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:
168419
Service:
DCA
Call Sign:
WJTS-CD
Channel:
24 (UHF)
File Number:
0000028091
FRN:
0015209620
Date Submitted:
09/29/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

Paul E Knies

Doing Business As: WJTS-CD

General Manager

P.O. BOX 1009

JASPER, IN 47547

United States

+1 (812) 482-2727 wjts1@DCBROADCASTING.COM Individual

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

John Neely , Esq .

counsel

Miller and Neely, PC

4 Simms Court

Kensington, MD 20895

United States

+1 (301) 933-6304 johnsneely@yahoo.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. No
Briefly describe transition plan Transition by Assigned Phase Completion Date

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 lu2000 atd
Year 2008
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 2 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-6
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 4.32 kW
Justification for New Transmitter Repacking from Ch. 18 to 24 results in higher power requirement than permitted by existing Tx maximum capability.

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? Yes
Size 24.0 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

Heat Exhcanger

4459.95

7 percent Indiana state use tax on purchase

11417.78

Install Material kit

590.75

XTE Exciter with supply of new Digital Mask Filter

14950.00

Antifreeze Coolant

247.26

Installation Service

26766.25

ULXT System wiring kit

590.75

Parallel Surge Suppressor

1726.66

Coupler

1375.30

Internal High Efficiency Pump Module

6442.64

Coolant Transfer charge kit

308.30

RF line connection kit

6314.65

Plumbing Integrated pump kit

1838.72

shipping

5000.00

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? No
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: 15.0 kW
Manufacturer
Model ALP12L4-HSO
Year 2008

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? No
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 Circular
Type Broadband Slot
Number of Stations Supported 1
Number of Panels/Bays 12
Lower Limit 530.00 MHz
Upper Limit 536.00 MHz
Design power capacity in use 100.0 %
Other Antenna Type N/A
ERP: 15.0 kW
Manufacturer
Model ALP12L4-CSO-24
Year 2017
Justification for New Antenna change from h-pol to c-pol

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 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? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

ERI - field services

field services

ERI - antenna installation

Antenna Installation services

ERI - add'l intall hardware

additional installation hardware

ERI - freight

Freight/shipping

ERI - Indiana Sales Tax

Indiana Sales Tax

ERI- filter systerm

filter system

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 Purchase New
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
Type Flexible Air
Diameter Other
Other Diameter 3 1/8 inches
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 10 feet per run

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? No
Type Rigid
Diameter 3 1/8 inches
Other Diameter N/A
Segment Length Other
Other Segment Length 10 feet
Number of parallel runs 1
Length 5 feet per run
Justification for New Transmission Line transmitter compatibility

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? 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 40
Explanation contract engineer project manager to supervise and facilitate equipment installation and coordinate equipment suppliers, tower crew, and ready the tx site for channel conversion. $125 per hour
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development No
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 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 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 Yes
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

Station Owner

Paul Knies station owner - for project management, contact with MVPD, assisting counsel to prepare forms 399, 1876 and 2100, identify suppliers/contractors; 80 hours at $25 per hour.

Ouside Electrical Contractor

Fischer Electric - transmitter shelter electrical site work to receive new transmitter

General Manager

Bill Potter WJTS General Manager - for project management, gather Form 399 costs, contact with MVPD, assess project needs, public outreach, coord. buildout schedule, coord suppliers/contractors; 80 hours at $25 per hour.

Medical Facility Notification

notification required as a special condition of the displacement construction permit

Part time staff engineer

Evan Elrod part time WJTS staff engineer labor to remove and dispose old transmitter, services as needed for additional wiring, site preparation, repack project equipment oversight. 60 hours at $25 per hour

Office Administrative Assistance

Celia Neukam WJTS at $25 per hour

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 No
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? No
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

Nonreducible Dark Station costs

nonreducible costs when station is dark pending coordination with linked-stations and commencing program test operations.

Newspaper and Radio advertising

Alert public as to rescan necessity. 3 newspaper $3000, 4 radio stations $3000

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 $210,708.81 $210,708.81 N/A $169,982.23 N/A
Total for all systems $427,823.09 $456,366.07 N/A $262,240.34 N/A
Primary Transmitter ULXTE-6 $210,708.81 $210,708.81 $169,982.23
shipping $5,000.00 $5,000.00 see price quote $5,000.00 N/A
Plumbing Integrated pump kit $1,838.72 $1,838.72 see price quote $0.00 N/A
RF line connection kit $20,986.82 $20,986.82 see price quote $20,986.82 N/A
Coolant Transfer charge kit $308.30 $308.30 see price quote $0.00 N/A
Internal High Efficiency Pump Module $6,442.64 $6,442.64 see price quote $0.00 N/A
Coupler $1,375.30 $1,375.30 see price quote $0.00 N/A
Parallel Surge Suppressor $1,726.66 $1,726.66 see price quote $0.00 N/A
ULXT System wiring kit $2,317.41 $2,317.41 see price quote $2,317.41 N/A
Installation Service $27,359.00 $27,359.00 see price quote $27,357.00 N/A
Antifreeze Coolant $247.26 $247.26 see price quote $0.00 N/A
XTE Exciter with supply of new Digital Mask Filter $14,950.00 $14,950.00 see price quote $0.00 N/A
7 percent Indiana state use tax on purchase $8,785.00 $8,785.00 7 percent Indiana state use tax $0.00 N/A
Heat Exhcanger $4,459.95 $4,459.95 see price quote $0.00 N/A
Other -- Building Addition Size: 24.0 $1,871.00 $1,871.00 The required outside heat exchanger requires concrete pad extension to the transmitter shelter with ice breaker hardware to protect the heat exchanger from falling ice damage $1,871.00 N/A
UHF - Liquid Cooled Solid State Transmitter 4.32 kW $112,450.00 $112,450.00 see price quote $112,450.00 N/A
Install Material kit $590.75 $590.75 see price quote $0.00 N/A

