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:
4301
Service:
DTV
Call Sign:
WUSI-TV
Channel:
23 (UHF)
File Number:
0000028018
FRN:
0005941323
Date Submitted:
08/30/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY

Board of Trustees Southern Illinois University

1003 COMMUNICATIONS BUILDING

MAILCODE 6602

CARBONDALE, IL 62901

United States

+1 (618) 453-6183 jak.tichenor@wsiu.org Government Entity

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

Greg Best

Consulting Engineer

Greg Best Consulting, Inc.

16100 Outlook Ave.

Stilwell, KS 66085

United States

+1 (816) 792-2913 gbconsulting54@gmail.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 See the attached transition plan document.

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 Diamond
Year 2006
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 6 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model UAXTE-12R44
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 7.2 kW
Justification for New Transmitter Current transmitter will not operate on the new channel & is no longer supported by manufacturer.

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) No
Power N/A
Rigid Conduit and Wiring Yes
Size 2 inches
Length 50.0 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 100.0 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 Retune Existing
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels 56
Design power capacity in use 10.0 %
Lower Limit 470.00 MHz
Upper Limit 698.00 MHz
Other Antenna Type N/A
ERP: 46.6 kW
Manufacturer Dielectric
Model TUF-O4-14/56H-1-R
Year 2006

Primary Antenna

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Adjustment to Existing Antenna

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

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

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Tuner adjustments

Tower & prof services crew to adjust tuners to reduce VSWR.

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? No

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 175
Explanation Engineer to oversee and coordinate delivery, installation, and commissioning of all equipment and services for the facility.
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 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 No
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

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)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? No
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? No
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

WUSI Reception antennas

Purchase and installation of WUSI owned TV antennas located at cable sites.

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 $353,200.00 $341,900.00 N/A $233,567.61 N/A
Total for all systems $463,340.00 $467,300.00 N/A $289,451.30 N/A
Primary Transmitter UAXTE-12R44 $353,200.00 $341,900.00 $233,567.61
10 Ton system $60,500.00 $31,900.00 See attached quote from SIU Physical Plant Services department. $2,254.67 N/A
2" Rigid Conduit and Wiring (Cost per foot) $1,300.00 $1,250.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 7.2 kW $236,500.00 $236,500.00 N/A $228,857.85 N/A
Switchgear - industrial 800 amp $38,200.00 $55,550.00 See attached quote prepared by SIU Physical Plant Services department. $1,216.00 N/A
Other -- Building Addition Size: 100.0 $16,700.00 $16,700.00 See attached quote from SIU Physical Plant Services department. $1,239.09 N/A

Components

Actual Information Description File Name
10 Ton system

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146744, engineering services
Amount:
$61.02

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146744, engineering services
Amount:
$20.34

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$28,780.75

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$2,254.67
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
UHF - Air Cooled Solid State Transmitter 7.2 kW

Component Description:
WUSI-TV Transmitter: Final Invoice due (revised memo, quotes & change orders included)
Amount:
$93,442.28

Component Description:
First payment for GatesAir transmitter. 70% of total cost per quote Q-75160 (included) with memo
Amount:
$135,415.57

Component Description:
First payment for GatesAir transmitter. 70% of total cost per quote Q-75160 (included)
Amount:
$135,415.57
Switchgear - industrial 800 amp

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #149719, engineering services
Amount:
$18,372.67

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146744, engineering services
Amount:
$209.00

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$3,145.52

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$2,601.39

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$545.10

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$15,105.42

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$141.94

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$890.05

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$659.60

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$308.00

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$957.00

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$342.00

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$437.00

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$152.00

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146744, engineering services
Amount:
$285.00
Other -- Building Addition Size: 100.0

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$1,239.09

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 $16,730.00 $16,400.00 N/A $0.00 N/A
Total for all systems $463,340.00 $467,300.00 N/A $289,451.30 N/A
Primary Antenna TUF-O4-14/56H-1-R $16,730.00 $16,400.00 $0.00
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
Tuner adjustments $10,000.00 $10,000.00 Line sweep indicates some adjustment may be needed for operation on post-repack channel. N/A N/A

Components

Information not provided.

