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:
67878
Service:
LPD
Call Sign:
KEVE-LD
Channel:
31 (UHF)
File Number:
0000090118
FRN:
0019858117
Eligibility Status:
Eligible
Date Submitted:
04/18/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

SOUTHERN OREGON CONFERENCE ASSN. OF SEVENTH-DAY ADVENTISTS

Doing Business As: SOUTHERN OREGON CONFERENCE ASSN. OF SEVENTH-DAY ADVENTISTS

Herald Follett

19800 OATFIELD ROAD

GLADSTONE, OR 97027

United States

+1 (503) 850-3500 Herald.Follett@oc.npuc.org Not-for-Profit

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

Tony Zummallen

President

QCommunications, LLC

Tony Zummallen

705B SE Melody Lane #314

Lee's Summit, MO 64063

United States

+1 (816) 729-1177 tony@Qcomm.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. No
Briefly describe transition plan Replace the transmitter and the antenna per the channel reassignment project using reasonable and customary engineering and business practices.

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 SDT202UB ARK1_ATSC
Year 2010
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity .9 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? No
Manufacturer
Model UAXTE-2-G2
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.2 kW
Justification for New Transmitter New transmitter required for new channel.

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? Yes
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 No
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

Name Description

Taxes

Estimated sales tax

Shipping

Estimated shipping and freight costs

Transmitter Site Prep

Prep site for installation crew

Decommission

De-install and disconnect old transmitter

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)
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? Yes
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model ALP16L2-HSOC
Year 2010

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Change Type Purchase New
Ownership Owned
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
ERP: 2.0 kW
Manufacturer
Model DLP-12H
Year 2019
Justification for New Antenna New antenna required for new channel

Primary Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Shipping

Shipping costs of new antenna

Sales Tax

Sales tax for new antenna

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)
Ownership Owned
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? No
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 3 1/8 inches
Segment Length 19 3/4 inches
Number of parallel runs 1
Length 620 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 3 1/8 inches
Segment Length 20 inches
Number of parallel runs 1
Length 920 feet per run
Justification for New Transmission Line Repack station KEVE, pre-repack channel 36, required line section lengths of 19 3/4 while the repack channel require 20' sections.
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? Yes

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Sweep

Sweep per Dielectric quote 1935287

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)
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? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1035761
Coordinates (NAD83) Latitude (NAD83) 45° 31' 13.0" N-
Longitude (NAD83) 122° 44' 41.0" W-
Overall Structure Height 918.62 feet
Support Structure Height 812.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 954.38 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Sinclair Portland Licensee, LLC
Date Constructed 08/15/1973

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
10192 KRCW-TV DTV
34882 KUNP-LD LPD
35380 KOIN 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: Tower mapping and report for structural engineer
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 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 Required to assist in the turnkey management of the channel relocation project in order that the existing internal personnel can maintain and operate the station's daily operational requirements and plans.
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 Yes
Quantity 1
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 Yes
Quantity 1
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Form 399 assistance or other program management costs Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 5
Justification Estimated field engineering required during transition activities

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Engineering-General

Engineering Consultations

Attorney Fees- REPACK Related

General Attorney fees due to REPACK

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 Yes
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
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

Name Description

Barrel Adapter

Barrel adapter - QComm

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $126,900.00 $102,291.00 N/A $64,891.00 N/A
Total for all systems $555,094.40 $406,491.65 N/A $242,568.34 N/A
Primary Transmitter UAXTE-2-G2 $126,900.00 $102,291.00 $64,891.00
Decommission $6,000.00 $6,000.00 Estimated costs to deinstall, disconnect and decommission old transmitter in preparation for new transmitter. N/A N/A
Transmitter Site Prep $16,000.00 $16,000.00 Per QComm quote KEVEInstall - dated 12/8/2020 $16,000.00 N/A
Shipping $2,500.00 $2,500.00 Estimated shipping and freight costs to ship transmitter from manufacturer to site. Actual costs to be determined. $2,500.00 N/A
Taxes $8,400.00 $8,400.00 4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. N/A N/A
Transmitter Building Site Survey/Installation $10,000.00 $25,000.00 4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. $2,000.00 N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $84,000.00 $44,391.00 Cost determined by invoices/quotes $44,391.00 N/A

