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:
28119
Service:
DTV
Call Sign:
WZDX
Channel:
18 (UHF)
File Number:
0000028526
FRN:
0028358455
Date Submitted:
04/16/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

TEGNA BROADCAST HOLDINGS, LLC

Denise A. Branson

8350 Broad Street

Suite 2000

TYSONS, VA 22102

United States

+1 (703) 873-6606 DBRANSON@TEGNA.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

Elizabeth Ryder

General Counsel

Nexstar Broadcasting, Inc.

Elizabeth Ryder

545 E. John Carpenter Freeway

Suite 700

Irving, TX 75062

United States

+1 (972) 373-8800 eryder@nexstar.tv

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 transmitter, using existing antenna and transmission line. Map and analyze tower; design and implement modifications if required. See attached.

Transmitters

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

Auxiliary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Auxiliary
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 TDU2 6K00 AV
Year 2005
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 12 kW

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model ULXTE-20
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 12.9 kW
Justification for New Transmitter The manufacturer of the existing solid state transmitter advises that the transmitter cannot be re-tuned to the assigned channel. See attachment.

Auxiliary 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 Yes
Description Labor and materials to disconnect the existing transmitter and hookup the new one
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

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

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 IOTD3130W
Year 2001
Type Inductive Output Tube
IOT Power Type Single
Power Capacity 25 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 ULXTE-30
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 19.2 kW
Justification for New Transmitter The manufacturer of the existing transmitter is out of business and no factory support is available for retuning the existing transmitter. A new Comark Paragon MSDC IOT transmitter is the basis for a replacement as suggested by the FCC. See attachment.

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) Yes
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring Yes
Size 3 inches
Length 100.0 feet
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

Name Description

Additional Interior RF System

Interior RF System Existing Transmitter to Interim Transmission line

Install Service

Install Service

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 Retune Existing
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? Yes
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 Full Power
Mounting Top Mount
Antenna position in stack Bottom
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels 70
Design power capacity in use 50.0 %
Lower Limit 470.00 MHz
Upper Limit 860.00 MHz
Other Antenna Type N/A
ERP: 700.0 kW
Manufacturer Dielectric
Model TUD-S5B-14/70H-1-T
Year 2001

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
57292 WAAY-TV

Primary Antenna

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Adjustment to Existing Antenna

Section Question Response
Sweep Test of Existing Antenna Do you need a sweep test of existing antenna? Yes

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? Yes
Type New
Number of channels supported 2
Frequencies of channels supported RF channel
Frequency N/A

Enter a list of RF channel numbers.

RF Channel Number
18
17

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)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer Dielectric
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 1150 feet per run

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Sweep Tests

Sweep tests to verify condition of line on assigned channel

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex?
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? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1041008
Coordinates (NAD83) Latitude (NAD83) 34° 44' 12.8" N-
Longitude (NAD83) 086° 31' 58.9" W-
Overall Structure Height 1001.96 feet
Support Structure Height 899.92 feet
Ground Elevation Above Mean Sea Level (AMSL) 1552.15 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner SpectraSite Communications, LLC. through American Towers, LLC.
Date Constructed 12/01/1977

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
67020 W17DJ-D DTV
57292 WAAY-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: No study needed
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 Other
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 295
Explanation Schedule and coordinate multiple vendors, complete progress reports, and update Schedule 399. Station does not have available personnel or personnel trained in project management for such complex projects. Internal accounting and Project management.
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 Yes
Quantity 1
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 Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 17
Justification It will be necessary to survey the site, plan the equipment, develop specifications for purchasing, and oversee multiple vendor RF projects. Station does not have available personnel or personnel trained in such services.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Other Engineering Services

Capital Contribution

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 No
Non-zoning permits Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application No
FCC Special Temporary Authority Application No
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