Cost Information

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Transmission Line

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $58,360.00 $80,500.00 N/A $50,702.69 N/A
Total for all systems $463,340.00 $467,300.00 N/A $289,451.30 N/A
Outside Professional Services $58,360.00 $80,500.00 $50,702.69
Project management of the transition $27,650.00 $39,250.00 Additional engineering oversight needed to complete the project on time. $37,723.09 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A $0.00 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 $15,000.00 Additional legal counsel needed to coordinate transition and construction delays/timeline changes. $8,827.60 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 $2,887.50 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $1,264.50 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $5,000.00 Project manager and legal counsel assistance may be required to execute tasks associated with this activity. $0.00 N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Engineering Services: project management, 12/01/19-01/04/20 (with memo)
Amount:
$225.00

Component Description:
Program Management Services (quote included)
Amount:
$19,900.00

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services: site visit, review building mods, prep design
Amount:
$570.13

Component Description:
Engineering Services: project management, 06/01/19-06/30/19
Amount:
$525.00

Component Description:
Engineering Services: project management, 04/01/19-05/31/19
Amount:
$7,350.00

Component Description:
Engineering Services: project management, 12/01/19-01/04/20
Amount:
$225.00

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$532.00

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146744, engineering services: removal of old transmitter.
Amount:
$152.00

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733 & 146744, engineering services: removal of old transmitter.
Amount:
$890.05

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services: removal of old transmitter.
Amount:
$308.46

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$308.46

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services: removal of old transmitter.
Amount:
$437.00

Component Description:
Quarterly Progress report. Engineering Repack Service 1/1/18 through 2/1/18 performed by Greg Best. New Attachment includes cover letter requested by reviewer.
Amount:
$175.00

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733 & 146744, engineering services: removal of old transmitter.
Amount:
$659.60

Component Description:
Engineering Services, 10/1-11/2/18, project planning re: transmitter & building modifications.
Amount:
$700.00

Component Description:
Engineering Services through 8/4/18: project planning, WUSI Q2 progress report, Initial draft of transmitter bid spec.
Amount:
$787.50

Component Description:
Engineering Services: project management, 10/01/19-11/01/19
Amount:
$875.00

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, 146744 & 149719, engineering services: removal of old transmitter & prep for new.
Amount:
$3,145.53

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, 146744 & 149719, engineering services: removal of old transmitter & prep for new.
Amount:
$2,601.39

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733 & 146744, engineering services: removal of old transmitter.
Amount:
$141.94

Component Description:
Engineering Services through 9/1/18: project planning, transmitter bid spec creation for WUSI.
Amount:
$1,050.00

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146744, engineering services: removal of old transmitter.
Amount:
$380.00

Component Description:
Engineering services: 9/1-9/30/18, project management. Memo included.
Amount:
$350.00

Component Description:
Engineering Services through 9/1/18: project planning, transmitter bid spec creation for WUSI.
Amount:
$1,050.00

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services: removal of old transmitter.
Amount:
$957.00

Component Description:
Engineering services, 11/1-12/31/18, project management re: transmitters and required power/cooling support costs.
Amount:
$350.00

Component Description:
WUSI: Engineering Services: 2/2-3/31/19. Revision of transmitter bid spec
Amount:
$175.00

Component Description:
WUSI: Engineering Services: 1/1/-2/1/19. 2018 Q4 Quarterly report.
Amount:
$175.00

Component Description:
Engineering Services: project management, 08/01/19-08/30/19
Amount:
$1,225.00

Component Description:
Engineering Services: 1/1-2/1/18 - Quarterly Progress report. Attachment includes cover letter requested by reviewer.
Amount:
$175.00

Component Description:
Engineering Services through 8/4/18: project planning, WUSI Q2 progress report, Initial draft of transmitter bid spec.
Amount:
$787.50

Component Description:
Engineering Services: project management, 09/01/19-09/28/19
Amount:
$875.00

Component Description:
Quarterly Progress report. Engineering Repack Service 1/1/18 through 2/1/18 performed by Greg Best. Attachment includes cover letter memo.
Amount:
$175.00