Components

Actual Information Description File Name
shipping

Component Description:
freight
Amount:
$5,000.00
Plumbing Integrated pump kit

Component Description:
Plumbing Integrated pump kit
Amount:
$1,838.72
RF line connection kit

Component Description:
RF Accessories
Amount:
$10,493.41

Component Description:
connection kit
Amount:
$10,493.41
Coolant Transfer charge kit

Component Description:
transfer charge kit
Amount:
$308.30
Internal High Efficiency Pump Module

Component Description:
Internal High Efficiency Pump Module
Amount:
N/A
Coupler

Component Description:
coupler
Amount:
$1,375.30
Parallel Surge Suppressor

Component Description:
surge suppressor
Amount:
N/A
ULXT System wiring kit

Component Description:
electrical
Amount:
$1,158.71

Component Description:
system wiring
Amount:
$1,158.70
Installation Service

Component Description:
remaining balance installation service
Amount:
$13,383.12

Component Description:
Installation and Proof
Amount:
$13,678.50

Component Description:
install material kit
Amount:
$295.38
Antifreeze Coolant

Component Description:
coolant
Amount:
$247.26
XTE Exciter with supply of new Digital Mask Filter

Component Description:
ignore this item
Amount:
N/A

Component Description:
Exciter
Amount:
N/A
7 percent Indiana state use tax on purchase

Component Description:
7 percent Indiana state use tax on purchase
Amount:
N/A
Heat Exhcanger

Component Description:
Heat Exchanger
Amount:
$4,459.95
Other -- Building Addition Size: 24.0

Component Description:
labor to assemble and install ice breaker at transmitter site
Amount:
$450.00

Component Description:
install 4x8 concrete pad and purchase ice breaker
Amount:
$1,421.00
UHF - Liquid Cooled Solid State Transmitter 4.32 kW

Component Description:
transmitter
Amount:
$13,383.13

Component Description:
transmitter
Amount:
$56,225.00

Component Description:
additional xm payment
Amount:
$42,841.87
Install Material kit

Component Description:
install material kit
Amount:
N/A

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 $69,904.58 $105,467.91 N/A $60,980.37 N/A
Total for all systems $427,823.09 $456,366.07 N/A $262,240.34 N/A
Primary Antenna ALP12L4-CSO-24 $69,904.58 $105,467.91 $60,980.37
ERI- filter systerm $8,870.00 $8,870.00 antenna filter system equipment $4,435.00 N/A
ERI - Indiana Sales Tax $2,372.70 $2,372.70 ***System Notice: Estimate adjusted and locked because line has been superseded.***Indian sales tax $2,239.37 The Sub-total is greater than Estimated Cost. Please provide an explanation for the difference in costs.
ERI - freight $285.88 $285.88 ship antenna to tower site. $0.00 N/A
ERI - add'l intall hardware $1,621.00 $1,621.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***required add'l install hardware $1,621.00 N/A
ERI - antenna installation $22,225.00 $22,225.00 antenna installation $11,112.50 N/A
ERI - field services $1,500.00 $1,500.00 field services $750.00 N/A
Sweep test of existing antenna $6,730.00 $6,250.00 ERI sweep testing $3,125.00 N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $62,343.33 per attached ERI invoice includes $8870 Bandpass filter, + $1500 mask filter installation fee + $27535 antenna cost + $22225 antenna installation services + $285.88 freight charge + 7% Indiana sales tax $1927.45 $37,697.50 N/A

Components

Actual Information Description File Name
ERI- filter systerm

Component Description:
50% filter system
Amount:
$4,435.00
ERI - Indiana Sales Tax

Component Description:
Indiana sales tax
Amount:
$2,239.37
ERI - freight

Component Description:
ship antenna to job site - expense not previously request
Amount:
$285.88

Component Description:
ship antenna to job site
Amount:
$285.88
ERI - add'l intall hardware

Component Description:
additional miscellaneous hardware required on installation date
Amount:
$1,621.00

Component Description:
disregard this item
Amount:
N/A
ERI - antenna installation

Component Description:
40% installation services
Amount:
$8,890.00

Component Description:
10% installation services
Amount:
$2,222.50
ERI - field services

