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:
73764
Service:
DCA
Call Sign:
KPDF-CD
Channel:
22 (UHF)
File Number:
0000027996
FRN:
0026907345
Date Submitted:
09/28/2021

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 Perform a flashcut transition to the new assigned channel by going off the air for some hours while the antenna is replaced with a new antenna, simultaneously replacing the mask filter and modifying the existing transmitter.

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 LU500ATD
Year 2010
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 0.5 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 TRN-5X-U-18-C
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 2 kW
Justification for New Transmitter The current transmitter cannot be retuned.

Primary Transmitter

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Other Transmitter Costs

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

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

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 RD16UA
Year 2001

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: 3.36 kW
Manufacturer
Model JA-SS-16/D22 SCC
Year 2017
Justification for New Antenna Existing antenna is tuned for the current licensed channel, it will not operate on the new assigned channel and it cannot be re-tuned. Same brand and similar model was too expensive, so we decided using another brand (attached both quotes)

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? No
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

Information not provided.

Transmission Line

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

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 Move Equipment
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Candelabra
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 Yes
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 33° 20' 00.1" N-
Longitude (NAD83) 112° 03' 47.4" W-
Overall Structure Height 120.00 feet
Support Structure Height 120.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 2785.00 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner American Tower
Date Constructed 01/01/1994

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
20638 KFLR-FM FM

Other Types of Users

Users
LPTV
FM translator
Wireless

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Candelabra
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Tower Permit Drawing Package

Generation of permit drawings for 1 customer.

Ground, Building and Permit Drawing Package

Generation of permit drawings for 1 customer.

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 240
Explanation Project management fee for pre-construction services, including initial antenna placement and RF compatibility review, zoning and permitting requirements review; leasing application services to support the transition of a single one broadcaster.
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 Yes
Environmental Assessment Yes
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) Yes
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service 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

Site Coordination Meetings

Site coordination meetings with all broadcasters, contractors and vendors involved with the site project. All involved parties will define an action plan and cutover approach to allow for construction activities in alignment with stations constrains.

Repacking Related Tax Services

Repacking Related Tax Services

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 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? 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

Permit Costs

The cost of preparation and submission of the needed forms, excluding permit drawing package for permits, on behalf of the broadcaster for jurisdictional permits, required for electrical, building and other required tasks associated with the installation.

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 $126,000.00 $29,758.00 N/A $29,758.00 N/A
Total for all systems $709,975.74 $235,595.42 N/A $178,150.42 N/A
Primary Transmitter TRN-5X-U-18-C $126,000.00 $29,758.00 $29,758.00
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $29,758.00 N/A $29,758.00 N/A

Components

Actual Information Description File Name
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
Transmitter installation. #20181031004
Amount:
$3,100.00

Component Description:
TX install shielding. #20200309004
Amount:
$350.00

Component Description:
Transmitter related cost. #20181203001
Amount:
$250.00

Component Description:
Transmitter cost, upgrade excluded. #7118-01
Amount:
$26,058.00

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 $33,030.00 $34,486.00 N/A $28,086.00 N/A
Total for all systems $709,975.74 $235,595.42 N/A $178,150.42 N/A
Primary Antenna JA-SS-16/D22 SCC $33,030.00 $34,486.00 $28,086.00
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $28,086.00 See quote from Jampro. $28,086.00 N/A

Components

Actual Information Description File Name
Sweep test of existing antenna Information not provided.
UHF - Lower Power Side Mount, Class A One Station antenna -- basic

Component Description:
Antenna cost, 50% down. #19158-A-B
Amount:
$13,395.50

Component Description:
Antenna cost balance due, upgrade excluded. #19158-A-B-R1
Amount:
$14,690.50

Cost Information

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Transmission Line

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 $430,400.00 $80,215.00 N/A $70,815.00 N/A
Total for all systems $709,975.74 $235,595.42 N/A $178,150.42 N/A
Primary Tower TOWER $430,400.00 $80,215.00 $70,815.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $70,815.00 Estimated cost updated from $70,000 to $70,815. $70,815.00 Item "Need More Information" should be removed.
Ground, Building and Permit Drawing Package $4,700.00 $4,700.00 N/A N/A N/A
Tower Permit Drawing Package $4,700.00 $4,700.00 N/A N/A N/A

Components

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

Component Description:
Balance of the project. #46361
Amount:
$41,865.00

Component Description:
KPDF - JTD Consulting - Short tower rigging - 50% deposit
Amount:
$28,950.00

