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:
57189
Service:
LPD
Call Sign:
KHLM-LD
Channel:
10 (High VHF)
File Number:
0000089147
FRN:
0011339363
Eligibility Status:
Eligible
Date Submitted:
05/28/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

LOTUS TV OF HOUSTON LLC

Doing Business As: LOTUS TV OF HOUSTON LLC

Jay A. Levine

3301 Barham Boulevard

Suite 200

LOS ANGELES, CA 90068

United States

+1 (323) 512-2225 headquarters@lotuscorp.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

Tony zumMallen

President

QCommunications, LLC

Tony zumMallen

705B SE Melody ln

#314

Lees SUmmit, MO 64063

United States

+1 (816) 729-1177 tony@qcomm.tv

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 Repack to new CH10 on time and on budget.

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)
Ownership Owned
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model INNOVATOR
Year 2009
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 15 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 VAXTE-2R37
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 2 kW
Justification for New Transmitter New transmitter required per the REPACK channel reassignment, transitioning from UHF to VHF.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Other Transmitter Costs
Does the transmitter installation require a Transmitter Building Site Survey/Installation? Yes
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Rigid Conduit and Wiring No
Other Electrical Service No
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 10 tons
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Site Prep

Site preparation for new transmitter installation

Transmitter Misc. Equipment

I/O rack customer IO plate, AC distro assembly, 2.5kW, post filter coupler kit, switch controller, associated cables

Encoder

Encoder

Transmitter Taxes

Transmitter sales tax

Transmitter Decommissioning

Harvesting and removal of old transmitter

Connectors

Connectors and misc parts/pieces to ensure proper mating of new transmitter, line, and connected equipment

Transmitter Shipping fee

Shipping fees for transmitter

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)
Ownership Owned
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Circular
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model ALP 24L3 CSMX-43
Year 2009

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Change Type Purchase New
Ownership Owned
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Slot
Number of Stations Supported 2
Number of Panels/Bays 4
Lower Limit 174.00 MHz
Upper Limit 216.00 MHz
Design power capacity in use 90.0 %
ERP: 3.0 kW
Manufacturer
Model TLS-V4/VP
Year 2019
Justification for New Antenna New antenna required for new channel. Original antenna unable to be retuned.

Primary 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? Broadband
Feed Line Size 4 1/16 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Custom Mounting Brackets

Custom mounting brackets for 7.5" OD round legs

Antenna Sales Tax

Sales tax for new antenna

Filter

VHF high band, 6-pole filter

Antenna Shipping fee

Shipping fees for new 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)
Ownership Owned
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 Waveguide
Number of parallel runs 1
Length 1654 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Waveguide
Number of parallel runs 1
Length 1654 feet per run
Justification for New Transmission Line Changing from UHF CH 43 to VHF CH 10 may require the existing line to be changed out. We await the results of sweep testing to determine if new line it required or not.
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? No

Primary 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)
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 Yes
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 1059622
Coordinates (NAD83) Latitude (NAD83) 29° 33' 45.2" N-
Longitude (NAD83) 095° 30' 35.9" W-
Overall Structure Height 1974.06 feet
Support Structure Height 1844.14 feet
Ground Elevation Above Mean Sea Level (AMSL) 74.15 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers LLC
Date Constructed 08/30/2000

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
167664 KUVM-LD LPD
22204 KRIV DTV
51569 KTXH DTV
69531 KZJL DTV
53847 KXLN-DT DTV
28324 KTBU DTV
13200 KUVM-CD DTV
31870 KYAZ DTV
7079 KCVH-LD LPD

Other Types of Users

Users
Cell phone

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Tower mapping and report for structural engineer
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

Information not provided.

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 325
Explanation Required to assist in the turnkey management of the channel relocation project in order that the existing internal personal can maintain and operate the stations daily operational requirements and plans.
Outside RF consulting Engineering Services Perform engineering study for displacement application 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
Prepare Form 601 Yes
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
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Form 399 assistance or other program management costs Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 5
Justification Estimated field engineering services during transition activities. Actual costs to be determined.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Consulting Engineering

Repack engineering work not covered by existing 399 default fields.