Components

Actual Information Description File Name
Decommission Information not provided.
Transmitter Site Prep

Component Description:
Site prep before installation of transmitter - QComm - INV 120064
Amount:
$16,000.00
Shipping

Component Description:
Cost of shipping
Amount:
$2,500.00
Taxes Information not provided.
Transmitter Building Site Survey/Installation

Component Description:
Site Survey
Amount:
$2,000.00
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
Remaining balance for the transmitter the remaining $2,500 will be requested in shipping
Amount:
$20,945.50

Component Description:
50% Down Payment invoice 1 of 2
Amount:
$23,445.50

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 $22,718.00 $20,327.00 N/A $10,597.00 N/A
Total for all systems $555,094.40 $406,491.65 N/A $242,568.34 N/A
Primary Antenna DLP-12H $22,718.00 $20,327.00 $10,597.00
Sales Tax $2,000.00 $2,000.00 Estimated sales tax for new antenna. Actual costs to be determined. N/A N/A
Shipping $2,000.00 $2,000.00 Estimated freight and shipping costs for new antenna. Actual costs to be determined. N/A N/A
Side Mount antenna brackets $4,625.00 $2,234.00 Cost determined by invoice. $2,234.00 N/A
Sweep test of transmission line and antenna $5,730.00 $5,730.00 N/A N/A N/A
UHF-Low Power, Side Mount, Slotted Coaxial, 2.0kW input, Horizontal $8,363.00 $8,363.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***Cost determined by invoices $8,363.00 N/A

Components

Actual Information Description File Name
Sales Tax Information not provided.
Shipping Information not provided.
Side Mount antenna brackets

Component Description:
Cost of side mounts
Amount:
$2,234.00
Sweep test of transmission line and antenna Information not provided.
UHF-Low Power, Side Mount, Slotted Coaxial, 2.0kW input, Horizontal

Component Description:
Cost of antenna
Amount:
$8,363.00

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 $97,114.50 $71,964.75 N/A $71,964.75 N/A
Total for all systems $555,094.40 $406,491.65 N/A $242,568.34 N/A
Primary Transmission Line $97,114.50 $71,964.75 $71,964.75
Sweep $6,400.00 $6,400.00 Per Dielectric quote 1935287 $6,400.00 N/A
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators $5,614.50 $5,614.50 Per Dielectric quote 1935287, Line 11 $5,614.50 N/A
Rigid Transmission Line - copper, 3 1/8" $85,100.00 $59,950.25 per actual costs from invoices. $59,950.25 N/A

Components

Actual Information Description File Name
Sweep

Component Description:
Sweep - Dielectric - INV 1935287
Amount:
$6,400.00

Component Description:
Sweep - Dielectric inv 1935287
Amount:
$6,400.00
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators

Component Description:
RF systems - Dielectric - INV 1935287
Amount:
$5,614.50

Component Description:
Scout system - Dielectric - INV 1935287
Amount:
$5,614.50
Rigid Transmission Line - copper, 3 1/8"

Component Description:
Transmission LIne - Dielectric - INV 1935287
Amount:
$59,950.25

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 $178,750.00 $59,000.00 N/A $33,625.00 N/A
Total for all systems $555,094.40 $406,491.65 N/A $242,568.34 N/A
Primary Tower TOWER $178,750.00 $59,000.00 $33,625.00
Tower mapping and report for structural engineer $21,000.00 $21,000.00 4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. N/A N/A
Tower Rigging Tall Tower (greater than 500') $157,750.00 $38,000.00 Cost based on submitted quote from Rio Steel dated 2/1/2022 plus associated change order per actual costs. $33,625.00 N/A

