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:
68061
Service:
LPX
Call Sign:
WRJK-LP
Channel:
11 (High VHF)
File Number:
0000089887
FRN:
0021414032
Eligibility Status:
Eligible
Date Submitted:
01/27/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

CHICAGO 22, LLC

Doing Business As: CHICAGO 22, LLC

Ravi Kapur

2118 WALSH AVE.

SUITE 208

SANTA CLARA, CA 95050

United States

+1 (415) 886-7284 FCC@CHICAGO22.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

Anywave

Tony zumMallen

300 Knightsbridge Parkway, Suite 150

Suite 1011

Lincolnshire, IL 60069

United States

+1 (816) 882-5600 tony.zummallen@anywavecom.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. Yes
Briefly describe transition plan Replace the transmitter, line and antenna per the channel reassignment with reasonable and customary engineering and business practices. Tenant on Willis Tower, Chicago.

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 unknown
Year 2013
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 600 W

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-1R37
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 800 W
Justification for New Transmitter New transmitter required for new channel.

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 Yes
Description Willis tower electrical service required
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

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Other Transmitter Cost Not Listed

Name Description

Interim Transmitter Taxes

Sales tax for interim transmitter

Interim Transmitter -Decommissioning

Harvesting and removal of old transmitter

Final Transmitter - Site prep

Preparation of site for final config transmitter

Final Transmitter Shipping fees

Transmitter shipping fees required for final configuration

Interim Transmitter Shipping fee

Shipping fees for interim transmitter

Interim Site Prep

Preparation of site for interim transmitter

Final Transmitter Installation

Transmitter installation costs required for final configuration

Final Transmitter

Transmitter required for final configuration

Final Transmitter Taxes

Transmitter sales taxes required for final configuration

Final Transmitter - Decommission

Decommissioning of STA transmitter in preparation for final config 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 Middle
Polarization Horizontal
Type Slotted Coaxial
ERP: 1.4 kW
Manufacturer
Model 4DR-16-2HW
Year 2013

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 Middle
Polarization Horizontal
Type Slotted Coaxial
ERP: 0.4 kW
Manufacturer
Model unknown
Year 2019
Justification for New Antenna New antenna required for new channel.

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? Single Channel
Feed Line Size 1 5/8 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

Interim Antenna Shipping fee

Shipping fees for interim antenna

Interim Antenna Sales Tax

Sales tax for interim antenna

Mount Design

Design of antenna mount to support proposed antenna to be placed upon the West Bridge of Willis Tower broadcast facilities.

Final Antenna Shipping fee

Shipping fees for final antenna

Final Antenna costs

Costs of final antenna

Final Antenna Sales Tax

Sales tax for final 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 Flexible Foam
Diameter 1 5/8 inches
Number of parallel runs 1
Length 200 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 Flexible Foam
Diameter 1 5/8 inches
Number of parallel runs 1
Length 400 feet per run
Justification for New Transmission Line New transmission line required for new channel.
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? Yes

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Final Transmission line shipping

Shipping for final transmission line

Final Transmission line taxes

Sales tax for final transmission line

Interim Transmission line shipping

Shipping for interim transmission line

Interim Transmission line taxes

Sales tax for interim transmission line

Final transmission line

Costs for final line

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? Located on Building
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? Yes
ASR Number 1032960
Coordinates (NAD83) Latitude (NAD83) 41° 52' 44.0" N-
Longitude (NAD83) 087° 38' 08.0" W-
Overall Structure Height 1722.09 feet
Support Structure Height 1435.35 feet
Ground Elevation Above Mean Sea Level (AMSL) 595.14 feet
Structure Type BMAST - Building with Mast
Tower Owner BRE 312 Broadcast, LLC
Date Constructed 09/30/2012