General Attorney fees for Repack

Repack attorney work not covered by existing 399 default fields.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Permit and Filing Costs FCC Construction Permit Major Change Yes
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? 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
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System No
New Point to Point Microwave System No

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 $307,465.54 $279,327.94 N/A $183,966.40 N/A
Total for all systems $717,690.04 $707,779.94 N/A $276,129.50 N/A
Primary Transmitter VAXTE-2R37 $307,465.54 $279,327.94 $183,966.40
10 Ton system $60,500.00 $22,862.40 See estimate attached to invoice # 12226 from Space City Mechanical Inc. $22,862.40 N/A
Transmitter Shipping fee $4,372.39 $4,372.39 Actual shipping costs for transmitter $4,372.39 N/A
Encoder $83,593.15 $83,593.15 Harmonic estimate for required 8-channel encoder and installation. Actual costs to be determined. The channel change requires replacement of the existing 8-channel encoder. $83,592.15 N/A
Transmitter Taxes $10,000.00 $10,000.00 Estimated taxes for new transmitter and associated eqpt. Actual costs to be determined. $4,718.96 N/A
Transmitter Decommissioning $8,000.00 $8,000.00 Per attached QCommunications quote. N/A N/A
Connectors $10,000.00 $10,000.00 Estimated costs of connectors and associated parts/pieces in order to ensure proper mating of new transmitter to existing equipment. Actual costs to be determined. N/A N/A
High VHF - Air Cooled Solid State Transmitter 1.1 - 4.4 kW $101,000.00 $101,000.00 N/A $61,918.40 N/A
Transmitter Building Site Survey/Installation $10,000.00 $19,500.00 Per attached QCommunications quote. N/A N/A
Site Prep $5,000.00 $5,000.00 Per attached QCommunications quote. N/A N/A
Transmitter Misc. Equipment $15,000.00 $15,000.00 Estimate based on attached GatesAir quote. Actual costs to be determined. $6,502.10 N/A

Components

Actual Information Description File Name
10 Ton system

Component Description:
KHLM - Space City Mechanical - HVAC - INV 12226 - Est 11139E
Amount:
$22,862.40
Transmitter Shipping fee

Component Description:
Transmitter shipping costs not included on original quote. US0335093
Amount:
$4,372.39
Encoder

Component Description:
Receipt for downpayment against invoice 42646. See last page of invoice to confirm amount.
Amount:
$41,796.58

Component Description:
2nd Invoice for Encoder. See cover letter.
Amount:
$41,795.57
Transmitter Taxes

Component Description:
Sales tax for transmitter not included on original quote. US0335093
Amount:
$4,718.96
Transmitter Decommissioning Information not provided.
Connectors Information not provided.
High VHF - Air Cooled Solid State Transmitter 1.1 - 4.4 kW

Component Description:
2nd transmitter Invoice Jw230004719-2 - Gates - Q-83941
Amount:
$18,692.70

Component Description:
3rd Transmitter invoice US0335093 - Gates - Q-83941
Amount:
$27,784.05

Component Description:
1st transmitter invoice # JW30004719-1 GatesAir
Amount:
$15,441.65
Transmitter Building Site Survey/Installation Information not provided.
Site Prep Information not provided.
Transmitter Misc. Equipment

Component Description:
Change order Q-85538. Gates Air INV US0335093.
Amount:
$6,502.10

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 $86,797.00 $82,202.00 N/A $58,992.00 N/A
Total for all systems $717,690.04 $707,779.94 N/A $276,129.50 N/A
Primary Antenna TLS-V4/VP $86,797.00 $82,202.00 $58,992.00
Antenna Sales Tax $4,000.00 $4,000.00 Estimated sales tax for new antenna. Actual costs to be determined. N/A N/A
Custom Mounting Brackets $8,449.00 $8,449.00 Per Dielectric invoice 746019 and associated quote 180087ESM attached to invoice. $8,449.00 N/A
Side Mount antenna brackets $4,625.00 $0.00 4-9-20 Costs captured under "custom mounts" component. Zeroed out. N/A N/A
Elbow complex, broadband, at antenna input, per 4 1/16. feedline (if needed) $10,950.00 $10,950.00 N/A N/A N/A
Sweep test of transmission line and antenna $5,730.00 $5,760.00 same N/A N/A
High VHF-Low Power, Side Mount, Broadband Slot, 4 bay, 3.0kW input, Elliptical $47,509.00 $47,509.00 Per attached Dielectric quote 180087ESM attached to Invoice 746019 $47,509.00 Costs Per actual invoice #746019 and quote # 180087ESM.
Antenna Shipping fee $2,500.00 $2,500.00 Estimated shipping fees for new antenna. Actual costs to be determined. N/A N/A
Filter $3,034.00 $3,034.00 Per attached Dielectric quote. $3,034.00 N/A

