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:
191262
Service:
DCA
Call Sign:
WMJF-CD
Channel:
23 (UHF)
File Number:
0000028675
FRN:
0022314215
Date Submitted:
07/16/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

HME EQUITY FUND II, LLC

Doing Business As: HME EQUITY FUND II, LLC

Seth Ellis

509 West Colonial Drive

Suite 100

ORLANDO, FL 32804

United States

+1 (407) 906-2484 sellis@assurancemezz.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

Davina Sashkin

Fletcher, Heald & Hildreth, PLC

Davina Sashkin

Fletcher, Heald & Hildreth, PLC

1300 N. 17th Street, Suite 1100

Arlington, VA 22209

United States

+1 (703) 812-0400 sashkin@fhhlaw.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 Build according to FCC transition plan.

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 TMU9-570
Year 2013
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? Yes
Manufacturer
Model TMU9-4 Evo
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.5 kW
Justification for New Transmitter Can't use current Transmitter so need to purchase a new one, need more power per construction permit approved by FCC

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 3 inches
Length 100.0 feet
Other Electrical Service Yes
Description Will need some electrical work to get it up and running, will submit quote from an electrician.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size Other
Other Size 2 tons
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

Installation

Cost to Install Transmitter Transmitter Install Quote # 101

Removal

Cost to just remove the transmitter from building Transmitter Removal Quote # 102

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 Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 5.0 kW
Manufacturer
Model PSILP8BH-39
Year 2014

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? No
New Antenna Manufacturer and Types Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 15.0 kW
Manufacturer
Model TLP-8VP-R P300-SP
Year 2020
Justification for New Antenna Higher power antenna is necessary for modification application parameters (filed in 1st priority window).

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? 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

Labor to install Antenna and Disposal Cost

Labor to install Antenna and then remove the old one. This will include travel.

Pipe and Mounting Pieces

Materials and Labor to fabricate custom tower leg transition mounts. Mounts needed to hold a 3 and a half inch OD pipe off the angle tower leg

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Foam
Diameter 7/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 250 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Type Flexible Foam
Diameter 7/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 250 feet per run
Justification for New Transmission Line Sweep test results will determine need.

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 Leased
Is this tower consider Complex? Located on Building
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
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? Yes
ASR Number 1037283
Coordinates (NAD83) Latitude (NAD83) 39° 24' 10.4" N-
Longitude (NAD83) 076° 36' 10.9" W-
Overall Structure Height 279.85 feet
Support Structure Height 189.96 feet
Ground Elevation Above Mean Sea Level (AMSL) 477.03 feet
Structure Type BTWR - Building with Tower
Tower Owner Towson City Center, LLC
Date Constructed 06/25/2013


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 documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: No reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Located on Building
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 600
Explanation Applicant has no internal resources capable of overseeing, identifying, purchasing, installing and commissioning this repack project. It will rely solely on outside services to manage all work required.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority No
Quantity N/A
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority No
Quantity N/A
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Other Transition- Related Professional Service Costs

Project Management of the transition. Preparation and review of reimbursement form.

Quarterly Transition Reports

Quarterly Transition Reports

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application 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? 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

Other Miscellaneous Expenses

Other Miscellaneous Expenses

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 $164,050.00 $91,070.00 N/A $48,618.00 N/A
Total for all systems $824,340.00 $510,573.00 N/A $156,495.33 N/A
Primary Transmitter TMU9-4 Evo $164,050.00 $91,070.00 $48,618.00
Service entrance 3 phase/800 amp/208 volt $14,400.00 $13,700.00 N/A N/A N/A
Other -- HVAC Service Type: C Size:2 (Other) $2,000.00 $2,000.00 No quote yet but Licensee is going with a wall unit instead. N/A N/A
Other Electrical Service: Will need some electrical work to get it up and running, will submit quote from an electrician. $1,500.00 $1,500.00 Waiting on Quotes to submit N/A N/A
3" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $4,900.00 N/A N/A N/A
Removal $3,000.00 $3,000.00 Removal only of old Transmitter. Transmitter Removal Quote 102 attached. N/A N/A
Installation $11,950.00 $11,950.00 Cost to install the new transmitter Transmitter Install Quote 101 attached. N/A N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $54,020.00 Please see document entitled " Updated Narrative for Transmitter Change WMJF-CD" for the cost justification and the quotes as supporting documentation. This amount is only for the transmitter itself. Per Geoffrey put the other costs in separate lines. $48,618.00 N/A