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
32334 WJYS DTV
28621 WBMX FM
71425 WWME-CD DTV
22211 WFLD DTV
74178 WKSC-FM FM
73228 WLS-FM FM
140658 W236CF FX
70042 WLIT-FM FM
73226 WLS-TV DTV
70119 WSNS-TV DTV
168662 WMEU-CD DTV
53971 WEBG FM
9617 WBBM-TV DTV
48772 WPWR-TV DTV
51165 WGCI-FM FM
71428 WCIU-TV DTV
6377 WTMX FM
10802 WTTW DTV
10801 WFMT FM
9613 WBBM-FM FM
71283 WCFS-FM FM
66978 WEDE-CD DTV
72115 WGN-TV 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: 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 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 500
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. Willis Tower adds complexity to project.
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 Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
Prepare Form 601 Yes
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
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 50
Justification Field engineering costs expected for transition on Willis Tower.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Attorney - General services

General legal fees related to Willis Tower

Engineering - General services

General outside engineering services related to Willis Tower

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

Name Description

Willis Tower Connection Fees

Connection fees for Willis Tower

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 $328,959.27 $334,535.13 N/A $52,535.13 N/A
Total for all systems $1,135,346.78 $1,339,214.64 N/A $182,069.83 N/A
Primary Transmitter VAXTE-1R37 $328,959.27 $334,535.13 $52,535.13
Transmitter Building Site Survey/Installation $10,000.00 $10,108.53 Estimated costs for site survey and transmitter installation. Revised upon Site Survey. $10,108.53 N/A
Final Transmitter - Decommission $25,000.00 $25,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Final Transmitter Taxes $2,305.38 $2,305.38 Estimated costs. Actual costs to be determined. $2,305.38 N/A
Final Transmitter $79,000.00 $79,000.00 Estimate of final transmitter costs. Actual costs to be determined. N/A N/A
Final Transmitter Installation $100,000.00 $100,000.00 Estimated costs for installation. Actual costs to be determined. $0.00 N/A
Final Transmitter Shipping fees $3,117.89 $3,117.89 Estimated costs. Actual costs to be determined. $3,117.89 N/A
Final Transmitter - Site prep $20,000.00 $20,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Interim Transmitter -Decommissioning $25,000.00 $25,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Interim Transmitter Taxes $8,000.00 $8,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Interim Transmitter Shipping fee $5,000.00 $5,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Other Electrical Service: Willis tower electrical service required $1,536.00 $1,536.00 Estimate of costs for electrical service in Willis Tower for new equipment. Actual costs to be determined. $1,536.00 N/A
High VHF - Air Cooled Solid State Transmitter 400 - 1000 Watts $30,000.00 $35,467.33 Cost determined by quote and invoices attached $35,467.33 N/A
Interim Site Prep $20,000.00 $20,000.00 Estimated costs. Actual costs to be determined. N/A N/A

Components

Actual Information Description File Name
Transmitter Building Site Survey/Installation

Component Description:
Tx Installation
Amount:
$4,209.45

Component Description:
Tx Installation
Amount:
$1,689.63

Component Description:
Tx Installation
Amount:
$4,209.45
Final Transmitter - Decommission Information not provided.
Final Transmitter Taxes

Component Description:
Transmitter Taxes
Amount:
$2,305.38
Final Transmitter Information not provided.
Final Transmitter Installation

Component Description:
Delete
Amount:
N/A

Component Description:
Delete
Amount:
N/A

Component Description:
Delete
Amount:
N/A
Final Transmitter Shipping fees

Component Description:
Transmitter shipping cost
Amount:
$3,117.89
Final Transmitter - Site prep Information not provided.
Interim Transmitter -Decommissioning Information not provided.
Interim Transmitter Taxes Information not provided.
Interim Transmitter Shipping fee Information not provided.
Other Electrical Service: Willis tower electrical service required

Component Description:
Electrical work for Transmitter Installation.
Amount:
$1,536.00
High VHF - Air Cooled Solid State Transmitter 400 - 1000 Watts

Component Description:
Transmitter Installment payment for transmitter 1 of 3 invoices.
Amount:
$11,822.44

Component Description:
Transmitter cost payment 3 of 3 invoices
Amount:
$11,822.45

Component Description:
Transmitter cost Payment 2 of 3 invoices
Amount:
$11,822.44
Interim Site Prep Information not provided.

