TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
Steward Doing Business As: DAWN STEWART	310 NORTH CENTER AVE HARDIN, MT 59034 United States	+1 (406) 665-1832	Montana@Digitaldevelopment.net	Individual

Applicant

Address

Phone

Applicant Type

Steward

Doing Business As: DAWN STEWART

310 NORTH CENTER AVE

HARDIN, MT 59034

United States

+1 (406) 665-1832

Montana@Digitaldevelopment.net

Individual

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant	Address	Phone	Email
[Confidential]

Preparer Contact Information

Preparer Contact Name and Information

Applicant	Address	Phone	Email
The Preparer is same as the reimbursement contact.

Broadcaster Information and Transition Plan

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	To migrate the transmission from Ch 43 to Ch 33 as efficiently and with as little downtime as possible in order to preserve customer satisfaction and meet the FCC requirements for reimbursement and licensing

Transmitters

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

Primary Transmitter

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	MXi 100
	Year	2005
	Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power Capacity	100 W

Primary Transmitter

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	TRN-U-200-FA
	Transmitter Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power capacity	280 W
	Justification for New Transmitter	EXISTING TRANSMITTER NOT CAPABLE OF OPERATING ON NEW CHANNEL ASSIGNMENT

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Other Transmitter Costs
Other Transmitter Costs	Does the transmitter installation require a Transmitter Building Site Survey/Installation?	No
Electrical Service	Service Entrance (3 phases 800A 208V)	Yes
	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?	No
Transmitter Building Addition/Modification or Leasehold Improvement	Does the Transmitter Building require an addition, modification, other leashold improvement?	No

Primary Transmitter

Other Transmitter Cost Not Listed

Name	Description
SITE PREPARATION	PREPARE SITE FOR NEW SYSTEM INTEGRATION
DECOMMISSIONING	DECOMMISSION AND REMOVE EXISTING EQUIPMENT
SHIPPING AND HANDLING	EXPECTED SHIPPING AND HANDLING OF NEW EQUIPMENT
SALES TAX	EXPECTED SALES TAX FOR EQUIPMENT

Antennas

Section	Question	Response
Antenna Related Expenses	Do you have antenna related expenses?	No

Transmission Line

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

Tower Equipment And Rigging Costs

Section	Question	Response
Tower Equipment or Rigging Costs Changes	Do you have tower equipment or rigging costs changes?	No

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	75
	Explanation	Required to assist in the turnkey management of the channel relocation project in order that the existing internal personnel 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	No
	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	3
	Justification	Estimated field engineering services during transition activities. Actual costs to be determined.

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

Section	Question	Response
AM Pattern Disturbance	Is an Impact Study needed?	No
AM Pattern Disturbance	Is Remediation needed?	No
Permit and Filing Costs	FCC Construction Permit Major Change	No
	FCC Construction Permit Minor Change	No
	FCC License to Cover Application	Yes
	FCC Special Temporary Authority Application	No
Other Miscellaneous Expenses	Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)?	Yes
	Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs?	No
	Does this relocation require Equipment Storage?	No
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

Other Expenses Not Listed

Information not provided.

Cost Information

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	$51,200.00	$42,785.00	N/A	$23,385.00	N/A
Total for all systems	$140,910.40	$124,417.40	N/A	$30,230.40	N/A
Primary Transmitter TRN-U-200-FA	$51,200.00	$42,785.00		$23,385.00
DECOMMISSIONING	$3,500.00	$3,500.00	Estimated costs to de-install, disconnect and decommission old transmitter.	N/A	N/A
SALES TAX	$3,000.00	$3,000.00	N/A	N/A	N/A
SITE PREPARATION	$5,000.00	$5,000.00	Estimated costs to prepare site for installation. Includes receiving and inventory of transmitter and its components; pre-assembly of cabinets and subassemblies; ensuring site has materials required by installation crew.	N/A	N/A
Service entrance 3 phase/800 amp/208 volt	$14,400.00	$7,200.00	3/30/2020- Working to obtain quote which may be delayed due to coronavirus pandemic	N/A	N/A
UHF - Air Cooled Solid State Transmitter 160 - 300 Watts	$24,300.00	$23,085.00	Cost determined from Anywave Invoice (with attached proposal) submitted on 4/10/20	$23,085.00	N/A
SHIPPING AND HANDLING	$1,000.00	$1,000.00	N/A	$300.00	N/A

Components

Actual Information Description	File Name
DECOMMISSIONING	Information not provided.
SALES TAX	Information not provided.
SITE PREPARATION	Information not provided.
Service entrance 3 phase/800 amp/208 volt	Information not provided.
UHF - Air Cooled Solid State Transmitter 160 - 300 Watts	Component Description: Cost of 280W transmitter; the lowest power transmitter that Anywave offers. Amount: $23,085.00
SHIPPING AND HANDLING	Component Description: Cost of shipping and handling of transmitter. Amount: $300.00

Cost Information

Antennas

Information not provided.

