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:
70414
Service:
DCA
Call Sign:
WBXJ-CD
Channel:
34 (UHF)
File Number:
0000027568
FRN:
0014037857
Date Submitted:
04/30/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

L4 MEDIA GROUP, LLC

Doing Business As: L4 MEDIA GROUP, LLC

PO Box 60606

Suite 2450

Chicago, IL 60606

United States

+1 (612) 202-4980 ssaldana@sktytrading.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

Joseph L. Snelson , Jr .

Technical Consultant

Meintel, Sgrignoli & Wallace

1282 Smallwood Drive, Suite 372

Waldorf, MD 20603

United States

+1 (303) 344-8037 joe.snelson@mswdtv.com

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan Current transmission system consists of a single transmitter feeding a flexible transmission line which connects to an antenna on the tower. Work includes tower study/rehabilitation to support new antenna, mounting antenna and retuning transmitter.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Retune Existing
Use Primary (Main)
Ownership Owned
Owner 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 Elettronika
Model TXUD2000
Year 2015
Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 2.0 kW

Primary Transmitter

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Retuning Transmitter Costs

Section Question Response
New IOT Tubes Number of Tubes (including accessories) needed N/A
New Mask Filter
Power 3 kW
Other Power N/A
New Exciter Is a new exciter needed? No

Primary Transmitter

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Other Transmitter Costs

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

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 Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 7.0 kW
Manufacturer
Model DLP8B
Year 2011

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 5.9 kW
Manufacturer
Model TLP8B
Year 2017
Justification for New Antenna The current antenna is tuned for channel 43 and cannot be retuned to the repack channel of 34. Applicant is proposing to replace with a similar antenna tuned to the repack 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?
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? 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.

Transmission Line

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Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? No

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users Yes
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1020783
Coordinates (NAD83) Latitude (NAD83) 30° 16' 35.0" N-
Longitude (NAD83) 081° 33' 50.7" W-
Overall Structure Height 1061.01 feet
Support Structure Height 1042.97 feet
Ground Elevation Above Mean Sea Level (AMSL) 29.86 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner SpectraSite Communications, LLC. through American Towers, LLC.
Date Constructed 11/05/2008

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
22005 WJXL-FM FM
48390 WCRJ FM
29719 WJEB-TV DTV
31936 WJKV FM
47425 WTRJ-FM FM

Other Types of Users

Users
LPFM
LPTV

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: 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

Coordination Meetings

Coordination efforts with all users on the tower to coordinate work with power cut backs.

Tower Project Management

Project management for required tower work

General Project Management

Tower owner overall project management fees

Local Building Permits

Required permits by local governing bodies to perform work on the tower.

Building Permit

Grounds and Building modification permit

Permit

Permit cost for proposed tower work

Structural Analysis

Analyze tower structural integrity to support proposed loads

Timing and Coordination

Coordination with other users on tower as to when work can be performed

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 200
Explanation Applicant has no internal resources capable of overseeing, identifying, purchasing, installing and commissioning this repack project. It will rely solely on outside services to manage all work required.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority No
Quantity N/A
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority No
Quantity N/A
NEPA Section 106 environmental review 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 Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Progress Reporting

Prepare and file 9 required progress reports on FCC Form 2100, Schedule 387 on a quarterly basis with the FCC.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application Yes
FCC Special Temporary Authority Application No
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? No

Other Expenses

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Other Expenses Not Listed

Name Description

Capital Contribution

Tower modification for new load associated with repacked stations, pro rated share of expense.

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 $109,355.00 $19,513.33 N/A $19,513.33 N/A
Total for all systems $600,236.00 $316,807.39 N/A $202,755.41 N/A
Primary Transmitter TXUD2000 $109,355.00 $19,513.33 $19,513.33
3 kW mask filter $4,155.00 $4,513.33 Actual cost exceeded original estimate which was outdated and did not include freight. $4,513.33 ORIGINAL COST ESTIMATE WAS OUTDATED, CURRENT ESTIMATE ATTACHED, INVOICE FINAL COST INCLUDES FREIGHT EXPENSE
UHF and VHF - minor banding issues $105,200.00 $15,000.00 N/A $15,000.00 N/A

Components

Actual Information Description File Name
3 kW mask filter

Component Description:
CHANNEL 34 MASK FILTER
Amount:
$4,513.33
UHF and VHF - minor banding issues

Component Description:
TRANSMITTER - UHF and 15,000.00 15,000.00 VHF - MINOR BANDING ISSUES - TRANSMITTER SERVICES
Amount:
$15,000.00

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $33,030.00 $29,500.00 N/A $18,574.77 N/A
Total for all systems $600,236.00 $316,807.39 N/A $202,755.41 N/A
Primary Antenna TLP8B $33,030.00 $29,500.00 $18,574.77
Sweep test of existing antenna $6,730.00 $4,500.00 N/A $4,500.00 N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $25,000.00 N/A $14,074.77 N/A