Component Description:
40% field services
Amount:
$600.00

Component Description:
10% field services
Amount:
$150.00
Sweep test of existing antenna

Component Description:
40% sweep testing
Amount:
$2,500.00

Component Description:
10% sweep testing
Amount:
$625.00
UHF - Lower Power Side Mount, Class A One Station antenna -- basic

Component Description:
50% equipment
Amount:
$7,525.00

Component Description:
ignore this item
Amount:
N/A

Component Description:
50% antenna deposit
Amount:
$30,172.50

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 $520.00 $6,314.65 N/A $0.00 N/A
Total for all systems $427,823.09 $456,366.07 N/A $262,240.34 N/A
Primary Transmission Line $520.00 $6,314.65 $0.00
Rigid Transmission Line - copper, 3 1/8" $520.00 $6,314.65 compatibility with transmitter $0.00 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 3 1/8"

Component Description:
transmission line and hangars
Amount:
$6,314.65

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 $116,304.99 $111,544.99 N/A $22,870.24 N/A
Total for all systems $427,823.09 $456,366.07 N/A $262,240.34 N/A
Outside Professional Services $116,304.99 $111,544.99 $22,870.24
General Manager $2,000.00 $2,000.00 wage $1,731.25 N/A
Station Owner $2,000.00 $2,000.00 wage $631.25 N/A
Part time staff engineer $1,500.00 $1,500.00 wages $728.75 N/A
Office Administrative Assistance $200.00 $200.00 N/A $154.00 N/A
Medical Facility Notification $0.00 $0.00 please reject $0.00 medical facility notification expense required as per special condition to the displacement construction permit
Ouside Electrical Contractor $2,464.99 $2,464.99 Electric Panel and sitework for transmitter replacement $2,464.99 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,340.00 N/A $2,340.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,220.00 N/A $5,220.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 Price quote from consulting engineer. $250.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $2,000.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $1,350.00 N/A
Project management of the transition $6,320.00 $6,320.00 N/A $6,000.00 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

Components

Actual Information Description File Name
General Manager

Component Description:
wages attributed to repack tasks
Amount:
$1,731.25
Station Owner

Component Description:
wages attributable to repack tasks
Amount:
$631.25
Part time staff engineer

Component Description:
wages attributed to repack tasks
Amount:
$728.75
Office Administrative Assistance

Component Description:
wages attributed to repack tasks
Amount:
$154.00
Medical Facility Notification

Component Description:
reject
Amount:
N/A
Ouside Electrical Contractor

Component Description:
Electric panel and sitework for transmitter replacement
Amount:
$2,464.99
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Legal Services repack license to cover
Amount:
$2,340.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Legal Services construction permit application
Amount:
$5,220.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
engineering work - application for license to cover CP
Amount:
$250.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
repack CP application engineering work
Amount:
$2,000.00
Prepare and or review reimbursement form

Component Description:
Legal Services repack reimbursement
Amount:
$1,350.00
Project management of the transition

Component Description:
Legal Services - repack reimbursement
Amount:
$6,000.00
Address transition timing and coordination issues w/ other stations and wireless 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 $30,384.71 $22,329.71 N/A $8,407.50 N/A
Total for all systems $427,823.09 $456,366.07 N/A $262,240.34 N/A
Other Expenses $30,384.71 $22,329.71 $8,407.50
Newspaper and Radio advertising $6,000.00 $6,000.00 N/A $4,537.50 N/A
Nonreducible Dark Station costs $7,000.00 $7,000.00 nonreducible costs while station is dark for tower work and linked-station coordination while preparing to commence program test operation. $1000 per day for 7 days. N/A N/A
MVPD Notification of Channel Change $500.00 $500.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $1,000.00 $1,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $889.71 $889.71 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,000.00 $2,000.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 Media Bureau Fee filer Guide $335.00 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 $3,535.00 required by construction permit special condition $3,535.00 .

Components

Actual Information Description File Name
Newspaper and Radio advertising

Component Description:
Repack/Rescan community education newspaper advertising
Amount:
$148.50

Component Description:
Repack/Rescan community education radio advertising
Amount:
$1,025.00

Component Description:
Repack/Rescan community education radio advertising
Amount:
$737.50

Component Description:
Repack/Rescan community education newspaper advertising
Amount:
$464.00

Component Description:
Repack/Rescan community education radio advertising
Amount:
$887.50

Component Description:
Repack/Rescan community education radio advertising
Amount:
$1,275.00
Nonreducible Dark Station costs Information not provided.
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Delivery and Handling Charges Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
FCC Filing Fees - Form 2100 license to cover application

Component Description:
Repack license to cover application filing fee
Amount:
$335.00
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
DTV Medical Facility Notification

Component Description:
required by CP special condition; estimate and invoice.
Amount:
$3,535.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $427,823.09 $456,366.07 $262,240.34

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.

Paul Knies

individual licensee


09/29/2021

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.

Paul Knies

individual licensee


09/29/2021

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.

Paul Knies

individual licensee


09/29/2021

Attachments

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