Cost Information

Transmission Line

Information not provided.

Cost Information

Tower Equipment and Rigging Costs

Information not provided.

Cost Information

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	$87,375.40	$79,297.40	N/A	$6,675.40	N/A
Total for all systems	$140,910.40	$124,417.40	N/A	$30,230.40	N/A
Outside Professional Services	$87,375.40	$79,297.40		$6,675.40
Form 399 assistance or other Program Management costs	$3,825.40	$3,825.40	399 Actual Program Assistance costs.	$3,825.40	Applicant incurred additional cost for assistance with completing 399 Form from another consultant.
Additional Field Engineering Service, 3 Days	$7,500.00	$7,500.00	3 DAYS OF FIELD ENGINEERING TO AFFET THE TRANSITION AT 2,500 DAY	N/A	N/A
Comprehensive coverage verification via field study, if needed	$52,600.00	$43,732.00	Per-attached quote number 721-R for Coverage Verification	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 -Prepare and File FCC Form 2100 (main), License to Cover Application	$1,577.50	$1,577.50	N/A	N/A	N/A
Prepare Form 601	$755.00	$755.00	3/30/2020- Working to obtain quote which may be delayed due to coronavirus pandemic	N/A	N/A
Project management of the transition	$7,912.50	$7,912.50	N/A	N/A	N/A
Prepare/ Review 399 reimbursement form	$1,710.00	$2,500.00	PER ATTACHED ANYWAVE QUOTE	$2,500.00	N/A
Perform engineering study for displacement application	$1,800.00	$1,800.00	N/A	N/A	N/A
Prepare request for Special Temporary Authorization	$1,280.00	$1,280.00	N/A	N/A	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$2,102.50	$2,102.50	N/A	$275.00	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,052.50	$1,052.50	N/A	$75.00	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

Components

Actual Information Description	File Name
Form 399 assistance or other Program Management costs	Component Description: 399 Paperwork PM Amount: $677.60 Component Description: 399 Paperwork PM Amount: $600.60 Component Description: Form 399 Assistance Amount: $500.00 Component Description: 399 Paperwork PM Amount: $1,047.20 Component Description: 399 Assistance to complete Amount: $1,000.00
Additional Field Engineering Service, 3 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 -Prepare and File FCC Form 2100 (main), License to Cover Application	Information not provided.
Prepare Form 601	Information not provided.
Project management of the transition	Information not provided.
Prepare/ Review 399 reimbursement form	Component Description: Prepare and/review reimbursement form. Amount: $2,500.00
Perform engineering study for displacement application	Information not provided.
Prepare request for Special Temporary Authorization	Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: Prepare Displacement Application Amount: $275.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Component Description: Prep and file license to cover Amount: $75.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Information not provided.

Cost Information

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	$2,335.00	$2,335.00	N/A	$170.00	N/A
Total for all systems	$140,910.40	$124,417.40	N/A	$30,230.40	N/A
Other Expenses	$2,335.00	$2,335.00		$170.00
Disposal Costs (for equipment and other waste, net of any salvage value)	$2,000.00	$2,000.00	3/30/2020- Working to obtain quote which may be delayed due to coronavirus pandemic	N/A	N/A
FCC Filing Fees - Form 2100 license to cover application	$335.00	$335.00	N/A	$170.00	N/A

Components

Actual Information Description	File Name
Disposal Costs (for equipment and other waste, net of any salvage value)	Information not provided.
FCC Filing Fees - Form 2100 license to cover application	Component Description: FCC Filing Fee for License to Cover CP Amount: $170.00

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$140,910.40	$124,417.40	$30,230.40

Reimbursement Status

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

Certification

Section	Question	Response
Submission of Final Allocation or Accounting Information Statements	WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates. 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. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. 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.	DAWN STEWART APPLICANT 10/14/2020

Section

Question

Response

Submission of Final Allocation or Accounting Information Statements

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.

The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.
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.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
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.

DAWN STEWART

APPLICANT

10/14/2020

(REFERENCE COPY - Not for submission) FCC Form 399: Reimbursement Request

Applicant Information

Applicant Name, Type, and Contact Information

Reimbursement Contact Information

Reimbursement Contact Name and Information

Preparer Contact Information

Preparer Contact Name and Information

Broadcaster Information and Transition Plan

Transmitters

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Antennas

Transmission Line

Tower Equipment And Rigging Costs

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Cost Information

Transmission Line

Cost Information

Tower Equipment and Rigging Costs

Cost Information

Outside Professional Services

Components

Cost Information

Other Expenses

Components

Cost Information

Grand Total

Reimbursement Status

Certification

Attachments