Components

Actual Information Description File Name
Sweep test of existing antenna

Component Description:
SWEEP TEST
Amount:
$4,500.00
UHF - Lower Power Side Mount, Class A One Station antenna -- basic

Component Description:
FLORIDA STATE SALES TAX FOR ANTENNA
Amount:
$859.02

Component Description:
UHF - LOW POWER SIDE MOUNT ANTENNA AND MOUNT TLP8B CH 34
Amount:
$13,215.75

Cost Information

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Transmission Line

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $267,918.00 $139,838.06 N/A $82,170.06 N/A
Total for all systems $600,236.00 $316,807.39 N/A $202,755.41 N/A
Primary Tower GTOWER $267,918.00 $139,838.06 $82,170.06
Tall Tower (greater than 500') $210,500.00 $100,000.00 N/A $63,000.00 N/A
Timing and Coordination $2,500.00 $2,500.00 Address transition timing and coordination issues with other stations and wireless (Cost per customer) N/A N/A
General Project Management $2,500.00 $2,500.00 Construction project management (Tower Modification reinforcements and facilities) 20 hrs x $125 N/A N/A
Structural Analysis $5,238.00 $5,238.00 Structural engineering tower load study for documented tower $0.00 N/A
Local Building Permits $4,700.00 $4,700.00 Tower Permit Drawing Package (if needed) (Cost per customer) $1,000.00 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $8,720.06 sales tax was not included in the estimate $8,720.06 Sales tax was not included in the estimate
Coordination Meetings $1,250.00 $1,250.00 Site Coordination Meeting N/A N/A
Building Permit $4,700.00 $4,700.00 Ground & Building A&E Permit Drawing Package (Cost per customer) $4,700.00 N/A
Permit $750.00 $750.00 Obtain building permits from local zoning authorities (cost of preparation, submission, and prosecution of necessary forms or applications per customer) $0.00 N/A
Tower Project Management $9,480.00 $9,480.00 Project management of the transition (Cost per hour per customer) 94.8 hrs x $100 $4,750.00 N/A

Components

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

Component Description:
TOWER ANTENNA SERVICES
Amount:
$63,000.00
Timing and Coordination Information not provided.
General Project Management Information not provided.
Structural Analysis

Component Description:
Structural Engineering
Amount:
$5,237.50
Local Building Permits

Component Description:
PERMIT APPLICATION
Amount:
$1,000.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
tower mapping
Amount:
$8,720.06
Coordination Meetings Information not provided.
Building Permit

Component Description:
Construction Drawing Package Fee Station WBXJ
Amount:
$4,700.00
Permit Information not provided.
Tower Project Management

Component Description:
PM SERVICES RELATED TO TOWER DOCUMENTATION AND PERMIT PROCESS
Amount:
$4,750.00

Component Description:
Coordination and transition planning with all parties onsite and management of timelines and schedules
Amount:
$4,268.00

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 $158,780.00 $103,225.00 N/A $69,918.75 N/A
Total for all systems $600,236.00 $316,807.39 N/A $202,755.41 N/A
Outside Professional Services $158,780.00 $103,225.00 $69,918.75
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $2,583.75 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $5,300.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Project management of the transition $31,600.00 $30,000.00 N/A $27,000.00 N/A
Progress Reporting $18,000.00 $18,000.00 Prepare and file 9 required progress reports on FCC Form 2100, Schedule 387 on a quarterly basis with the FCC. $1,060.00 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $30,000.00 See QUOTE 695, WBXJ L4, 010119 REPACK FEILD TEST $30,000.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $0.00
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 and or review reimbursement form $2,630.00 $3,975.00 The predetermined estimate predated the effort, this amount is the actual expense incurred. $3,975.00 N/A

Components

Actual Information Description File Name
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
WBXJ-CD Jacksonville, FL Prepare Technical Portions of FCC Form 2100 Construction Permit Application and Engineering Exhibits required to be filed with Initial Repack Channel Construction Permit Application FCC Form 2100
Amount:
$2,583.75

Component Description:
WBXJ-CD Jacksonville, FL Prepare technical portions of FCC Form 2100 Construction Permit Application and Engineering Exhibits required to be filed with initial Repack Construction Permit Application - Filing Window. 9.75 hours
Amount:
$2,583.75
Perform engineering study for new channel assignment and antenna development

Component Description:
Conduct TVStudy analysis of initial channel assignment and analyze interference issue with new repack channel
Amount:
$5,300.00

Component Description:
WBXJ-CD Jacksonville, FL Conduct TVStudy analysis of initial channel assignment and analyze interference issues with new repack channel. 15.0 hours
Amount:
$3,975.00

Component Description:
WBXJ-CD Jacksonville, FL Develop antenna azimuth patterns and determine antenna required for FCC Form 2100 Construction Permit Application for initial Repack Channel CP Filing. 5.0 hours
Amount:
$1,325.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Project management of the transition

