual Information Description File Name
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Tower Mapping
Amount:
$24,800.00
Minor tower reinforcement/modifications Information not provided.
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
installation top mount deposit
Amount:
$452,710.00
Obtain building permits from local zoning authorities

Component Description:
Am Twr 370433 v200130jgv1
Amount:
$1,000.00
Pedestal Information not provided.
Capital Contribution to Am Twr

Component Description:
Am Twr 460220503 v191129jgv1
Amount:
$5,000.00
Interim Install

Component Description:
down payment for Int.
Amount:
$169,690.00

Component Description:
TCI 8961 v200208pmv1
Amount:
$84,845.00
Structural engineering tower load study for a documented tower with candelabra

Component Description:
Structural reporting
Amount:
$19,000.00
Tower Permit Drawing Package

Component Description:
Am Twr 370433 v200130jgv1
Amount:
$4,700.00
Weather Day

Component Description:
TCI 8980 v200220pmv1
Amount:
$6,713.75

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 $84,645.00 $70,500.00 N/A $9,480.00 N/A
Total for all systems $3,785,308.75 $3,712,024.06 N/A $2,572,779.74 N/A
Outside Professional Services $84,645.00 $70,500.00 $9,480.00
RF Exposure Measurements $21,050.00 $11,000.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 N/A N/A N/A
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 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
Project management of the transition $47,400.00 $45,000.00 N/A $9,480.00 N/A

Components

Actual Information Description File Name
RF Exposure Measurements Information not provided.
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 Information not provided.
Perform engineering study for new channel assignment and antenna development Information not provided.
Project management of the transition

Component Description:
Am Twr 370433 v200130jgv1
Amount:
$9,480.00

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 $71,550.00 $71,000.00 N/A $25,572.21 N/A
Total for all systems $3,785,308.75 $3,712,024.06 N/A $2,572,779.74 N/A
Other Expenses $71,550.00 $71,000.00 $25,572.21
MVPD Notification of Channel Change $5,000.00 $5,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $0.00 $0.00 N/A N/A N/A
Equipment Storage $15,000.00 $15,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $25,000.00 $25,000.00 N/A $22,622.21 N/A
Local Zoning $15,000.00 $15,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $2,950.00 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:
Tri-City Iron 40099 v200211pmv1
Amount:
$1,541.68

Component Description:
Die 667010 v200210pmv1
Amount:
$5,159.92

Component Description:
Die 672008 v200220pmv1
Amount:
$443.21

Component Description:
Die 670005 v200220pmv1b
Amount:
$15,477.40
Local Zoning Information not provided.
DTV Medical Facility Notification

Component Description:
MEDICAL TESTING
Amount:
$2,950.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,785,308.75 $3,712,024.06 $2,572,779.74

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


02/20/2020

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.

Jeffrey C Gehman

Engineering Associate


02/20/2020

Attachments

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