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:
10132
Service:
DTV
Call Sign:
WFFF-TV
Channel:
16 (UHF)
File Number:
0000028521
FRN:
0009961889
Date Submitted:
09/14/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

NEXSTAR BROADCASTING, INC.

Elizabeth Ryder

545 E. JOHN CARPENTER FREEWAY

SUITE 700

IRVING, TX 75062

United States

+1 (972) 373-8800 eryder@nexstar.tv Corporation

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

Elizabeth Ryder

General Counsel

Nexstar Broadcasting, Inc.

Elizabeth Ryder

545 E. John Carpenter Freeway

Suite 700

Irving, TX 75062

United States

+1 (972) 373-8800 eryder@nexstar.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. Yes
Briefly describe transition plan Purchase new transmitter, antenna, line and tower. Use existing transmitter, antenna, line and tower during construction and duration of the assigned phase. Dismantle existing facilities post-transition. See attached.

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 NV7340V
Year 2006
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power Capacity 5.4 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 THU9evo-12
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 19 kW
Justification for New Transmitter The manufacturer of the existing transmitter advises that the transmitter cannot be re-tuned to the assigned channel. See attachment.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring Yes
Size 2 inches
Length 100.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Additional Transmitter Costs

Additional Transmitter Costs

Additional Interior RF System

Additional Interior RF System

Standby Exciter and switch

Standby exciter with auto change over switch

Antennas

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Section Question Response
Antenna Related Expenses Do you have antenna related expenses? Yes

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Top
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: 47.0 kW
Manufacturer
Model SFN-3050-O3-STACK
Year 2006

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Top
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 26.4 kW
Manufacturer
Model TFU-4GTH/VP-R O3
Year 2019
Justification for New Antenna The existing primary antenna is a single channel slotted coaxial which cannot accommodate the assigned channel.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Broadband
Feed Line Size 3 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna?
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

Input Complex for Antenna

Input Complex for Antenna

Antenna Adapter Section

Antenna Adapter Section

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? Yes
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 3 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 480 feet per run

Facility ID's and Call Signs of all stations with whom the transmission line is shared.

Facility ID Call Sign
11259 WVNY

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 3 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 480 feet per run
Justification for New Transmission Line The new line will feed the new antenna on a new tower, which will allow the existing antenna, line and tower to serve as the interim for the assigned phase. See attached.

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)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? Terrain Constrained
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 44° 31' 33.1" N-
Longitude (NAD83) 072° 48' 55.4" W-
Overall Structure Height 138.00 feet
Support Structure Height 80.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 4011.00 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Nexstar Broadcasting, Inc.
Date Constructed 01/01/2006

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
11259 WVNY DTV

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for undocumented/poorly documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: Major Reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Terrain constrained
Helicopter Services Required Are helicopter services required? Yes

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 291
Explanation Schedule and coordinate multiple vendors, complete progress reports, and update Schedule 399. Station does not have available personnel or personnel trained in project management for such complex projects. Internal accounting and Project management.
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 No
Quantity N/A
NEPA Section 106 environmental review Yes
Environmental Assessment Yes
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 9
Justification It will be necessary to survey the site, plan the equipment, develop specifications for purchasing, and oversee multiple vendor RF projects. Station does not have available personnel or personnel trained in such services.

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 No
Non-zoning permits Yes
BLM or NFS Coordination No
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
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

Engineering Study CP

Perform engineering study for new channel assignment and antenna development

Sales Taxes

The catalog of expenses does not include a range of estimated costs for taxes. Therefore, we are budgeting for tax costs since actual tax expenses are reasonable reimbursement items.

New Combiner

Combiner required for interim operation solution by adding a port on an existing UHF station's combiner on the mountain.

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 $874,524.00 $569,444.00 N/A $411,344.00 N/A
Total for all systems $2,841,995.00 $2,064,136.10 N/A $858,663.04 N/A
Primary Transmitter THU9evo-12 $874,524.00 $569,444.00 $411,344.00
Additional Transmitter Costs $29,174.00 $29,174.00 See R&S quotes 272118.0 and 334515.1 $29,174.00 N/A
Standby Exciter and switch $25,000.00 $25,000.00 N/A N/A N/A
Additional Interior RF System $70,000.00 $70,000.00 N/A N/A N/A
2" Rigid Conduit and Wiring (Cost per foot) $2,600.00 $2,500.00 N/A N/A N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $24,300.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW $684,000.00 $382,170.00 See Rohde & Schwarz quote 267332.2 $382,170.00 N/A