Components

Actual Information Description File Name
Antenna Sales Tax Information not provided.
Custom Mounting Brackets

Component Description:
Custom mounts for antenna. KHLM - INV 746019
Amount:
$8,449.00
Side Mount antenna brackets Information not provided.
Elbow complex, broadband, at antenna input, per 4 1/16. feedline (if needed) Information not provided.
Sweep test of transmission line and antenna Information not provided.
High VHF-Low Power, Side Mount, Broadband Slot, 4 bay, 3.0kW input, Elliptical

Component Description:
KHLM - Dielectric - Antenna costs - INV 746019 - Quote 180087ESM
Amount:
$47,509.00
Antenna Shipping fee Information not provided.
Filter

Component Description:
KHLM - Dielectric - mask filter - INV 746019 - Quote 180087ESM
Amount:
$3,034.00

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $19,000.00 $19,000.00 N/A $0.00 N/A
Total for all systems $717,690.04 $707,779.94 N/A $276,129.50 N/A
Primary Transmission Line $19,000.00 $19,000.00 $0.00
Waveguide Transmission Line - " 1 parallel runs 1654 feet $19,000.00 $19,000.00 Only concerned with the horizontal 200 ft run. Existing line may need to be replaced due to going from UHF CH43 to VHF CH10. The line has not been tested yet for operations on CH10. If the lines sweeps well, then the line will not be required. N/A N/A

Components

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 $146,000.00 $146,000.00 N/A $10,865.60 N/A
Total for all systems $717,690.04 $707,779.94 N/A $276,129.50 N/A
Primary Tower GTOWER $146,000.00 $146,000.00 $10,865.60
Minor tower reinforcement/modifications $50,000.00 $50,000.00 Estimated tower modification costs, depending on engineering report results. Actual costs to be determined. N/A N/A
Tower mapping and report for structural engineer $21,000.00 $21,000.00 N/A N/A N/A
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas) $75,000.00 $75,000.00 Estimated rigging costs. Actual costs to be determined. $10,865.60 N/A

Components

Actual Information Description File Name
Minor tower reinforcement/modifications Information not provided.
Tower mapping and report for structural engineer Information not provided.
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas)

Component Description:
25% of contract upon mobilization. INV 820023-1 - NOTE: Vendor name is Rio Steel & Tower, LTD; "and" was substituted for special character "&".
Amount:
$10,865.60

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 $144,217.50 $167,040.00 N/A $22,305.50 N/A
Total for all systems $717,690.04 $707,779.94 N/A $276,129.50 N/A
Outside Professional Services $144,217.50 $167,040.00 $22,305.50
General Attorney fees for Repack $7,500.00 $7,500.00 Repack Attorney fees not covered by existing 399 default fields. $5,395.50 N/A
Consulting Engineering $8,530.00 $8,530.00 Consulting Engineering work not covered by existing 399 default fields. $8,530.00 Actual costs per consulting engineer invoices.
Additional Field Engineering Service, 5 Days $12,500.00 $12,500.00 Estimated field engineering services during transition activities. Actual costs to be determined. N/A N/A
Comprehensive coverage verification via field study, if needed $52,600.00 $52,600.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $2,235.00 $2,235.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $3,262.50 $3,262.50 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,025.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,052.50 N/A $930.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,102.50 N/A $1,500.00 N/A
Prepare request for Special Temporary Authorization $1,280.00 $2,700.00 Actual costs per consulting engineer invoices. $2,700.00 N/A
Project management of the transition $34,287.50 $50,050.00 Estimated 325 hours at $154/hr. N/A N/A
Prepare/ Review 399 reimbursement form $1,710.00 $2,650.00 Estimated costs to prepare 399 reimbursement form. Actual costs to be determined. $150.00 N/A
Form 399 assistance or other Program Management costs $10,000.00 $10,000.00 Estimated costs for form 399 assistance. Actual costs to be determined. N/A N/A
Perform engineering study for displacement application $1,800.00 $6,500.00 Displacement studies-required to ascertain the final channel assignment $3,100.00 N/A
Prepare Form 601 $755.00 $755.00 N/A N/A N/A