Components

Actual Information Description File Name
Service entrance 3 phase/800 amp/208 volt Information not provided.
Other -- HVAC Service Type: C Size:2 (Other) Information not provided.
Other Electrical Service: Will need some electrical work to get it up and running, will submit quote from an electrician. Information not provided.
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Removal Information not provided.
Installation Information not provided.
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
This is the first of 3 invoices for the transmitter. There is a cover letter attached to the invoice to explain reimbursement. Quote # 276446.0 has already been submitted with transmitter change narrative.
Amount:
$16,206.00

Component Description:
Requesting amount of invoice less prorated portion of upgrade. Invoice has cover letter attached explaining the reimbursement amount.
Amount:
$32,412.00

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $51,080.00 $72,950.00 N/A $57,720.42 N/A
Total for all systems $824,340.00 $510,573.00 N/A $156,495.33 N/A
Primary Antenna TLP-8VP-R P300-SP $51,080.00 $72,950.00 $57,720.42
Pipe and Mounting Pieces $3,050.00 $3,050.00 See Narrative $3,050.00 N/A
Labor to install Antenna and Disposal Cost $15,000.00 $15,000.00 See attached narrative N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 Quote for this was originally provided in 2017 and since then prices have gone up and the new standard for a sweep test is $6400 and this is still below the predetermined amount. See line #6 on quote # 900237CMZ-2 from Dielectric $6,400.00 N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $48,500.00 See document entitled "Narrative for Antenna Estimate Change WMJF-CD" for cost justification and details on corresponding quotes. $48,270.42 N/A

Components

Actual Information Description File Name
Pipe and Mounting Pieces

Component Description:
Custom mounts, plates, bolts and piping to mount the Antenna legs
Amount:
$3,050.00
Labor to install Antenna and Disposal Cost Information not provided.
Sweep test of existing antenna

Component Description:
Requesting just 1/2 of the sweep test on this invoice for this catogory. Please see narrative attached to invoice from vendor stating why their invoices don't foot and that the FCC is fine with their billing process
Amount:
$3,200.00

Component Description:
Requesting just 1/2 of the sweep test on this invoice for this catogory. Please see narrative attached to invoice from vendor stating why their invoices don't foot and that the FCC is fine with their billing process
Amount:
$3,200.00
UHF - Lower Power Side Mount, Class A One Station antenna -- basic

Component Description:
Sales tax on Antenna at 6 percent, requesting less because the Vpol is not reimbursable. Sales tax not reimbursable $219.36 (3656 x .06) See attached Cover Letter
Amount:
$2,590.92

Component Description:
See Attached narrative entitled "Narrative on why we are requesting less reimbursement on the Dielectric Invoices"
Amount:
$21,591.00

Component Description:
See Attached narrative entitled "Narrative on why we are requesting less reimbursement on the Dielectric Invoices"
Amount:
$21,591.00

Component Description:
Freight charge for delivering the antenna.
Amount:
$2,497.50

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 $2,750.00 $4,000.00 N/A $0.00 N/A
Total for all systems $824,340.00 $510,573.00 N/A $156,495.33 N/A
Primary Transmission Line $2,750.00 $4,000.00 $0.00
Flexible Foam Transmission Line - dielectric, 7/8" $2,750.00 $4,000.00 N/A 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 $433,600.00 $162,000.00 N/A $0.00 N/A
Total for all systems $824,340.00 $510,573.00 N/A $156,495.33 N/A
Primary Tower BTWR $433,600.00 $162,000.00 $0.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $150,000.00 Crane required to install antenna, transmitter and HVAC. Phone quote min $50,000 per day for crane rental and crew, and assuming 2 non-contiguous days (only able to shut down street/building on Sundays). Additional $50,000 sought to cover tower crew. N/A N/A
Structural engineering tower load study for well documented tower $12,600.00 $12,000.00 N/A N/A N/A

Components

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 $132,310.00 $141,200.00 N/A $39,803.91 N/A
Total for all systems $824,340.00 $510,573.00 N/A $156,495.33 N/A
Outside Professional Services $132,310.00 $141,200.00 $39,803.91
Other Transition- Related Professional Service Costs $2,500.00 $2,500.00 Prepare and/or review reimbursement form $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 $5,000.00 N/A $1,298.13 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 $2,000.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $2,625.00 The actual hours on the engineering studies came in a little higher than originally estimated.
Prepare and or review reimbursement form $2,630.00 $6,500.00 Originally when the estimate was put in was put in based off of what the cost catalog had as that was the best estimate at the time. As they went thru to complete the form there were a lot of revisions for transmitter&antenna costs that got revised $6,496.62 N/A
Quarterly Transition Reports $8,450.00 $8,450.00 see attached quote for preparation and filing of reports by counsel and technical consultant $1,502.50 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $15,000.00 Attorneys fees for negotiation of Unable to Construct Channel Resolution Agreement with WETA and MPT, preparation and filing and related CP modification and updated 399. $5,338.00 N/A
Project management of the transition $94,800.00 $90,000.00 Project management expenses. $20,543.66 N/A