Components

Actual Information Description File Name
Additional Transmitter Costs

Component Description:
Additional transmitter costs
Amount:
$18,449.00

Component Description:
Additional transmitter costs
Amount:
$10,725.00
Standby Exciter and switch Information not provided.
Additional Interior RF System Information not provided.
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 150 KVA Information not provided.
Switchgear - industrial 800 amp Information not provided.
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW

Component Description:
Transmitter, installment #1
Amount:
$95,542.50

Component Description:
Transmitter, installment #2
Amount:
$286,627.50

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 $358,163.00 $173,183.00 N/A $150,104.70 N/A
Total for all systems $2,841,995.00 $2,064,136.10 N/A $858,663.04 N/A
Primary Antenna TFU-4GTH/VP-R O3 $358,163.00 $173,183.00 $150,104.70
Elbow complex, broadband, at antenna input, per 3 1/8. feedline (if needed) $9,340.00 $6,848.00 See Dielectric quote DMS177-3 $6,163.20 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $107,342.00 See attached quote DMS177-3. Price for V Pol component has been deducted from the estimated cost. $96,607.80 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
Input Complex for Antenna $15,053.00 $15,053.00 See Dielectric quote DMS177-3 $13,547.70 N/A
Antenna Adapter Section $37,540.00 $37,540.00 See Dielectric quote DMS177-3 $33,786.00 N/A

Components

Actual Information Description File Name
Elbow complex, broadband, at antenna input, per 3 1/8. feedline (if needed)

Component Description:
Elbow complex, installment #1
Amount:
$3,081.60

Component Description:
Elbow complex, installment #2
Amount:
$3,081.60
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Antenna, installment #1
Amount:
$48,303.90

Component Description:
Antenna, installment #2
Amount:
$48,303.90
Sweep test of existing antenna Information not provided.
Input Complex for Antenna

Component Description:
Input complex, installment #1
Amount:
$6,773.85

Component Description:
Input complex, installment #2
Amount:
$6,773.85
Antenna Adapter Section

Component Description:
Antenna adapter section, installment #1
Amount:
$16,893.00

Component Description:
Antenna adapter section, installment #2
Amount:
$16,893.00

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 $49,920.00 $21,744.10 N/A $19,569.70 N/A
Total for all systems $2,841,995.00 $2,064,136.10 N/A $858,663.04 N/A
Primary Transmission Line $49,920.00 $21,744.10 $19,569.70
Rigid Transmission Line - copper, 3 1/8" $49,920.00 $21,744.10 See Dielectric quote DMS177-3 $19,569.70 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 3 1/8"

Component Description:
Transmission line, installment #1
Amount:
$9,784.85

Component Description:
Transmission line, installment #2
Amount:
$9,784.85

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 $1,118,300.00 $862,500.00 N/A $187,386.06 N/A
Total for all systems $2,841,995.00 $2,064,136.10 N/A $858,663.04 N/A
Primary Tower TOWER $1,118,300.00 $862,500.00 $187,386.06
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $400,000.00 Rigging for WFFF only. Because of the two different phases for WVNY and WFFF the rigging must be done independently. The stack cannot be replaced at the same time. $187,386.06 N/A
Major tower reinforcement/modifications $421,000.00 $200,000.00 WFFF's share of structural reinforcements to accommodate changes. N/A N/A
Tower Helicopter Lift $250,000.00 $250,000.00 N/A N/A N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $12,500.00 WFFF's share of structural study. N/A N/A

Components

Actual Information Description File Name
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
Antenna installation, installment #1; 50% shared cost with WVNY
Amount:
$62,462.02

Component Description:
Antenna installation, installment #2; 50% shared cost with WVNY
Amount:
$124,924.04
Major tower reinforcement/modifications Information not provided.
Tower Helicopter Lift Information not provided.
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study 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 $112,048.00 $106,900.00 N/A $37,097.00 N/A
Total for all systems $2,841,995.00 $2,064,136.10 N/A $858,663.04 N/A
Outside Professional Services $112,048.00 $106,900.00 $37,097.00
Project management of the transition $45,978.00 $43,650.00 N/A $22,472.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $625.00 N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A $1,500.00 N/A
Additional Field Engineering Service, 9 Days $18,000.00 $18,000.00 N/A N/A N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $10,000.00 N/A N/A N/A
NEPA Section 106 environmental review, if needed $6,310.00 $6,000.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $3,000.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $7,000.00 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
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $2,500.00 N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Project management services
Amount:
$229.00