Sales Taxes

Sales and use tax on goods and services

Capital Contribution

Capital Contribution

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 $1,406,586.13 $1,160,849.65 N/A $1,130,949.65 N/A
Total for all systems $2,525,610.28 $1,881,278.80 N/A $1,342,227.55 N/A
Primary Transmitter ULXTE-30 $887,086.13 $635,466.34 $630,566.34
Install Service $38,359.10 $38,359.10 See attached / uploaded PDF file titled "Gates US0336527 v200622jgv1b.pdf" $38,359.10 N/A
Additional Interior RF System $95,777.03 $95,777.03 See attached / uploaded PDF file titled "Gates US0336527 v200622jgv1b.pdf" $95,777.03 N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $10,679.71 See attached / uploaded PDF file titled "Gates US0336527 v200622jgv1b.pdf" $10,679.71 N/A
Switchgear - industrial 800 amp $38,200.00 $46,800.00 See attached / uploaded PDF files titled "Mr Elec 93159735 v200324jgv1.pdf" and "Mr Elec 93536519 v200324jgv1.pdf" $46,800.00 N/A
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW $684,000.00 $438,950.50 See attached / uploaded PDF file titled "Gates US0336527 v200622jgv1b.pdf" $438,950.50 N/A
3" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $4,900.00 N/A N/A N/A
Auxiliary Transmitter ULXTE-20 $519,500.00 $525,383.31 $500,383.31
Other Electrical Service: Labor and materials to disconnect the existing transmitter and hookup the new one $25,000.00 $25,000.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $494,500.00 $500,383.31 See attached / uploaded PDF file titled "Gates JW30004701-1 v200505jgv1.pdf" $500,383.31 N/A

Components

Actual Information Description File Name
Install Service

Component Description:
Gates US0336527 v200622jgv1b
Amount:
$38,359.10
Additional Interior RF System

Component Description:
Gates US0336527 v200622jgv1b
Amount:
$95,777.03
Transformer 3 phase/480v - 150 KVA

Component Description:
Gates US0336527 v200622jgv1b
Amount:
$10,679.71
Switchgear - industrial 800 amp

Component Description:
Mr Elec 93536519 v200324jgv1
Amount:
$30,420.00

Component Description:
Mr Elec 93159735 v200324jgv1
Amount:
$16,380.00
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW

Component Description:
Gates US0336527 v200622jgv1
Amount:
$438,950.50
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Other Electrical Service: Labor and materials to disconnect the existing transmitter and hookup the new one Information not provided.
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW

Component Description:
Gates US0336148 v210125pmv1
Amount:
$264,496.76

Component Description:
Gates JW30004701-1 v200622jgv2
Amount:
$235,886.55

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 $104,630.00 $99,400.00 N/A $0.00 N/A
Total for all systems $2,525,610.28 $1,881,278.80 N/A $1,342,227.55 N/A
Primary Antenna TUD-S5B-14/70H-1-T $104,630.00 $99,400.00 $0.00
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,700.00 $13,000.00 N/A N/A N/A
New combiner, cost per channel (without antenna) $84,200.00 $80,000.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A 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 $6,400.00 $6,400.00 N/A $0.00 N/A
Total for all systems $2,525,610.28 $1,881,278.80 N/A $1,342,227.55 N/A
Primary Transmission Line $6,400.00 $6,400.00 $0.00
Sweep Tests $6,400.00 $6,400.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $421,000.00 $40,000.00 N/A $0.00 N/A
Total for all systems $2,525,610.28 $1,881,278.80 N/A $1,342,227.55 N/A
Primary Tower GTOWER $421,000.00 $40,000.00 $0.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $40,000.00 Rigging to replace elbow complex or retune existing complex N/A N/A

Components

Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $120,165.00 $121,380.00 N/A $37,322.75 N/A
Total for all systems $2,525,610.28 $1,881,278.80 N/A $1,342,227.55 N/A
Outside Professional Services $120,165.00 $121,380.00 $37,322.75
Other Engineering Services $4,635.00 $4,635.00 See attached invoices/quotes $4,168.75 N/A
Additional Field Engineering Service, 17 Days $34,000.00 $34,000.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 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
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $675.00 N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 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 $0.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $3,000.00 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 $5,750.00 N/A
Prepare and or review reimbursement form $2,630.00 $8,245.00 See attached invoices/quotes $7,807.50 N/A
Project management of the transition $46,610.00 $44,250.00 N/A $15,921.50 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A N/A N/A