Components

Actual Information Description File Name
General Attorney fees for Repack

Component Description:
Gen Legal Jan 2020 - McLaughlin - INV 382250. NOTE: Vendor name is McLaughlin & Stern, LLP; "and" was substituted for special character "&"
Amount:
$1,580.50

Component Description:
Gen Legal Feb 2020 - McLaughlin - INV 383614 . NOTE: Vendor name is McLaughlin & Stern, LLP; "and" was substituted for special character "&"
Amount:
$1,308.00

Component Description:
Legal 4th qtr 2019. INV 376907. NOTE: Vendor name is McLaughlin & Stern, LLP; "and" was substituted for special character "&"
Amount:
$2,507.00
Consulting Engineering

Component Description:
Engineering services: resumption of operatoins app, and reimbursement application; INV 201911-1461-09. NOTE: vendor name is Lohnes & Culver. "And" was substituted for special character "&".
Amount:
$1,350.00

Component Description:
Engineering services - final antenna selection: INV 201908-1461-09. NOTE: vendor's name is Lohnes & Culver. "And" has been substituted for special character "&".
Amount:
$1,350.00

Component Description:
Engineering services - INV 201902-1461-09. NOTE: Vendor name is Lohnes & Culver - "and" was substituted for special character "&".
Amount:
$1,590.00

Component Description:
Engineering services - INV 202001-1461-09. NOTE: vendor name is Lohnes & Culver - "and" was substituted for special character "&".
Amount:
$2,560.00

Component Description:
New facility planning & development - engineering services. INV 201905-1461-09. NOTE: vendor name is Lohnes & Culver; "and" was substituted for "&".
Amount:
$1,680.00
Additional Field Engineering Service, 5 Days Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Engineering services - Form 2100 - INV 201902-1461-09. NOTE: Vendor name is Lohnes & Culver - "and" was substituted for special character "&".
Amount:
$930.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Construction Permit application - Form 2100 eng section. INV 201805-1461-02
Amount:
$1,500.00
Prepare request for Special Temporary Authorization

Component Description:
Request to extend silent STA; INV 201905-1461-09. NOTE: Vendor name is Lohnes & Culver; however, since the tool doesn't allow special characters, "and" was substituted for "&".
Amount:
$450.00

Component Description:
Assist legal counsel in preparing request; INV 201902-1461-09. NOTE: Vendor name is Lohnes & Culver - "and" was substituted for special character "&".
Amount:
$150.00

Component Description:
Engineering STA; Inv 201908-1461-09 NOTE: Vendor name is Lohnes & Culver; "and" was substituted for "&".
Amount:
$1,500.00

Component Description:
Request for silent STA; Invoice 201911-1461-09. NOTE: vendor name is Lohnes & Culver - "and" was substituted for special character "&".
Amount:
$600.00
Project management of the transition Information not provided.
Prepare/ Review 399 reimbursement form

Component Description:
Technical support for 399 application. INV 201911-1461-09. NOTE: vendor name is Lohnes & Culver; "and" was substituted for special character "&".
Amount:
$150.00
Form 399 assistance or other Program Management costs Information not provided.
Perform engineering study for displacement application

Component Description:
Engineering studies - INV 201805-1461-02. NOTE: vendor name is Lohnes & Culver; "and" was replaced with special character "&"
Amount:
$3,100.00
Prepare Form 601 Information not provided.

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 $14,210.00 $14,210.00 N/A $0.00 N/A
Total for all systems $717,690.04 $707,779.94 N/A $276,129.50 N/A
Other Expenses $14,210.00 $14,210.00 $0.00
FCC Filing Fees - Special Temporary Authorization request $305.00 $305.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,110.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A N/A N/A
FCC Filing Fees - Form 2100 Major change CP application $4,960.00 $4,960.00 N/A N/A N/A
Equipment Storage $3,000.00 $3,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $2,000.00 $2,000.00 Estimated transport, forklift rental and handling fees from staging area to transmitter site. Actuals to be determined. N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,500.00 $2,500.00 Estimated 4-6 yard disposal bin on site to capture all waste from on site system integration and tower vendors. Actual costs to be determined. N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $717,690.04 $707,779.94 $276,129.50

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. No
Construction of final facilities or all necessary modifications are complete. No
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator. No

Certification

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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.

JAY LEVINE

SENIOR VICE PRESIDENT


05/28/2020

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.

JAY LEVINE

SENIOR VICE PRESIDENT


05/28/2020

Attachments

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