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:
71508
Service:
DTV
Call Sign:
WENY-TV
Channel:
35 (UHF)
File Number:
0000028802
FRN:
0003761855
Date Submitted:
09/23/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

LILLY BROADCASTING, L.L.C.

Doing Business As: LILLY BROADCASTING, L.L.C.

Kevin Lilly

2 EAST LEIGH LANE

NATICK, MA 01760

United States

+1 (508) 651-4994 kevin@lillytv.com Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

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. Yes
Briefly describe transition plan Pre-repack, WENY-TV operated on the same antenna as WSKA and WYDC. All 3 stations were repacked. Post-repack, WENY-TV will share an antenna with WYDC.

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 HU5000 INNOVATOR HX
Year 2007
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 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 THU9-8 EVO
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 13 kW
Justification for New Transmitter The existing transmitter cannot be retuned to operate on channel 35. The manufacturer is no longer supporting the equipment.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
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 Installation of new transmitter
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? Yes
Size 100.0 square feet
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

Interconnect

Certain equipment necessary to interconnect the new transmitter to the mask filter.

Antennas

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

Primary Antenna

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Add 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 this antenna currently shared with any other stations? Yes
Is this 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 Not in Stack
Polarization Horizontal
Type Other
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 Multi-Station Antenna
ERP: 100.0 kW
Manufacturer
Model TUA-C4SP-8 28M-1-T
Year 2006

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

Facility ID Call Sign
62219 WYDC
78908 WSKA

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? Yes
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 2
Number of Panels/Bays 12
Lower Limit 470.00 MHz
Upper Limit 600.00 MHz
Design power capacity in use 90.0 %
Other Antenna Type N/A
ERP: 100.0 kW
Manufacturer
Model TLP-BB-24B/VP-R
Year 2017
Justification for New Antenna New antenna needed to support maximized facilities.

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
Do you need a combiner output splitter/switcher for dual feed lines? No
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Broadband
Feed Line Size 4 1/16 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Enter a list of RF channel numbers.

RF Channel Number
30
35

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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Add Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmission currently shared with any other stations? Yes
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 3 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 950 feet per run

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

Facility ID Call Sign
62219 WYDC

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Type Rigid
Diameter 4 1/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 950 feet per run
Justification for New Transmission Line Existing transmission line is unavailable.

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)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 42° 08' 31.2" N-
Longitude (NAD83) 077° 04' 38.8" W-
Overall Structure Height 800.52 feet
Support Structure Height 800.52 feet
Ground Elevation Above Mean Sea Level (AMSL) 1679.77 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner GRI Telecom, Inc.
Date Constructed 08/27/2006

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
78908 WSKA DTV
62219 WYDC 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: Study needed for documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: Minor Reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower 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 200
Explanation Tower mod, coordinate shared antenna issues, manage and advise on reimbursements and project management for accounting and legal issues.
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 No
Number of Days N/A
Justification N/A

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
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 No
BLM or NFS Coordination No
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? No
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

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 $330,563.51 $329,863.51 N/A $327,681.67 N/A
Total for all systems $1,083,898.51 $505,643.51 N/A $384,303.67 N/A
Primary Transmitter THU9-8 EVO $330,563.51 $329,863.51 $327,681.67
Interconnect $3,728.51 $3,728.51 Invoice from vendor $3,728.51 N/A
Other -- Building Addition Size: 100.0 $9,840.00 $9,840.00 Invoice from vendor $9,840.00 N/A
UHF - Air Cooled Solid State Transmitter 13 kW $297,795.00 $297,795.00 Estimate from manufacturer $297,795.00 N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $13,700.00 N/A $11,518.16 N/A
Other Electrical Service: Installation of new transmitter $4,800.00 $4,800.00 Quote from manufacturer $4,800.00 N/A

Components

Actual Information Description File Name
Interconnect

Component Description:
RF Specialties of Pennsylvania, Inc. Invoice #21600
Amount:
$3,728.51

Component Description:
RF Specialties of PA Invoice #21600
Amount:
$3,728.51
Other -- Building Addition Size: 100.0

Component Description:
Architectural Concrete Plus, LLC Invoice #2062
Amount:
$9,840.00
UHF - Air Cooled Solid State Transmitter 13 kW

Component Description:
R&S Invoice #9500107461 - 60% and 10% Payments
Amount:
$208,456.50

Component Description:
R&S Invoice #9500099195 - 30% Payment
Amount:
$89,338.50
Service entrance 3 phase/800 amp/208 volt

Component Description:
Bouille Electric Invoice #40395
Amount:
$11,518.16

Component Description:
Bouille Electric Invoice #40395
Amount:
$11,518.16
Other Electrical Service: Installation of new transmitter