Components

Actual Information Description File Name
Other Engineering Services

Component Description:
Osborn 40309 v210113pmv1
Amount:
$466.25

Component Description:
Osborn 39010 v200722pmv1
Amount:
$3,702.50
Additional Field Engineering Service, 17 Days 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.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Osborn 38336 v200727pmv1
Amount:
$675.00
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Osborn 39689 v210125pmv1
Amount:
$675.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Vendor has issued a revised invoice; see 29305R
Amount:
($3,000.00)

Component Description:
Vendor has issued a revised invoice; see 29305R
Amount:
$3,000.00

Component Description:
Prepare engineering section of FCC Form 2100, item 4 from invoice summary
Amount:
$3,000.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
Prepare engineering study for new channel assignment; item 3 from invoice summary
Amount:
$5,750.00

Component Description:
Vendor has issued a revised invoice; see 29305R
Amount:
$5,750.00

Component Description:
Vendor has issued a revised invoice; see 29305R
Amount:
($5,750.00)
Prepare and or review reimbursement form

Component Description:
Osborn 39010 v200722pmv1
Amount:
$25.00

Component Description:
Osborn 38336 v200727pmv1
Amount:
$95.00

Component Description:
Osborn 40023 v210113pmv1
Amount:
$1,315.00

Component Description:
Osborn 42171 v210416pmv1
Amount:
$730.00

Component Description:
Osborn 37443 v210416pmv1
Amount:
$182.50

Component Description:
Osborn 40962 v210113pmv1
Amount:
$50.00

Component Description:
Osborn 41456 v210416pmv1
Amount:
$60.00

Component Description:
Osborn 37942 v210416pmv1
Amount:
$350.00

Component Description:
Prepare reimbursement form, item 2 from invoice summary
Amount:
$2,500.00

Component Description:
Osborn 39396 v201116pmv1
Amount:
$475.00

Component Description:
Osborn 40022 v210125pmv1
Amount:
$1,585.00

Component Description:
Osborn 39690 v210113pmv1
Amount:
$1,425.00

Component Description:
Osborn 39689 v210125pmv1
Amount:
$25.00

Component Description:
Vendor has issued a revised invoice; see 29305R
Amount:
$2,500.00

Component Description:
Osborn 40308 v210125pmv1
Amount:
$150.00

Component Description:
Vendor has issued a revised invoice; see 29305R
Amount:
($2,500.00)

Component Description:
Osborn 38634 v200722pmv1
Amount:
$600.00
Project management of the transition

Component Description:
Project Management for Structural Analysis and Tower Modifications for services from June 30, 2018 through July 27, 2018.
Amount:
$570.00

Component Description:
Project Management for Structural Analysis and Tower Modifications including consultants Kessler and Gehman Associates. Services from January 1, 2018 through February 23, 2018.
Amount:
$375.00

Component Description:
Osborn 38336 v200727pmv1
Amount:
$1,034.00

Component Description:
Osborn 40023 v210113pmv1
Amount:
$395.00

Component Description:
Osborn 42171 v210416pmv1
Amount:
$79.00

Component Description:
Osborn 37443 v210416pmv1
Amount:
$553.00

Component Description:
Osborn 40657 v210113pmv1
Amount:
$316.00

Component Description:
Project management services 12.1.18 through 1.31.19
Amount:
$450.00

Component Description:
Project management services April 2019
Amount:
$84.50

Component Description:
Osborn 40962 v210113pmv1
Amount:
$474.00

Component Description:
Project management services March 2019
Amount:
$110.50

Component Description:
Osborn 41456 v210416pmv1
Amount:
$237.00

Component Description:
Osborn 41750 v210416pmv1
Amount:
$158.00

Component Description:
Osborn 37942 v210416pmv1
Amount:
$940.00

Component Description:
Osborn 40308 v210125pmv1
Amount:
$948.00

Component Description:
Vendor has issued a revised invoice; see 29305R
Amount:
($1,000.00)