Component Description:
Engineering Services: project management, 07/01/19-08/02/19
Amount:
$1,575.00

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services assoc with WSIU transmitter replacement
Amount:
$532.00
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Legal Fees: WUSI-TV repack services, October 2019
Amount:
$702.00

Component Description:
Legal Fees: WUSI-TV repack services, November 2019
Amount:
$108.00

Component Description:
Legal Fees: WUSI-TV repack services, September 2019
Amount:
$594.00

Component Description:
Legal Fees: WUSI-TV repack services, December 2018 (memo included)
Amount:
$433.60

Component Description:
Legal Fees: WUSI-TV repack services, June 2019
Amount:
$432.00

Component Description:
Legal Fees: WUSI-TV repack services, July 2019
Amount:
$2,106.00

Component Description:
Work on FCC post-auction repack construction permit/reimbursement filing deadlines for WUSI-TV; correspondence re: same; Prep for & conference call w/station team & consulting engineer (G Best) re: WUSI-TV repack, including CP & Schedule 399 preparations.
Amount:
$812.50

Component Description:
Legal Fees: WUSI-TV repack services, April 2019
Amount:
$216.00

Component Description:
Legal Services: Repack activities, November 2018
Amount:
$437.50

Component Description:
email re Oct 10 deadline for 3rd Qtr repack transition report & availability of Form 2100 Schedule 387 on LMS
Amount:
$56.00

Component Description:
Legal Fees: WUSI-TV repack services, February 2019
Amount:
$663.00

Component Description:
Legal Fees: WUSI-TV repack services, August 2019
Amount:
$486.00

Component Description:
Review complete & file online FCC repack channel chg construction permit app; update station records; prep correspondence; teleconf WSIU team/G Best re repack, transition/contingency plans, 399, reimburs costs & CP. Review public notice/database re grant.
Amount:
$1,781.00
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:
Engineering Repack Service 6/1/17 through 7/14/17. Creation of CP app and input/review for form 399 performed by Greg Best.
Amount:
$875.00

Component Description:
Engineering Repack Service 5/1/17 through 6/10/17. Initial CP app input performed by Greg Best. New Attachment includes cover letter requested by reviewer.
Amount:
$437.50

Component Description:
Engineering Service 5/1-6/10/17. Initial CP app input performed by Greg Best. Attachment includes cover letter.
Amount:
$437.50

Component Description:
Review of transmission system for WUSI. Project start-up, information gathering, and evaluation of antenna repacked channel usage. Initial Ix analysis for CP prep. Engineering Repack Services 4/1/17 through 5/1/17 performed by Greg Best.
Amount:
$1,575.00

Component Description:
Engineering Services: 5/1-6/10/17 - Initial CP app input. Attachment includes cover letter requested by reviewer.
Amount:
$437.50
Perform engineering study for new channel assignment and antenna development Information not provided.
Prepare and or review reimbursement form

Component Description:
Legal Fees: WUSI quarterly repack transition report. Attachment includes cover letter requested by reviewer.
Amount:
$50.50

Component Description:
review FCC Public Notice on initial allocation of repack funding & approval of individual coast estimates & availability of reimbursement process for repacked stations.
Amount:
$112.00

Component Description:
Analysis & review FCC online databases re repack transition qrtrly progress report deadline & submission status for WUSI-TV; update station records.
Amount:
$39.00

Component Description:
email re FCC Auction Closing & Channel Reassignment Public Notice (CCRPN); Review FCC channel reassignment & Form1876 letter, analyze repack/reimbursement process & forward letter, Form 1876 instructions & repack timetable to station.
Amount:
$151.50

Component Description:
Legal Fees: repack services, January 2019 (memo included)
Amount:
$324.00

Component Description:
email reminder of WUSI quarterly repack transition report due by July 10, 2018. New Attachment includes cover letter requested by reviewer.
Amount:
$50.50

Component Description:
email reminder re WUSI-TV repack quarterly report due April 10, 2018.
Amount:
$50.50