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 $112,255.00 $131,900.00 N/A $0.00 N/A
Total for all systems $1,135,346.78 $1,339,214.64 N/A $182,069.83 N/A
Primary Antenna unknown $112,255.00 $131,900.00 $0.00
Final Antenna Sales Tax $5,000.00 $5,000.00 Estimated costs. Actual costs to be determined. $0.00 N/A
Final Antenna Shipping fee $5,000.00 $5,000.00 Estimated costs. Actual costs to be determined. $0.00 N/A
Side Mount antenna brackets $4,625.00 $10,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Elbow complex, single channel, 1 5/8” input (if needed) $6,900.00 $6,900.00 N/A N/A N/A
Sweep test of transmission line and antenna $5,730.00 $20,000.00 Estimated costs for interim and final sweeps. Actual costs to be determined. N/A N/A
High VHF-Low Power, Side Mount, Slotted Coaxial, 0.4kW input, Horizontal $20,000.00 $20,000.00 Estimated costs of new antenna. Actual costs to be determined. N/A N/A
Final Antenna costs $50,000.00 $50,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Interim Antenna Shipping fee $5,000.00 $5,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Interim Antenna Sales Tax $2,000.00 $2,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Mount Design $8,000.00 $8,000.00 Per attached ERE quote, plus estimated costs for final config. Actual costs to be determined. N/A N/A

Components

Information not provided.

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 $35,200.00 $35,200.00 N/A $0.00 N/A
Total for all systems $1,135,346.78 $1,339,214.64 N/A $182,069.83 N/A
Primary Transmission Line $35,200.00 $35,200.00 $0.00
Interim Transmission line shipping $2,000.00 $2,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Final Transmission line shipping $2,000.00 $2,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators $10,000.00 $10,000.00 Estimate of interior RF systems required for transition to new channel. Actual costs to be determined. N/A N/A
Flexible Foam Transmission Line - dielectric, 1 5/8" $9,600.00 $9,600.00 N/A N/A N/A
Final transmission line $9,600.00 $9,600.00 Estimated costs. Actual costs to be determined. N/A N/A
Interim Transmission line taxes $1,000.00 $1,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Final Transmission line taxes $1,000.00 $1,000.00 Estimated costs. Actual costs to be determined. 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 $174,495.01 $203,495.01 N/A $3,495.00 N/A
Total for all systems $1,135,346.78 $1,339,214.64 N/A $182,069.83 N/A
Primary Tower BMAST $174,495.01 $203,495.01 $3,495.00
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas) $3,495.01 $3,495.01 Estimate of costs related to antenna installation. Actual costs to be determined. $3,495.00 N/A
Tower mapping and report for structural engineer $21,000.00 $50,000.00 Estimate for mapping, reports, and Willis Tower structural engineer fees. Actual costs to be determined. N/A N/A
Minor tower reinforcement/modifications $150,000.00 $150,000.00 Estimated tower modification costs. Actual costs to be determined. N/A N/A

Components

Actual Information Description File Name
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas)