Components

Actual Information Description File Name
Tower mapping and report for structural engineer Information not provided.
Tower Rigging Tall Tower (greater than 500')

Component Description:
2nd inv - tower rigging - INV 821149-2
Amount:
$5,000.00

Component Description:
Down payment for antenna installation.
Amount:
$5,000.00

Component Description:
Line install - Rio Steel - INV 822014-1
Amount:
$8,125.00

Component Description:
Change orders - Tower rigging - INV 821149-4
Amount:
$5,500.00

Component Description:
3rd inv - tower rigging - INV 821149-3
Amount:
$10,000.00

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 $116,596.25 $139,893.25 N/A $60,780.00 N/A
Total for all systems $555,094.40 $406,491.65 N/A $242,568.34 N/A
Outside Professional Services $116,596.25 $139,893.25 $60,780.00
Project management of the transition $21,100.00 $52,475.00 Cost determined by invoices. $52,475.00 Actual equals estimated
Attorney Fees- REPACK Related $1,086.25 $1,086.25 Cost determined by Invoices. $1,005.00 N/A
Engineering-General $2,310.00 $2,310.00 Cost determined by invoices. $2,310.00 N/A
Additional Field Engineering Service, 5 Days $12,500.00 $12,500.00 Estimated costs for field engineering services during transition activities. Actual costs to be determined. N/A N/A
Comprehensive coverage verification via field study, if needed $52,600.00 $43,732.00 Per-attached quote number 732-R for Coverage Verification N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $2,235.00 $2,235.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $3,262.50 $3,262.50 4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. N/A N/A
Prepare Form 601 $755.00 $755.00 4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. N/A 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 $540.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,102.50 N/A $1,950.00 N/A
Prepare request for Special Temporary Authorization $1,280.00 $1,280.00 N/A N/A N/A
Perform engineering study for displacement application $1,800.00 $1,800.00 N/A N/A N/A
Form 399 assistance or other Program Management costs $8,200.00 $8,200.00 Per attached QCommunications quote. $0.00 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $2,500.00 Per attached QCommunications quote. $2,500.00 N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
PM paperwork
Amount:
$539.00

Component Description:
Paperwork PM
Amount:
$993.30

Component Description:
March 2022 PM - Qcomm - INV 20220303
Amount:
$1,593.90

Component Description:
Oct 2021 TEch & 399 PM - QComm - INV 230072
Amount:
$2,941.40

Component Description:
Dec 2021 Tech & 399 PM - QComm - INV 2022003
Amount:
$3,773.00

Component Description:
Sept 2021 Tech & 399 PM - QComm - INV 230050
Amount:
$4,635.40

Component Description:
Jan 2022 PM - QComm - INV 220025
Amount:
$2,849.00

Component Description:
Tech & 399 PM - QComm - INV 220042
Amount:
$3,927.00

Component Description:
PM Paperwork
Amount:
$1,108.80

Component Description:
PM Paperwork
Amount:
$1,601.60

Component Description:
PM Paperwork
Amount:
$2,941.40

Component Description:
PM Paperwork
Amount:
$539.00

Component Description:
Paperwork PM
Amount:
$1,108.80

Component Description:
PM Paperwork
Amount:
$415.80

Component Description:
PM Paperwork
Amount:
$1,509.20

Component Description:
PM Paperwork
Amount:
$2,371.60

Component Description:
PM Paperwork
Amount:
$1,093.40

Component Description:
PM Paperwork
Amount:
$600.60

Component Description:
Prepare and Process Form 399
Amount:
$500.00

Component Description:
Paperwork PM
Amount:
$970.20

Component Description:
Paperwork PM
Amount:
$2,002.00

Component Description:
PM Paperwork
Amount:
$831.60

Component Description:
PM Paperwork
Amount:
$600.60

Component Description:
PM Paperwork and Tech PM
Amount:
$4,727.80

Component Description:
PM Paperwork
Amount:
$1,540.00

Component Description:
Paperwork PM
Amount:
$2,063.60

Component Description:
Paperwork PM
Amount:
$924.00

Component Description:
Prepare and process 399
Amount:
$500.00

Component Description:
PM Paperwork
Amount:
$2,294.60

Component Description:
Nov 2021 Tech & 399 PM - QComm - INV 230088
Amount:
$1,078.00

