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:
57187
Service:
LPD
Call Sign:
KVQT-LD
Channel:
14 (UHF)
File Number:
0000088722
FRN:
0006751481
Eligibility Status:
Eligible
Date Submitted:
06/15/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

C. Dowen Johnson

Doing Business As: C. DOWEN JOHNSON

C. Dowen Johnson

104 WOODMONT

MONTGOMERY, TX 77356

United States

+1 (936) 443-4451 windsongcomm@swbell.net 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

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. No
Briefly describe transition plan Replace the transmitter, line and antenna per the channel reassignment project with 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 ELM10KIOT
Year 2009
Type Other Type
Other Transmitter Type Inductive Output
Power Capacity 10 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 TRN-5x-U-88C
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 8.8 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

Transmitter Site Prep

Prepare the site for installation of new transmitter

Decommission Old Transmitter

De-install and disconnect all components of existing transmitter to prepare for installation of new one

Shipping

Estimated shipping of transmitter not included in quote

Taxes

Estimated taxes not included in transmitter quote

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 Middle
Polarization Circular
Type Broadband Panel
Number of Stations Supported 1
Number of Panels 16
Design power capacity in use 100.0 %
Lower Limit 18.00 MHz
Upper Limit 69.00 MHz
ERP: 10.5 kW
Manufacturer
Model SUP24P4
Year 2001

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 Middle
Polarization Circular
Type Slotted Coaxial
ERP: 5.0 kW
Manufacturer
Model PSILP16AWCR-14-CP
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

Taxes

Antenna sales tax

Shipping

Antenna shipping fees

Plate reducer

Plate reducer

Transmission Line

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Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? No

Tower Equipment And Rigging Costs

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Section Question Response
Tower Equipment or Rigging Costs Changes Do you have tower equipment or rigging costs changes? 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? Candelabra
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) No
Others Types of Users Yes
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 1064696
Coordinates (NAD83) Latitude (NAD83) 29° 34' 16.0" N-
Longitude (NAD83) 095° 30' 38.0" W-
Overall Structure Height 1973.07 feet
Support Structure Height 1842.17 feet
Ground Elevation Above Mean Sea Level (AMSL) 76.77 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers LLC
Date Constructed 11/19/2001


Other Types of Users

Users
Phone-two-way
Microwave

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: Minor Reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Candelabra
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Install Equipment

Equipment to Complete Installation

Tower Rigging

Installation of Antennas

Sales Tax

Sales Tax

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 350
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 On-site field engineering anticipated during transition activities.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Permit pickup

Flat fee for picking up permit

A and E Walk

Site walk coordinated with A&E firm

Displacement Window Filings

Displacement Window Filings

Field and Technical Project Management

Field and Technical Project Management

Building permit application

Flat fee for preparation of BP application

Co-location application

Flat fee for preparation of co-location application

Complex zoning

Potential for complex zoning with hearing

Construction drawings

Construction drawings

Fully executed amendment with non-MLA landlord

Flat fee service for completion of amendment

Landlord NTP

Flat fee for landlord approval to proceed

Leasing audit

Entitlement review of existing lease documents

NEPA and SHPO compliance

NEPA/SHPO compliance

Negotiation of co-location lease

Negotiation of co-location lease by telecom consultant

Zoning and permitting determination

Flat fee service for zoning/permitting determination

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

Land Study

Costs for land study

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 $348,314.22 $218,208.22 N/A $172,736.22 N/A
Total for all systems $789,838.67 $635,174.67 N/A $341,982.26 N/A
Primary Transmitter TRN-5x-U-88C $348,314.22 $218,208.22 $172,736.22
Taxes $20,000.00 $20,000.00 Estimated taxes on transmitter not included on quote N/A N/A
Shipping $5,540.22 $5,540.22 Per attached invoices. $2,357.22 N/A
Decommission Old Transmitter $9,907.00 $9,907.00 Actual labor costs from invoice to de-install and disconnect old transmitter and its components in preparation for installation of new transmitter $0.00 N/A
Transmitter Site Prep $2,122.00 $2,122.00 Prepare site for arrival of new transmitter. Includes receiving and inventory of transmitter and its components; pre-assembling cabinets and subassemblies; ensuring that the installation crew has all materials necessary on site before arrival $0.00 N/A
Transmitter Building Site Survey/Installation $10,000.00 $27,300.00 Estimated costs for site survey and transmitter installation. Actual costs to be determined. $27,300.00 N/A
Channel 14 -- Additional field engineering time, 5 days $5,000.00 $5,000.00 Estimated field engineering time required. N/A N/A
Channel 14 Mask Filter $189,500.00 $42,094.00 Cost determined from invoice and quote submitted. $42,094.00 N/A
RF Consulting Engineer $5,260.00 $5,260.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 8.8 kW $100,985.00 $100,985.00 Per attached Anywave invoice. $100,985.00 N/A

