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:
167733
Service:
LPT
Call Sign:
K30QH-D
Channel:
30 (UHF)
File Number:
0000089917
FRN:
0018223693
Eligibility Status:
Not Determined
Date Submitted:
06/02/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

GRAY TELEVISION LICENSEE, LLC

4370 Peachtree Road, NE

Atlanta, GA 30319

United States

+1 (701) 237-5211 robert.folliard@gray.tv Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Samuel Hariton

Widelity

Samuel Hariton

4031 University Dr

Suite 100

Fairfax, VA 22030

United States

+1 (339) 222-8107 sam.hariton@widelity.com

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan K30QH-D is planning to purchase a new upgraded transmitter. It will reuse its pre-displacement antenna and line while remaining on the same pre-displacement tower.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Ownership Owned
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model CS788
Year 2010
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 500 W

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model TX9
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.2 kW
Justification for New Transmitter K30QH-D cannot retune the transmitter, as the current transmitter was not re-tunable. Please see attached narrative and justification letter.

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? No
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Rigid Conduit and Wiring No
Other Electrical Service Yes
Description Larger gauge wire run and a larger size breaker.
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

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 Retune Existing
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? No
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels 8
Design power capacity in use 60.0 %
Lower Limit 470.00 MHz
Upper Limit 860.00 MHz
ERP: 15.0 kW
Manufacturer Dielectric
Model TUA-C3-3/8M-1
Year 2012

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?

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?
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Retuning Expense

Cost to retune antenna; does not involve a tower climb

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? No

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 254
Explanation K30QH-D does not have sufficient resource capacity/ expertise in house to handle reimbursement filing, expense tracking, vendor coordination, progress reporting, budget creation, review & tracking, daisy-chain monitoring & all other activities necessary
Outside RF consulting Engineering Services Perform engineering study for displacement application Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority No
Prepare Form 601 Yes
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority 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 No
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 Yes
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)? No
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? No
Does this relocation require Equipment Storage? No
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System No
New Point to Point Microwave System No

Other Expenses

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Other Expenses Not Listed

Information not provided.

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 $84,588.00 $61,038.01 N/A $50,450.00 N/A
Total for all systems $130,550.50 $123,226.01 N/A $69,465.75 N/A
Primary Transmitter TX9 $84,588.00 $61,038.01 $50,450.00
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $84,000.00 $60,450.01 Please see Rohde & Schwarz quote 109007.2 $50,450.00 N/A
Other Electrical Service: Larger gauge wire run and a larger size breaker. $588.00 $588.00 see Justifying Quote K30QH-D-LPTV Peterson's Reliable Electric N/A N/A

Components

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

Component Description:
DP Milestone 2 75% downpayment
Amount:
$37,837.50

Component Description:
DP Milestone
Amount:
$12,612.50
Other Electrical Service: Larger gauge wire run and a larger size breaker. Information not provided.

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $738.00 $738.00 N/A $738.00 N/A
Total for all systems $130,550.50 $123,226.01 N/A $69,465.75 N/A
Primary Antenna TUA-C3-3/8M-1 $738.00 $738.00 $738.00
Retuning Expense $738.00 $738.00 Estimated Cost Justification K30QH-D-210-Primary Antenna - Retuning Expense v0 $738.00 N/A

Components

Actual Information Description File Name
Retuning Expense

Component Description:
Install and ground 15' of 2" ridged pipe, rearrange antennas
Amount:
$738.00

Cost Information

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Transmission Line

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

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 $38,819.50 $55,045.00 N/A $18,277.75 N/A
Total for all systems $130,550.50 $123,226.01 N/A $69,465.75 N/A
Outside Professional Services $38,819.50 $55,045.00 $18,277.75
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 N/A N/A N/A
Prepare Form 601 $755.00 $755.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,102.50 N/A N/A N/A
Prepare/ Review 399 reimbursement form $1,710.00 $1,710.00 N/A N/A N/A
Project management of the transition $26,797.00 $41,910.00 see Justifying Quote K30QH-D-LPTV Widelity strategic support quote $15,365.25 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,025.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,052.50 N/A N/A N/A
Perform engineering study for displacement application $1,800.00 $2,912.50 see Estimated Cost Justification K30QH-D-530-RF Eng - Engineering Study for Displacement Application v0 $2,912.50 N/A

Components

Actual Information Description File Name
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare Form 601 Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare/ Review 399 reimbursement form Information not provided.
Project management of the transition

Component Description:
Project Management
Amount:
$117.50

Component Description:
Project Management
Amount:
$235.00

Component Description:
Project Management
Amount:
$90.15

Component Description:
Project Management
Amount:
$1,972.90

Component Description:
Project Management
Amount:
$157.40

Component Description:
Project Management
Amount:
$31.25

Component Description:
Project Management
Amount:
$262.20

Component Description:
Project Management
Amount:
$567.95

Component Description:
Project Management
Amount:
$1,830.70

Component Description:
Project Management
Amount:
$193.75

Component Description:
Project Management
Amount:
$889.65

Component Description:
Project Management
Amount:
$127.20

Component Description:
Project Management
Amount:
$20.70

Component Description:
Project management
Amount:
$2,533.70

Component Description:
Project Management
Amount:
$612.15

Component Description:
Project Management
Amount:
$348.75

Component Description:
Project management
Amount:
$116.10

Component Description:
Project Management
Amount:
$143.60

Component Description:
Project management
Amount:
$989.95

Component Description:
Project Management
Amount:
$545.30

Component Description:
Project Management
Amount:
$1,107.05

Component Description:
Project Management
Amount:
$75.15

Component Description:
Project management
Amount:
$62.50

Component Description:
Project Management
Amount:
$27.75

Component Description:
Project Management
Amount:
$1,500.35

Component Description:
Project Management
Amount:
$25.35

Component Description:
Project Management
Amount:
$25.50

Component Description:
Project Management
Amount:
$62.45

Component Description:
Project Management
Amount:
$693.25
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Perform engineering study for displacement application

Component Description:
Consulting Engineer - Hourly
Amount:
$375.00

Component Description:
Work re alternative displacement channel 19.
Amount:
$1,050.00

Component Description:
Review existing panel antenna configuration, work with manufacturer to develop reconfiguration to emphasize signals towards desired areas.
Amount:
$1,487.50

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 $6,405.00 $6,405.00 N/A $0.00 N/A
Total for all systems $130,550.50 $123,226.01 N/A $69,465.75 N/A
Other Expenses $6,405.00 $6,405.00 $0.00
FCC Filing Fees - Form 2100 Major change CP application $4,960.00 $4,960.00 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
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,110.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $130,550.50 $123,226.01 $69,465.75

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 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.

Robert Folliard , III .

Assistant Secretary


06/02/2021

Attachments

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