Components

Actual Information Description File Name
Other Transition- Related Professional Service Costs

Component Description:
Entered in this section in error
Amount:
N/A
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:
Attorney fees for preparing and filing FCC Form 2100 (main), construction permit application for WMJF-CD for the Baltimore station. The fees are all the ones denoted with the letter D next to them.
Amount:
$1,298.13
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 work to complete the construction permit application section of form 2100
Amount:
$2,000.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Engineering study on new channel assignment and antenna development No longer over amount allocated other vendor on hold for clarification
Amount:
$2,125.00

Component Description:
Removing for the time being need clarification from vendor and don't want to hold up other expenses
Amount:
N/A

Component Description:
Removing for the time being need clarification from vendor and don't want to hold up other expenses
Amount:
N/A

Component Description:
Removing for the time being need clarification from vendor and don't want to hold up other expenses
Amount:
N/A

Component Description:
Removing for the time being need clarification from vendor and don't want to hold up other expenses
Amount:
N/A

Component Description:
Engineering work on new channel assignment and antenna development. No longer over amount allocated other vendor on hold for clarification
Amount:
$500.00
Prepare and or review reimbursement form

Component Description:
Form 399 Fees are all the ones w/the letter E. This cost is more than the form has but there was not enough info to put an amount other than the one in the cost catalog. The detailed invoice has all the break out on what all the time was spent on.
Amount:
$6,496.62
Quarterly Transition Reports

Component Description:
Attorney Fees for preparing quarterly transition reports.
Amount:
$1,027.50

Component Description:
Attorney fees for preparing quarterly transition reports for WMJF-CD for the Baltimore station. The fees are all the ones denoted with the letter A next to them.
Amount:
$475.00

Component Description:
Quarterly Transition report work.
Amount:
$1,027.50
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
Various Attorney fees for other matters for WMJF-CD for the Baltimore station. The fees are all the ones denoted with the letter B next to them.
Amount:
$5,338.00
Project management of the transition

Component Description:
Project Management Services. Invoice has been revised to include an invoice # and project manager name. Narrative is also attached.
Amount:
$3,293.66

Component Description:
Project Management services, invoice has been revised to include the needed items. Deducting the Smith and Fischer part from this reimbursement for now. As requested a narrative is attached to this invoice.
Amount:
$15,750.00

Component Description:
Repack project management services - research and coordination with engineering, attorney's and vendors.
Amount:
$1,500.00

Component Description:
Transition Project Management services, receipts for expenses attached to invoice. This company does not use invoice #'s so just did a description.
Amount:
$18,150.00

Component Description:
Project management services. A narrative letter is attached explaining the breakout of the invoice. Expense receipts are attached to the invoice. Also this company does not use specific invoice numbers so I just did a description
Amount:
$3,293.66

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 $40,550.00 $39,353.00 N/A $10,353.00 N/A
Total for all systems $824,340.00 $510,573.00 N/A $156,495.33 N/A
Other Expenses $40,550.00 $39,353.00 $10,353.00
Equipment Storage $2,500.00 $2,500.00 N/A N/A N/A
Non-zoning permits $2,000.00 $2,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $10,353.00 Adjusting cost to the current market rate for this service, original amount was put in over 2 years ago. Attached is INV-002398 & EST-001750 $10,353.00 N/A
Develop and air announcement of upcoming channel change $2,500.00 $2,500.00 N/A N/A N/A
Local Zoning $2,000.00 $2,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $5,000.00 $5,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $5,000.00 $5,000.00 N/A N/A N/A
MVPD Notification of Channel Change $5,000.00 $5,000.00 N/A N/A N/A
Other Miscellaneous Expenses $5,000.00 $5,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Equipment Storage Information not provided.
Non-zoning permits Information not provided.
DTV Medical Facility Notification

Component Description:
Service fee to do the Notification of Medical Facilities for Baltimore.
Amount:
$10,353.00
Develop and air announcement of upcoming channel change Information not provided.
Local Zoning Information not provided.
Equipment Delivery and Handling Charges Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
MVPD Notification of Channel Change Information not provided.
Other Miscellaneous Expenses Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $824,340.00 $510,573.00 $156,495.33

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.

Ann Olsen

Consultant


07/16/2020

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.

Ann Olsen

Consultant


07/16/2020

Attachments

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