Component Description:
Tower Rigging
Amount:
$3,495.00
Tower mapping and report for structural engineer Information not provided.
Minor tower reinforcement/modifications 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 $327,727.50 $470,049.50 N/A $41,039.70 N/A
Total for all systems $1,135,346.78 $1,339,214.64 N/A $182,069.83 N/A
Outside Professional Services $327,727.50 $470,049.50 $41,039.70
Additional Field Engineering Service, 50 Days $50,000.00 $50,000.00 Estimate of field engineering required to assist in transition activities. Actual costs to be determined. N/A N/A
Comprehensive coverage verification via field study, if needed $52,600.00 $43,732.00 Per-attached quote number 726-R for Coverage Verification N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $4,470.00 $10,000.00 Estimate of costs. Actual costs to be determined. N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $3,262.50 $100,000.00 Estimate of costs. Actual costs to be determined. N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $5,000.00 Estimate of costs. Actual costs to be determined. N/A N/A
Prepare Form 601 $755.00 $755.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $5,000.00 Estimate of costs. Actual costs to be determined. N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $5,000.00 Estimate of costs. Actual costs to be determined. N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $10,000.00 Estimate of costs. Actual costs to be determined. N/A N/A
Prepare request for Special Temporary Authorization $2,560.00 $6,000.00 Estimate of costs. Actual costs to be determined. N/A N/A
Perform engineering study for displacement application $1,800.00 $5,000.00 Estimate of expected costs. Actual costs to be determined. N/A N/A
Form 399 assistance or other Program Management costs $20,000.00 $20,000.00 Estimated costs. Actual costs to be determined. $8,477.20 N/A
Engineering - General services $30,062.50 $30,062.50 Cost determined from invoices $30,062.50 N/A
Attorney - General services $100,000.00 $100,000.00 Estimated costs of general attorney fees related to Willis Tower project. Actual costs to be determined. N/A N/A
Project management of the transition $52,750.00 $77,000.00 Estimated 500 hours at $154/hr. N/A N/A
Prepare/ Review 399 reimbursement form $1,710.00 $2,500.00 Per attached Anywave invoice. $2,500.00 N/A

Components

Actual Information Description File Name
Additional Field Engineering Service, 50 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.
Prepare Form 601 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 Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
Perform engineering study for displacement application Information not provided.
Form 399 assistance or other Program Management costs

Component Description:
Paperwork
Amount:
$1,247.40

Component Description:
Paperwork
Amount:
$1,632.40

Component Description:
Paperwork
Amount:
$2,895.20

Component Description:
Paperwork PM
Amount:
$569.80

Component Description:
Paperwork PM
Amount:
$523.60

Component Description:
399 Follow Up Work
Amount:
$154.00

Component Description:
399 Follow Up Work
Amount:
$616.00

Component Description:
Form 399 Assistance
Amount:
$500.00

Component Description:
399 Follow Up Work
Amount:
$338.80
Engineering - General services

Component Description:
Engineering Services.
Amount:
$30,062.50
Attorney - General services Information not provided.
Project management of the transition Information not provided.
Prepare/ Review 399 reimbursement form

Component Description:
399 Submittal
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 $156,710.00 $164,035.00 N/A $85,000.00 N/A
Total for all systems $1,135,346.78 $1,339,214.64 N/A $182,069.83 N/A
Other Expenses $156,710.00 $164,035.00 $85,000.00
Equipment Storage $25,000.00 $25,000.00 Estimate of expected costs. Actual costs to be determined. N/A N/A
Equipment Delivery and Handling Charges $20,000.00 $20,000.00 Estimate of expected delivery and handling costs. Actual costs to be determined. N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $20,000.00 $20,000.00 Estimate of expected disposal costs. Actual costs to be determined. N/A N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $700.00 Estimated costs. Actual costs to be determined. N/A N/A
FCC Filing Fees - Form 2100 Major change CP application $4,960.00 $10,000.00 Estimated costs. Actual costs to be determined. 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 minor change CP application $1,110.00 $3,000.00 Estimated costs. Actual costs to be determined. N/A N/A
Willis Tower Connection Fees $85,000.00 $85,000.00 Willis Tower connection fees, for interim and final configs. $85,000.00 N/A

Components

Actual Information Description File Name
Equipment Storage 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.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 Major change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
Willis Tower Connection Fees

Component Description:
Willis Tower (WRJK) connection. One-time charge to WRJK for temporary use of the antenna owned by the building.
Amount:
$85,000.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,135,346.78 $1,339,214.64 $182,069.83

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.

Deepti Dawar

Reimbursement Representative


01/27/2021

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.

Deepti Dawar

Reimbursement Representative


01/27/2021

Attachments

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