Component Description:
R&S Invoice #9500117142 -- Installation
Amount:
$4,800.00

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 $130,290.00 $19,250.00 N/A $0.00 N/A
Total for all systems $1,083,898.51 $505,643.51 N/A $384,303.67 N/A
Primary Antenna TLP-BB-24B/VP-R $130,290.00 $19,250.00 $0.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $0.00 N/A N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $0.00 N/A N/A N/A
Elbow complex, broadband, at antenna input, per 4 1/16. feedline (if needed) $10,950.00 $0.00 N/A N/A N/A
New combiner, cost per channel (without antenna) $84,200.00 $19,250.00 N/A N/A N/A
UHF - High Power, Side Mount, broadband panel, 12 bay,, 100 kW input, elliptically or circularly polarized $0.00 $0.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $0.00 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 $134,900.00 $46,700.00 N/A $0.00 N/A
Total for all systems $1,083,898.51 $505,643.51 N/A $384,303.67 N/A
Primary Transmission Line $134,900.00 $46,700.00 $0.00
Rigid Transmission Line - copper, 4 1/16" $134,900.00 $46,700.00 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 $381,100.00 $0.00 N/A $0.00 N/A
Total for all systems $1,083,898.51 $505,643.51 N/A $384,303.67 N/A
Primary Tower TOWER $381,100.00 $0.00 $0.00
Structural engineering tower load study for well documented tower $12,600.00 $0.00 N/A N/A N/A
Minor tower reinforcement/modifications $158,000.00 $0.00 N/A N/A N/A
Tall Tower (greater than 500') $210,500.00 $0.00 N/A 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 $66,520.00 $69,900.00 N/A $39,935.00 N/A
Total for all systems $1,083,898.51 $505,643.51 N/A $384,303.67 N/A
Outside Professional Services $66,520.00 $69,900.00 $39,935.00
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $7,500.00 The actual costs were greater than the estimated costs. Estimated costs increased to reflect. $7,050.00 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A $1,260.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $1,021.25 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $1,520.75 N/A
Prepare request for Special Temporary Authorization $2,050.00 $2,050.00 N/A $1,627.50 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
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $0.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $150.00 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
Project management of the transition $31,600.00 $31,600.00 N/A $27,305.50 N/A

Components

Actual Information Description File Name
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Prepare and or review reimbursement form

Component Description:
Lerman Senter -- September 2021 -- Invoice #488179-WENY
Amount:
$220.00

Component Description:
LS - November 2020 - Invoice #483717-WENY
Amount:
$1,430.00

Component Description:
Lerman Senter -- March 2021 -- Invoice #485523-WENY
Amount:
$110.00

Component Description:
LS - August 2020 - Invoice #482078-WENY
Amount:
$770.00

Component Description:
LS - July 2020 - Invoice #481596-WENY
Amount:
$220.00

Component Description:
Lerman Senter -- July 2021 -- Invoice #487575-WENY
Amount:
$110.00

Component Description:
Lerman Senter -- August 2021 -- Invoice #487794-WENY
Amount:
$1,100.00

Component Description:
Lerman Senter -- January 2021 -- Invoice #484613-WENY
Amount:
$110.00

Component Description:
Lerman Senter - Jan 2019 - Invoice #472830-WENY
Amount:
$105.00

Component Description:
Assist with reimbursement requests - LS April 2018, #467309.
Amount:
$135.00

Component Description:
Lerman Senter - Sept 2018 - Invoice #470556-WENY
Amount:
$210.00

Component Description:
Lerman Senter - June 2020 - WENY Invoice #481003
Amount:
$880.00

Component Description:
Lerman Senter - Jan 2019 - WENY Invoice #472830
Amount:
$105.00

Component Description:
Lerman Senter -- December 2020-- Invoice #484246-WENY
Amount:
$440.00

Component Description:
Lerman Senter - Oct 2019 - WENY Invoice #477087
Amount:
$1,210.00

Component Description:
Lerman Senter -- Sept 2018 - WENY Invoice #470556
Amount:
$210.00
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
Lerman Senter - Nov 2018 - WENY Invoice #471739
Amount:
$1,260.00

Component Description:
Lerman Senter - Nov 2018 - Invoice #471739-WENY
Amount:
$1,260.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Lerman Senter - Feb 2020 - WENY Invoice #479171 - License to Cover
Amount:
$691.25

Component Description:
Lerman Senter - March 2020 - WENY Invoice #479655
Amount:
$330.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Lerman Senter - Feb 2020 - WENY Invoice #479171 - CP Extension
Amount:
$1,520.75
Prepare request for Special Temporary Authorization

Component Description:
Lerman Senter - Sept 2019 - WENY Invoice #476745
Amount:
$1,177.50

Component Description:
Mid-State Invoice #1907-5031 - August 2019
Amount:
$450.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
WENY - Mid-State Consultants, prepare WENY CP. Invoice #1707-5013.
Amount:
$780.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Mid-State Invoice #1810-5011 - Nov 2018
Amount:
$150.00

Component Description:
Mid-State Invoice #1907-5031 - August 2019
Amount:
$450.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Project management of the transition

Component Description:
Project management services with regard to engineering, accounting, and/or legal work - Feb 2018, #465104.
Amount:
$302.50