Component Description:
Project management services
Amount:
$150.00

Component Description:
Project management serivces
Amount:
$250.00

Component Description:
Project management services
Amount:
$250.00

Component Description:
Project management services
Amount:
$250.00

Component Description:
Project management services
Amount:
$150.00

Component Description:
Project management services 3.30.19 through 4.26.19
Amount:
$150.00

Component Description:
Project management services
Amount:
$1,027.00

Component Description:
Project management services
Amount:
$1,034.50

Component Description:
Project management services 4.27.19 through 5.31.19
Amount:
$150.00

Component Description:
Project management services 6.1.19 through 6.28.19
Amount:
$375.00

Component Description:
Project management services
Amount:
$991.00

Component Description:
Project management services
Amount:
$948.00

Component Description:
Project management services 12.1.18 through 1.31.19
Amount:
$675.00

Component Description:
Item 7 from invoice summary
Amount:
$150.00

Component Description:
Project Management for Structural Analysis and Tower Modifications for services from June 30, 2018 through July 27, 2018.
Amount:
$375.00

Component Description:
Project management services 7.28.18 through 9.28.18
Amount:
$975.00

Component Description:
Project management services 5.26.18 through 6.29.18
Amount:
$270.00

Component Description:
Item 6 from invoice summary
Amount:
$300.00

Component Description:
Project management services 10.27.18 through 11.30.18
Amount:
$1,425.00

Component Description:
Project management services Mar 2019
Amount:
$110.50

Component Description:
Project management services - Item 1 from invoice summary
Amount:
$5,925.00

Component Description:
Project Management for Structural Analysis and Tower Modifications including consultants Kessler and Gehman Associates. Services from January 27, 2018 through February 23, 2018.
Amount:
$2,400.00

Component Description:
Project management services
Amount:
$859.00

Component Description:
Project management services 2.1.19 through 3.1.19
Amount:
$375.00

Component Description:
Project management services 09.29.18 through 10.26.18
Amount:
$300.00

Component Description:
Item 8 from invoice summary
Amount:
$2,695.00

Component Description:
Project management services Feb 2019
Amount:
$299.00

Component Description:
Project management services 3.2.19 through 3.29.19
Amount:
$375.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Prepare License to Cover
Amount:
$625.00
Prepare request for Special Temporary Authorization

Component Description:
Prepare STA
Amount:
$1,500.00
Additional Field Engineering Service, 9 Days Information not provided.
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet Information not provided.
NEPA Section 106 environmental review, if needed 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), Construction Permit Application

Component Description:
Item 5 from invoice summary
Amount:
$3,000.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Item 3 from invoice summary
Amount:
$7,000.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
Item 2 from invoice summary
Amount:
$2,500.00

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 $329,040.00 $330,365.00 N/A $53,161.58 N/A
Total for all systems $2,841,995.00 $2,064,136.10 N/A $858,663.04 N/A
Other Expenses $329,040.00 $330,365.00 $53,161.58
Equipment Delivery and Handling Charges $43,000.00 $43,000.00 N/A $14,090.00 N/A
Sales Taxes $90,350.00 $90,350.00 Sales Tax in VT is 6%. Estimate is based on costs for transmitters, antennas, line and tower multiplied by the tax rate. $29,780.38 N/A
Equipment Storage $20,000.00 $20,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $20,000.00 $20,000.00 N/A N/A N/A
New Combiner $80,000.00 $80,000.00 N/A N/A N/A
Engineering Study CP $7,000.00 $7,000.00 Engineering Study for CP related to Priority 1 waiver $7,000.00 N/A
MVPD Notification of Channel Change $2,000.00 $2,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $3,500.00 $3,500.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $2,291.20 N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $3,000.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
Non-zoning permits $50,000.00 $50,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Equipment Delivery and Handling Charges

Component Description:
Transmitter consolidation services
Amount:
$12,986.00

Component Description:
Shipping cost for additional transmitter parts
Amount:
$1,104.00
Sales Taxes

Component Description:
Tax on additional transmitter parts and shipping
Amount:
$1,368.71

Component Description:
Tax on transmitter consolidation services
Amount:
$909.02

Component Description:
Tax due on transmitter
Amount:
$26,751.90

Component Description:
Tax on additional transmitter component
Amount:
$750.75
Equipment Storage Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
New Combiner Information not provided.
Engineering Study CP

Component Description:
Item 4 from invoice summary
Amount:
$7,000.00
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
DTV Medical Facility Notification

Component Description:
Notification of medical facilities
Amount:
$2,291.20
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
Non-zoning permits Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,841,995.00 $2,064,136.10 $858,663.04

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.

Elizabeth Ryder

General Counsel


09/14/2020

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.

Elizabeth Ryder

General Counsel


09/14/2020

Attachments

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