Component Description:
Osborn 40309 v210113pmv1
Amount:
$316.00

Component Description:
Vendor has issued a revised invoice; see 29305R
Amount:
$900.00

Component Description:
Project management services various, items 7 and 8 from invoice summary
Amount:
$789.50

Component Description:
Project management services 3.2.19 through 3.29.19
Amount:
$375.00

Component Description:
Osborn 40961 v210125pmv1
Amount:
$869.00

Component Description:
Osborn 40022 v210125pmv1
Amount:
$1,422.00

Component Description:
Osborn 40656 v210125pmv1
Amount:
$395.00

Component Description:
Project management services 5.26.18 through 6.29.18
Amount:
$270.00

Component Description:
Prepare FCC Schedule 387, item 6 from invoice summary
Amount:
$150.00

Component Description:
Osborn 39689 v210125pmv1
Amount:
$870.00

Component Description:
Osborn 38634 v200722pmv1
Amount:
$524.00

Component Description:
Project management services, item 1 from invoice summary
Amount:
$3,150.00

Component Description:
Project management services 3.30.19 through 4.26.19
Amount:
$375.00

Component Description:
Project management services 7.28.18 through 9.28.18
Amount:
$950.00

Component Description:
Prepare FCC Schedule 387, item 5 from invoice summary
Amount:
$300.00

Component Description:
Osborn 39010 v200722pmv1
Amount:
$474.00

Component Description:
Osborn 39690 v210113pmv1
Amount:
$1,185.00

Component Description:
Vendor has issued a revised invoice; see 29305R
Amount:
($900.00)

Component Description:
Project management services 9.29.18 through 10.26.18
Amount:
$300.00

Component Description:
Vendor has issued a revised invoice; see 29305R
Amount:
$1,000.00

Component Description:
Project management services Sep 2018
Amount:
$75.00

Component Description:
Osborn 39689 v210125pmv1
Amount:
$2,923.00

Component Description:
Project management services 10.27.18 through 11.30.18
Amount:
$675.00

Component Description:
Osborn 39396 v201116pmv1
Amount:
$237.00
Attorney Fees - Prepare and File request for Special Temporary Authorization 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 $199,399.15 $198,849.15 N/A $173,955.15 N/A
Total for all systems $2,525,610.28 $1,881,278.80 N/A $1,342,227.55 N/A
Other Expenses $199,399.15 $198,849.15 $173,955.15
MVPD Notification of Channel Change $1,959.00 $1,959.00 N/A $1,959.00 N/A
Capital Contribution $97,151.00 $97,151.00 See attached / uploaded PDF file titled "SpectraSite 160133788 v200722pmv1" $97,151.00 N/A
Sales Taxes $52,538.97 $52,538.97 See attached / uploaded PDF file titled "Gates US0336527 v200622jgv1b.pdf" $52,538.97 N/A
Develop and air announcement of upcoming channel change $3,500.00 $3,500.00 N/A N/A N/A
Equipment Storage $5,000.00 $5,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $17,700.18 $17,700.18 See attached / uploaded PDF file titled "Gates US0336527 v200622jgv1b.pdf" $17,700.18 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $5,000.00 $5,000.00 N/A N/A N/A
Non-zoning permits $5,000.00 $5,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $4,606.00 N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change

Component Description:
Osborn 37048 v210416pmv1
Amount:
$1,959.00
Capital Contribution

Component Description:
SpectraSite 160133788 v200722pmv1
Amount:
$97,151.00
Sales Taxes

Component Description:
Gates US0336527 v200622jgv1
Amount:
$52,538.97
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges

Component Description:
Gates US0336527 v200622jgv1
Amount:
$11,833.72

Component Description:
Gates US0336148 v210125pmv1
Amount:
$5,866.46
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Non-zoning permits Information not provided.
DTV Medical Facility Notification

Component Description:
Osborn 37048 v210416pmv1
Amount:
$4,606.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,525,610.28 $1,881,278.80 $1,342,227.55

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. Yes
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.

Jeffrey C Gehman

Engineering Associate


04/16/2021

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.

Jeffrey C Gehman

Engineering Associate


04/16/2021

Attachments

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