Components

Actual Information Description File Name
Taxes Information not provided.
Shipping

Component Description:
Transmitter components delivery
Amount:
$3,183.00

Component Description:
Cost of shipping transmitter to Next Level TV Group
Amount:
$2,357.22

Component Description:
Remove
Amount:
N/A
Decommission Old Transmitter Information not provided.
Transmitter Site Prep

Component Description:
Site Survey/installation.
Amount:
$2,122.00
Transmitter Building Site Survey/Installation

Component Description:
Remove
Amount:
N/A

Component Description:
See attached cover letter
Amount:
$8,000.00

Component Description:
Electric services related to transmitter installation
Amount:
$3,800.00

Component Description:
Remove
Amount:
N/A

Component Description:
Survey/installation
Amount:
$6,366.00

Component Description:
Cost of transmitter install
Amount:
$15,500.00
Channel 14 -- Additional field engineering time, 5 days Information not provided.
Channel 14 Mask Filter

Component Description:
Remove
Amount:
N/A

Component Description:
Cost of Mask Filter
Amount:
$42,094.00

Component Description:
Cost of mask filter. See attached 3kW quote for pricing.
Amount:
$42,094.00
RF Consulting Engineer Information not provided.
UHF - Air Cooled Solid State Transmitter 8.8 kW

Component Description:
Cost of 3kW transmitter
Amount:
$100,985.00

Component Description:
Remove
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 $46,565.55 $46,565.55 N/A $32,985.00 N/A
Total for all systems $789,838.67 $635,174.67 N/A $341,982.26 N/A
Primary Antenna PSILP16AWCR-14-CP $46,565.55 $46,565.55 $32,985.00
Shipping $1,800.00 $1,800.00 Estimated shipping & freight costs not included on quote $1,800.00 N/A
Plate reducer $325.55 $325.55 Per attached ERI quote. N/A N/A
Taxes $2,900.00 $2,900.00 Estimated antenna taxes not included on quote. Actual costs to be determined. N/A 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, 5.0kW input, Circular $31,185.00 $31,185.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***Cost determined from invoice $31,185.00 N/A
Side Mount antenna brackets $4,625.00 $4,625.00 N/A N/A N/A

Components

Actual Information Description File Name
Shipping

Component Description:
Cost of shipping
Amount:
$1,800.00

Component Description:
Antenna Shipping
Amount:
$1,800.00
Plate reducer Information not provided.
Taxes Information not provided.
Sweep test of transmission line and antenna Information not provided.
UHF-Low Power, Side Mount, Slotted Coaxial, 5.0kW input, Circular

Component Description:
Cost of antenna
Amount:
$31,185.00
Side Mount antenna brackets Information not provided.

Cost Information

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Transmission Line

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 $190,383.40 $190,383.40 N/A $46,987.21 N/A
Total for all systems $789,838.67 $635,174.67 N/A $341,982.26 N/A
Primary Tower GTOWER $190,383.40 $190,383.40 $46,987.21
Minor tower reinforcement/modifications $50,000.00 $50,000.00 Estimated costs to modify tower not included in scope of work - if needed. N/A N/A
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas) $63,114.00 $63,114.00 Per attached proposal 20191002-922 from Electronics Research, Inc dated 10/02/19 $0.00 N/A
Sales Tax $741.48 $741.48 Cost determined by invoices. $741.48 N/A
Install Equipment $3,000.00 $3,000.00 Costs determined by invoices $2,967.41 N/A
Tower Rigging $52,527.92 $52,527.92 Actual costs submitted $42,528.32 Actual costs only submitted
Tower mapping and report for structural engineer $21,000.00 $21,000.00 N/A $750.00 N/A

