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:
68574
Service:
LPA
Call Sign:
KAZH-LD
Channel:
35 (UHF)
File Number:
0000085412
FRN:
0026907345
Eligibility Status:
Eligible
Date Submitted:
03/11/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

HC2 STATION GROUP, INC

RENEE ILHARDT

450 PARK AVENUE, 29TH FLOOR

NEW YORK, NY 10022

United States

+1 (954) 606-5486 RILHARDT@HC2BROADCASTING.COM 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

The Preparer is same as the reimbursement contact.

 

 

 

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 This displaced facility is currently in the process of complying with its new displacement construction permit as part of the repack program.

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 Retune Existing
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 R&S
Model LU1000AT
Year 2016
Type Other Type
Other Transmitter Type Analog
Power capacity 0.2 kW

Primary Transmitter

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Retuning Transmitter Costs

Section Question Response
New Mask Filter Does the transmitter require a new mask filter? No
New Exciter Is a new exciter needed? No

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) Yes
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

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Other Transmitter Cost Not Listed

Name Description

Additional Field Engineering Time

Additional Field Engineering Time

UHF inside RF system including switching

UHF inside RF system including switching

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Ownership Owned
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Other
Other Antenna Type Panel
ERP: 7.0 kW
Manufacturer
Model 4DR-16-HO
Year 2010

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? No
New Antenna Manufacturer and Types
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Other
Other Antenna Type Panel
ERP: 5.0 kW
Manufacturer
Model UTV-11/4/LP
Year 2019
Justification for New Antenna The applicant plans on replacing the existing antenna to support the new displacement construction permit.

Primary Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
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

Information not provided.

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 Utilize Existing
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 Andrew
Type Flexible Foam
Diameter 1 5/8 inches
Number of parallel runs 1
Length 414 feet per run

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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Section Question Response
Tower Equipment or Rigging Costs Changes Do you have tower equipment or rigging costs changes? Yes

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? 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 1062607
Coordinates (NAD83) Latitude (NAD83) 26° 15' 24.3" N-
Longitude (NAD83) 098° 13' 52.0" W-
Overall Structure Height 479.98 feet
Support Structure Height 439.96 feet
Ground Elevation Above Mean Sea Level (AMSL) 113.84 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Global Signal Acquisitions LLC
Date Constructed 01/01/1966


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 need for guyed or free-standing 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 N/A
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 150
Explanation Outside consulting engineering, legal work, and accounting services, as well as project management for regional and comprehensive repack execution.
Outside RF consulting Engineering Services Perform engineering study for displacement application No
Prepare engineering section of Form FCC Construction Permit Application No
Prepare engineering section of Form FCC License to Cover Application No
Prepare request for Special Temporary Authority No
Prepare Form 601 No
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application No
Prepare and file Form FCC License to Cover Application No
Prepare request for Special Temporary Authority No
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 No
RF exposure measurements No
Additional Field Engineering Service No

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
Permit and Filing Costs FCC Construction Permit Major Change No
FCC Construction Permit Minor Change Yes
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? Yes
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

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Other Expenses Not Listed

Name Description

Filter Box and Taxes

Filter Box and Taxes

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 $53,710.24 $5,949.04 N/A $5,949.04 N/A
Total for all systems $158,509.75 $64,708.55 N/A $38,167.61 N/A
Primary Transmitter LU1000AT $53,710.24 $5,949.04 $5,949.04
UHF inside RF system including switching $2,090.24 $2,090.24 N/A $2,090.24 N/A
Additional Field Engineering Time $3,420.00 $3,420.00 N/A $3,420.00 N/A
Analog $0.00 $0.00 N/A N/A N/A
Transmitter Building Site Survey/Installation $10,000.00 $0.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $438.80 N/A $438.80 N/A

Components

Actual Information Description File Name
UHF inside RF system including switching

Component Description:
UHF inside RF system including switching. #20259
Amount:
$708.28

Component Description:
Filter retune. #759006
Amount:
$800.00

Component Description:
UHF inside RF system including switching. #22367
Amount:
$581.96
Additional Field Engineering Time

Component Description:
Engineering services. #WCI-HC2-082012
Amount:
$3,000.00

Component Description:
Electric service for new tx. #630020
Amount:
$240.00

Component Description:
TX preinstall prep, troubleshoot ASI converter. #331020
Amount:
$180.00
Analog Information not provided.
Transmitter Building Site Survey/Installation Information not provided.
Switchgear - industrial 800 amp