Component Description:
project management services
Amount:
$1,500.00

Component Description:
project management services
Amount:
$3,000.00

Component Description:
project management services
Amount:
$4,500.00

Component Description:
project management services
Amount:
$3,000.00

Component Description:
Project Management services, research and coordination w/rf engineering, equipment vendors and site owners
Amount:
$750.00

Component Description:
PROJECT MANAGEMENT SERVICES
Amount:
$2,250.00

Component Description:
PROJECT MANAGEMENT SERVICES
Amount:
$3,000.00

Component Description:
PROJECT MANAGEMENT SERVICES
Amount:
$3,750.00

Component Description:
PROJECT MANAGEMENT SERVICES
Amount:
$3,000.00

Component Description:
Project Management services, research and coordination w/rf engineering, equipment vendors and site owners
Amount:
$2,250.00
Progress Reporting

Component Description:
Prepare FCC Form 387 Repack Progress Report Filing - WBXJ-CD
Amount:
$1,060.00
Comprehensive coverage verification via field study, if needed

Component Description:
PERFORM IN FIELD COMPREHENSIVE COVERAGE FIELD STUDY TO CONFIRM PROPAGATION MATCHES DESIGN EXPECTATIONS
Amount:
$30,000.00
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:
WBXJ-CD Jacksonville, FL Prepare initial budgets, equipment list, and determine equipment replacements for new repack channel operations; Prepare FCC Form 2100 Schedule 399 Budget and Narrative for filing in initial CP Filing Window. 15.0 hour
Amount:
$3,975.00

Component Description:
WBXJ-CD Jacksonville, FL Prepare initial budgets, equipment lists, and determine equipment replacements for new repack channel; Prepare FCC Form 399 Budget and Narrative
Amount:
$1.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare and or review reimbursement form

Component Description:
WBXJ-CD Jacksonville, FL Prepare initial budgets, equipment lists, and determine equipment replacements for new repack channel; Prepare FCC Form 399 Budget and Narrative for filing with Initial CP Filing Window
Amount:
$3,975.00

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 $31,153.00 $24,731.00 N/A $12,578.50 N/A
Total for all systems $600,236.00 $316,807.39 N/A $202,755.41 N/A
Other Expenses $31,153.00 $24,731.00 $12,578.50
Develop and air announcement of upcoming channel change $2,500.00 $2,500.00 It is required that the applicant give notification to viewers of the repack channel change. Applicant has limited internal resources to create and produce such notifications and will most likely have to obtain the services from an outside vendor. N/A N/A
Equipment Storage $2,500.00 $2,500.00 Applicant may receive antenna and transmitter parts prior to set installation dates. There is no on-site storage available and applicant may be forced to use outside temporary storage facilities. $1,595.00 N/A
Non-zoning permits $2,000.00 $2,000.00 It is currently unknown what the city or county may levy on applicant in terms of a building permit to perform the tower work required. It is felt this estimate should cover the associated costs for any required permits. N/A N/A
Local Zoning $2,000.00 $2,000.00 It is currently unknown what the local zoning authority or city/county may levy on applicant to perform the tower work required. It is felt this estimate should cover the associated costs for any required permits. N/A N/A
DTV Medical Facility Notification $11,550.00 $5,128.00 N/A $5,128.00 COST WAS ESTIMATED BEFORE QUOTATION WAS AVAILABLE.
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 FCC changed the fee $335.00 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $1,000.00 $1,000.00 Applicant will be required to dispose of the current pre-repack antenna and parts that were replaced for transmitter retuning. The exact costs are not known at this time. N/A N/A
Equipment Delivery and Handling Charges $5,000.00 $5,000.00 There will be shipping charges for the antenna and transmitter costs. Precise costs will not be known until the carrier issues an invoice. Currently, applicant does not estimate costs to be more than this estimate. $1,252.50 N/A
Capital Contribution $4,268.00 $4,268.00 N/A $4,268.00 N/A

Components

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

Component Description:
ANTENNA STORAGE
Amount:
$1,595.00
Non-zoning permits Information not provided.
Local Zoning Information not provided.
DTV Medical Facility Notification

Component Description:
DTV Notification Service Notification of Medical Facilities Transmitter Medical Facility Notification
Amount:
$5,128.00
FCC Filing Fees - Form 2100 license to cover application

Component Description:
license fee
Amount:
$335.00
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Equipment Delivery and Handling Charges

Component Description:
FREIGHT
Amount:
$1,252.50
Capital Contribution

Component Description:
CAPITAL CONTRIBUTION - JACKSONVILLE 1069 FL 1 / 302757 / ASSET#302757 / 12944351 / ASR/FID: 1020783 / 70414 / WBXJ-CD Channel 34 / MILESTONE 1
Amount:
$4,268.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $600,236.00 $316,807.39 $202,755.41

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. Yes
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.

Robert Wayne Jordan

ENGINEER


04/30/2020

Certification

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Section Question Response
Submission of Final Allocation or Accounting Information 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 and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

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

  3. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.

  4. 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.

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

  6. 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.

Robert Wayne Jordan

ENGINEER


04/30/2020

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