Component Description:
PM Paperwork
Amount:
$1,540.00
Attorney Fees- REPACK Related

Component Description:
Legal Services - Donald Martin - INV 2022.02.15
Amount:
$1,005.00

Component Description:
Attorney Fees
Amount:
$1,086.25
Engineering-General

Component Description:
Gen Eng - Lohnes - INV 202202-1613-01-1
Amount:
$1,380.00

Component Description:
Engineering Consulting
Amount:
$930.00
Additional Field Engineering Service, 5 Days Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization 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.
Prepare Form 601 Information not provided.
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

Component Description:
License to cover - eng - Lohnes - INV 202202-1613-01-1
Amount:
$540.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Eng CP - Lohnes - INV 202202-1613-01-1
Amount:
$1,950.00
Prepare request for Special Temporary Authorization Information not provided.
Perform engineering study for displacement application Information not provided.
Form 399 assistance or other Program Management costs

Component Description:
Resubmitted in 'Project Management of the Transition'.
Amount:
N/A

Component Description:
Resubmitted in 'Project Management of the Transition'.
Amount:
N/A

Component Description:
Resubmitted in 'Project Management of the Transition'.
Amount:
N/A

Component Description:
Resubmitted in 'Project Management of the Transition'.
Amount:
N/A

Component Description:
Resubmitted in 'Project Management of the Transition'.
Amount:
N/A

Component Description:
Resubmitted in 'Project Management of the Transition'.
Amount:
N/A

Component Description:
Resubmitted in 'Project Management of the Transition'.
Amount:
N/A
Prepare/ Review 399 reimbursement form

Component Description:
From 399 Submission
Amount:
$2,500.00

Component Description:
Form 399 Submission.
Amount:
$2,500.00

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 $13,015.65 $13,015.65 N/A $710.59 N/A
Total for all systems $555,094.40 $406,491.65 N/A $242,568.34 N/A
Other Expenses $13,015.65 $13,015.65 $710.59
Barrel Adapter $305.65 $305.65 Costs per actual invoices $305.65 N/A
Equipment Storage $2,000.00 $2,000.00 Expecting multiple staggered equipment deliveries from different vendors and need to store and stage new equipment prior to installation date. Anticipate 6-24 months of storage time. N/A N/A
Equipment Delivery and Handling Charges $2,000.00 $2,000.00 Estimate of transport, forklift rental and handling fees from staging area to transmitter site. Actual costs to be determined. $404.94 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,000.00 $2,000.00 4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. N/A N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $305.00 N/A N/A N/A
FCC Filing Fees - Form 2100 Major change CP application $4,960.00 $4,960.00 4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. 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
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A N/A N/A

Components

Actual Information Description File Name
Barrel Adapter

Component Description:
Barrel Adapter - QComm - INV 220022
Amount:
$305.65
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges

Component Description:
forklift rental - Pape - INV 742996001
Amount:
$404.94
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 Major change CP application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $555,094.40 $406,491.65 $242,568.34

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. No
Construction of final facilities or all necessary modifications are complete. No
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator. No

Certification

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Section Question Response
Submission of Estimated Expenses Statements

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.

  1. The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.

  2. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

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

  4. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).

  5. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.

  6. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.

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

  8. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Herald Follett

Applicant


04/18/2022

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.

Herald Follett

Applicant


04/18/2022

Attachments

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