Component Description:
Lerman Senter - Oct 2018 - Invoice #471150-WENY
Amount:
$525.00

Component Description:
Lerman Senter - April2019 - WENY Invoice #474392
Amount:
$312.50

Component Description:
LS Invoice #476745 - Sept 2019
Amount:
$990.00

Component Description:
Lerman Senter - May 2019 - WENY Invoice #474671
Amount:
$630.00

Component Description:
Lerman Senter - Nov 2019 - WENY Invoice #477619
Amount:
$330.00

Component Description:
Lerman Senter - Dec 2019- WENY Invoice #478101
Amount:
$110.00

Component Description:
Lerman Senter - May 2020 - WENY Invoice #480697
Amount:
$3,520.00

Component Description:
Project management services with regard to engineering, accounting, and/or legal work - October 2017, #463130.
Amount:
$200.00

Component Description:
Project management services with regard to engineering, accounting, and/or legal work - November 2017, #463385.
Amount:
$200.00

Component Description:
Like Spectrum LLC Invoice #19101.pdf
Amount:
$8,400.00

Component Description:
Lerman Senter - Dec 2018 - Invoice #472554-WENY
Amount:
$945.00

Component Description:
Lerman Senter - July 2019 - WENY Invoice #475145
Amount:
$1,210.00

Component Description:
Lerman Senter - July 2019 - WENY Invoice #475570
Amount:
$770.00

Component Description:
Project management services with regard to engineering, accounting, and/or legal work - August 2017, #461545.
Amount:
$5,328.75

Component Description:
Lerman Senter - Feb 2020 - WENY Invoice #479171 - Project Management
Amount:
$553.00

Component Description:
Lerman Senter - March 2019 - WENY Invoice #473835
Amount:
$210.00

Component Description:
Lerman Senter - Aug 2019 - WENY Invoice #476016
Amount:
$330.00

Component Description:
Lerman Senter - Dec 2018 - WENY Invoice #472554
Amount:
$945.00

Component Description:
Lerman Senter - Feb 2019 - WENY Invoice #473410
Amount:
$420.00

Component Description:
Project management services with regard to engineering, accounting, and/or legal work - September 2017, #461699.
Amount:
$558.75

Component Description:
Lerman Senter - Aug 2018 - WENY Invoice #470013
Amount:
$281.25

Component Description:
Lerman Senter - Aug 2018 - Invoice #470013-WENY
Amount:
$281.25

Component Description:
Lerman Senter - Oct 2018 - WENY Invoice #471150
Amount:
$525.00

Component Description:
Lerman Senter - Jan 2020 - WENY Invoice #478707
Amount:
$440.00

Component Description:
Project management services with regard to engineering, accounting, and/or legal work - July 2018, #469169.
Amount:
$671.25

Component Description:
Project management services with regard to engineering, accounting, and/or legal work - May 2018, #467739.
Amount:
$67.50

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 $40,525.00 $39,930.00 N/A $16,687.00 N/A
Total for all systems $1,083,898.51 $505,643.51 N/A $384,303.67 N/A
Other Expenses $40,525.00 $39,930.00 $16,687.00
MVPD Notification of Channel Change $5,000.00 $5,000.00 Estimate based on prior experience. $1,562.00 N/A
Develop and air announcement of upcoming channel change $10,000.00 $10,000.00 Estimate based on prior experience. N/A N/A
Equipment Storage $5,658.00 $5,658.00 Quote from manufacturer $5,658.00 N/A
Equipment Delivery and Handling Charges $6,677.00 $6,677.00 Quote from vendor. $6,677.00 N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $200.00 FCC Filing Fee is $200.00. $200.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $2,590.00 N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change

Component Description:
DTVNotification - MVPD Notification - Invoice #INV-002111
Amount:
$1,562.00

Component Description:
DTVNotification - MVPD Notifications - Invoice #002111
Amount:
$1,562.00
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage

Component Description:
R&S Invoice #9500117142 -- Equipment Storage
Amount:
$5,658.00
Equipment Delivery and Handling Charges

Component Description:
R&S Invoice #9500117142 -- Equipment Delivery
Amount:
$6,677.00
FCC Filing Fees - Special Temporary Authorization request

Component Description:
LS Invoice #476745 - Sept 2019
Amount:
$200.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
DTV Medical Facility Notification

Component Description:
DTVNotification -- Medical Facility Notifications -- Invoice #INV-002110
Amount:
$2,590.00

Component Description:
DTVNotification - Medical Facility Notification - Invoice #002110
Amount:
$2,590.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,083,898.51 $505,643.51 $384,303.67

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. Yes
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.

Kevin Lilly

Manager of Sole Member


09/23/2021

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.

Kevin Lilly

Manager of Sole Member


09/23/2021

Certification

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Section Question Response
Submission of Final Allocation or Accounting Information 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 and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

  2. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  3. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.

  4. 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.

  5. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  6. 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.

Kevin Lilly

Manager of Sole Member


09/23/2021

Attachments

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