Component Description:
50% downpayment. #46097
Amount:
$28,950.00

Component Description:
Tower rigging related cost. #46097
Amount:
$28,950.00
Ground, Building and Permit Drawing Package Information not provided.
Tower Permit Drawing Package 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 $87,100.74 $65,291.42 N/A $35,541.42 N/A
Total for all systems $709,975.74 $235,595.42 N/A $178,150.42 N/A
Outside Professional Services $87,100.74 $65,291.42 $35,541.42
Site Coordination Meetings $5,145.00 $5,145.00 Updated cost of estimated amount per FCC requirement. $5,145.00 N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A N/A N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $2,000.00 N/A N/A N/A
NEPA Section 106 environmental review, if needed $6,310.00 $2,000.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A
Project management of the transition $37,920.00 $30,275.68 N/A $30,275.68 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A N/A 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
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
Repacking Related Tax Services $120.74 $120.74 N/A $120.74 N/A

Components

Actual Information Description File Name
Site Coordination Meetings

Component Description:
Site coordination. #460205779
Amount:
$5,145.00
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet Information not provided.
NEPA Section 106 environmental review, if needed Information not provided.
Prepare and or review reimbursement form Information not provided.
Project management of the transition

Component Description:
$1,399.33 credit to be split across 7 HC2 stations (see attached allocation) reimbursed for invoice 472568 (correct amount is $821.47).
Amount:
($164.29)

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #472568
Amount:
$985.76

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #471659
Amount:
$1,206.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1116
Amount:
$1,254.03

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 27 stations. #119
Amount:
$271.70

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 27 stations. #130
Amount:
$450.81

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #474784
Amount:
$374.23

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 8 stations. #321
Amount:
$605.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 20 stations. #145
Amount:
$745.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #1140
Amount:
$1,503.60

Component Description:
Legal services cost. #2020-KPDF
Amount:
$36.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #1165
Amount:
$497.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #473451
Amount:
$1,054.24

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #475439
Amount:
$268.86

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #1163
Amount:
$607.03

Component Description:
Legal services cost. #474786
Amount:
$402.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #1146
Amount:
$888.15

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #475011
Amount:
$1,023.40

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 20 stations. #1144
Amount:
$796.10

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1096
Amount:
$714.93

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #1122
Amount:
$1,979.10

Component Description:
Legal services cost. #475969
Amount:
$50.00

Component Description:
Legal services cost. #481058
Amount:
$36.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #472232
Amount:
$901.10

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #474243
Amount:
$1,304.02

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #1134
Amount:
$1,678.60

Component Description:
Legal services cost. #475032
Amount:
$714.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #1158
Amount:
$723.06

Component Description:
Legal services cost. #480859
Amount:
$75.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1118
Amount:
$1,609.03

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1112
Amount:
$521.40

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #475948
Amount:
$419.80

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 20 stations. #473857
Amount:
$1,198.13

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #1150
Amount:
$630.93

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1112
Amount:
$1,881.13

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 27 stations. #115
Amount:
$467.12

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. 473121
Amount:
$2,044.14

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1104
Amount:
$1,359.73

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #1129
Amount:
$1,758.65

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1104
Amount:
$644.80
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Perform engineering study for new channel assignment and antenna development Information not provided.
Prepare engineering section of 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.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Repacking Related Tax Services

Component Description:
Services rendered in relation to discussion and analysis of the tax treatment of invoice related to FCC repacking. #1034466828-9
Amount:
$120.74

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 $33,445.00 $25,845.00 N/A $13,950.00 N/A
Total for all systems $709,975.74 $235,595.42 N/A $178,150.42 N/A
Other Expenses $33,445.00 $25,845.00 $13,950.00
Permit Costs $750.00 $750.00 N/A N/A N/A
MVPD Notification of Channel Change $2,500.00 $2,500.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $2,000.00 $2,000.00 N/A N/A N/A
Equipment Storage $1,500.00 $1,500.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $4,000.00 N/A $3,750.00 N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
Local Zoning $1,000.00 $1,000.00 N/A N/A N/A
Non-zoning permits $9,400.00 $9,400.00 See attached quote from ATC. $9,400.00 N/A
Equipment Delivery and Handling Charges $2,500.00 $2,500.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $800.00 $800.00 N/A $800.00 N/A

Components

Actual Information Description File Name
Permit Costs Information not provided.
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
DTV Medical Facility Notification

Component Description:
Medical notification services. #1025
Amount:
$3,750.00
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
Local Zoning Information not provided.
Non-zoning permits

Component Description:
Tower permit drawing package and ground drawing package. #317848
Amount:
$9,400.00
Equipment Delivery and Handling Charges Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Install cleanup. #20200316004
Amount:
$800.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $709,975.74 $235,595.42 $178,150.42

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.

Michael Voge

Director of Engineering Operations


09/28/2021

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.

Michael Voge

Director of Engineering Operations


09/28/2021

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