Component Description:
240-volt 40-amp circuit install. #ST6572Q
Amount:
$438.80

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 $13,193.85 $13,193.85 N/A $7,463.85 N/A
Total for all systems $158,509.75 $64,708.55 N/A $38,167.61 N/A
Primary Antenna UTV-11/4/LP $13,193.85 $13,193.85 $7,463.85
UHF-Low Power, Side Mount, Other, 5.0kW input, Horizontal $0.00 $0.00 N/A N/A N/A
UHF-Low Power, Side Mount, Other, 5.0kW input, Horizontal $7,463.85 $7,463.85 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $7,463.85 N/A
Sweep test of transmission line and antenna $5,730.00 $5,730.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF-Low Power, Side Mount, Other, 5.0kW input, Horizontal Information not provided.
UHF-Low Power, Side Mount, Other, 5.0kW input, Horizontal

Component Description:
Antenna costs. #1253
Amount:
$7,463.85
Sweep test of transmission line and antenna 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 $0.00 $0.00 N/A $0.00 N/A
Total for all systems $158,509.75 $64,708.55 N/A $38,167.61 N/A
Primary Transmission Line $0.00 $0.00 $0.00

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 $64,890.00 $18,850.00 N/A $18,850.00 N/A
Total for all systems $158,509.75 $64,708.55 N/A $38,167.61 N/A
Primary Tower TOWER $64,890.00 $18,850.00 $18,850.00
Study needed for guyed or free-standing tower $8,700.00 $2,500.00 N/A $2,500.00 N/A
Tower Rigging Short Tower (less than 500') $56,190.00 $16,350.00 N/A $16,350.00 N/A

Components

Actual Information Description File Name
Study needed for guyed or free-standing tower

Component Description:
Site inspection fee. #32180690
Amount:
$1,500.00

Component Description:
Structural analysis. #32060499
Amount:
$1,000.00
Tower Rigging Short Tower (less than 500')

Component Description:
Antenna install, 30% down. #820036-1
Amount:
$4,905.00

Component Description:
Antenna install, 2nd 30%. #820036-2
Amount:
$4,905.00

Component Description:
Antenna install, 40% balance. #820036-3
Amount:
$6,540.00

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 $20,535.00 $20,535.00 N/A $4,169.06 N/A
Total for all systems $158,509.75 $64,708.55 N/A $38,167.61 N/A
Outside Professional Services $20,535.00 $20,535.00 $4,169.06
Project management of the transition $15,825.00 $15,825.00 N/A $4,169.06 N/A
Form 399 assistance or other Program Management costs $3,000.00 $3,000.00 N/A N/A N/A
Prepare/ Review 399 reimbursement form $1,710.00 $1,710.00 N/A N/A N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 6 stations. #254
Amount:
$1,829.16

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #477015
Amount:
$406.37

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 29 stations. #188
Amount:
$656.55

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 22 stations. #191
Amount:
$974.31

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #1149
Amount:
$302.67
Form 399 assistance or other Program Management costs Information not provided.
Prepare/ Review 399 reimbursement form Information not provided.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $6,180.66 $6,180.66 N/A $1,735.66 N/A
Total for all systems $158,509.75 $64,708.55 N/A $38,167.61 N/A
Other Expenses $6,180.66 $6,180.66 $1,735.66
Equipment Delivery and Handling Charges $1,650.86 $1,650.86 N/A $1,650.86 N/A
Filter Box and Taxes $84.80 $84.80 N/A $84.80 N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,110.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $3,000.00 $3,000.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A N/A N/A

Components

Actual Information Description File Name
Equipment Delivery and Handling Charges

Component Description:
2nd filter shipping. #3304
Amount:
$404.42

Component Description:
Filter shipping. #3161
Amount:
$504.00

Component Description:
6pole filter box. #747007
Amount:
N/A

Component Description:
Sales tax for 6pole filter box. #ST747007
Amount:
N/A

Component Description:
Antenna shipping. #10708126197
Amount:
$573.19

Component Description:
RTUNEFEE shipping. #763037
Amount:
$169.25
Filter Box and Taxes

Component Description:
Sales tax for 6pole filter box. #ST747007
Amount:
$4.80

Component Description:
6pole filter box. #747007
Amount:
$80.00
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $158,509.75 $64,708.55 $38,167.61

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.

Kurt Hanson

CTO


03/11/2021

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.

Kurt Hanson

CTO


03/11/2021

Attachments

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