Component Description:
work on online FCC cost reimbursement filing issues for WUSI-TV; review & respond to correspondence; work on WUSI-TV repack narrative justification for project management costs.
Amount:
$330.50

Component Description:
email reminder of WUSI quarterly repack transition report due by July 10, 2018. Attachment includes cover letter requested by reviewer.
Amount:
$50.50

Component Description:
Review FCC Public Notices re acceptance for filing of WUSI-TV minor change repack construction permit app & update station records; review, complete & file online FCC form 399 repack cost reimbursement filing for WUSI-TV; update station records.
Amount:
$156.00

Component Description:
email reminder of quarterly Transition progress Report on WUSI-TV repack progress due at FCC by January 10, 2018.
Amount:
$50.50
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Legal Fees: repack services, April 2019
Amount:
$216.00

Component Description:
Legal Fees: repack services, June 2019
Amount:
$432.00

Component Description:
Legal Fees: repack services, December 2018 - January 2019 (memo included)
Amount:
$433.60

Component Description:
Legal Fees: repack services, February-March 2019
Amount:
$663.00

Component Description:
Legal Fees: repack services, November-December 2018
Amount:
$437.50

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 $35,050.00 $28,500.00 N/A $5,181.00 N/A
Total for all systems $463,340.00 $467,300.00 N/A $289,451.30 N/A
Other Expenses $35,050.00 $28,500.00 $5,181.00
Disposal Costs (for equipment and other waste, net of any salvage value) $11,000.00 $11,000.00 See attached quote from SIU Physical Plant Services department. $0.00 Expenses have gone over expected costs. Budget revisions expected.
WUSI Reception antennas $7,500.00 $7,500.00 N/A $0.00 N/A
MVPD Notification of Channel Change $2,500.00 $2,500.00 Actual number of mailings exceeded original estimate for the MVPD Notifications (WUSI-TV). $2,246.00 N/A
Equipment Storage $2,000.00 $2,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $5,000.00 N/A $2,935.00 N/A
Local Zoning $500.00 $500.00 N/A N/A N/A

Components

Actual Information Description File Name
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
SIUC Physical Plant, Project No 18172; Work Order #146733, engineering services
Amount:
$2,266.00

Component Description:
Design Services to dispose of transmitter and other equipment from WUSI
Amount:
$532.00

Component Description:
Physical Plant Services for removal of old transmitter from WUSI
Amount:
$532.00

Component Description:
Design Services to dispose of transmitter and other equipment from WUSI
Amount:
$437.00

Component Description:
Design Services to dispose of transmitter and other equipment from WUSI
Amount:
$308.46

Component Description:
Physical Plant Services for removal of old transmitter from WUSI
Amount:
$659.60

Component Description:
Physical Plant Services for removal of old transmitter from WUSI
Amount:
$308.46

Component Description:
Physical Plant Services for removal of old transmitter from WUSI
Amount:
$957.06

Component Description:
Physical Plant Services for removal of old transmitter from WUSI
Amount:
$437.00

Component Description:
Physical Plant Services for removal of old transmitter from WUSI
Amount:
$570.15

Component Description:
Physical Plant Services for removal of old transmitter from WUSI
Amount:
$152.00

Component Description:
Physical Plant Services for removal of old transmitter from WUSI
Amount:
$570.15
WUSI Reception antennas

Component Description:
Antenna system repack sweep WUSI; WUSI Repack Sweep Report (quote included)
Amount:
$2,190.00

Component Description:
Antenna system repack sweep WUSI; WUSI Repack Sweep Report (quote included)
Amount:
$2,190.00
MVPD Notification of Channel Change

Component Description:
Notification of Cable/Satellite MVPD Providers of new RF Channel and Transport Stream Parameters on Repack Channel
Amount:
$2,246.00
Equipment Storage Information not provided.
DTV Medical Facility Notification

Component Description:
Transmitter Medical Facility Notification
Amount:
$2,935.00
Local Zoning Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $463,340.00 $467,300.00 $289,451.30

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 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.

Dan Mahony

President, Southern Illinois University


08/30/2020

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.

Dan Mahony

President, Southern Illinois University


08/30/2020

Attachments

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