Components

Actual Information Description File Name
Minor tower reinforcement/modifications Information not provided.
Complex Tower (includes, e.g., towers with candelabras and/or stacked antennas)

Component Description:
Antenna installation
Amount:
N/A
Sales Tax

Component Description:
Sales Tax for antenna installation .
Amount:
$741.48
Install Equipment

Component Description:
Final parts to complete installation
Amount:
$2,967.41
Tower Rigging

Component Description:
Antenna installation on a Candelabras tower.
Amount:
$3,183.00

Component Description:
25% upon contract acceptance. Sales tax will be requested separately. All rates are flat fees.
Amount:
$8,987.50

Component Description:
Actual cost per invoice
Amount:
$20,541.22

Component Description:
Remove and replace antenna & line
Amount:
$9,999.60

Component Description:
Credit on the invoice of $271.02 is due to the station overpaying the previous (821032-1) invoice, not FCC. The total reimbursement requested is $9999.60.
Amount:
$9,999.60

Component Description:
See attached cover letter
Amount:
$3,000.00
Tower mapping and report for structural engineer

Component Description:
PE Letter
Amount:
$750.00

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 $184,197.20 $159,639.20 N/A $83,105.53 N/A
Total for all systems $789,838.67 $635,174.67 N/A $341,982.26 N/A
Outside Professional Services $184,197.20 $159,639.20 $83,105.53
Zoning and permitting determination $650.00 $650.00 Per est. #1219 N/A N/A
Negotiation of co-location lease $1,750.00 $1,750.00 N/A $758.33 N/A
Landlord NTP $1,000.00 $1,000.00 N/A N/A N/A
Fully executed amendment with non-MLA landlord $4,000.00 $4,000.00 N/A N/A N/A
Construction drawings $3,500.00 $3,500.00 N/A N/A N/A
Complex zoning $2,000.00 $2,000.00 Per est. #1219 (non-complex) N/A N/A
Co-location application $700.00 $700.00 N/A N/A N/A
Building permit application $1,500.00 $1,500.00 Per est. #1219 N/A N/A
Field and Technical Project Management $8,932.00 $8,932.00 Cost determined from invoices. $8,932.00 N/A
Displacement Window Filings $1,500.00 $1,500.00 Actual costs for displacement window filings. $1,500.00 N/A
A and E Walk $4,500.00 $4,500.00 N/A N/A N/A
Permit pickup $700.00 $700.00 N/A N/A N/A
Additional Field Engineering Service, 5 Days $5,000.00 $5,000.00 Estimated field engineering required 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 722-R for Coverage Verification $20,000.00 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 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 N/A $0.00 N/A
Prepare Form 601 $755.00 $755.00 N/A 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 $1,000.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,102.50 N/A N/A N/A
Prepare 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 $36,890.20 $36,890.20 Cost determined by invoices $36,890.20 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $2,500.00 Per attached Anywave quote. $2,500.00 N/A
Project management of the transition $36,925.00 $20,445.00 Actuals plus est. #1219 $11,525.00 N/A
NEPA and SHPO compliance $2,500.00 $2,500.00 N/A N/A N/A
Leasing audit $750.00 $750.00 Per est. #1219 N/A N/A

Components

Actual Information Description File Name
Zoning and permitting determination Information not provided.
Negotiation of co-location lease

Component Description:
Lease negotiations
Amount:
$263.33

Component Description:
Lease negotiations
Amount:
$495.00
Landlord NTP Information not provided.
Fully executed amendment with non-MLA landlord Information not provided.
Construction drawings Information not provided.
Complex zoning Information not provided.
Co-location application Information not provided.
Building permit application Information not provided.
Field and Technical Project Management

Component Description:
Technical PM
Amount:
$308.00

Component Description:
June 2021 Technical PM - QComm - INV 120011
Amount:
$462.00

Component Description:
Dec 2021 Technical PM - QComm - INV 2022010
Amount:
$616.00

Component Description:
September 2021 Technical PM - QComm - INV 230045
Amount:
$462.00

Component Description:
Technical Project Management
Amount:
$1,848.00

Component Description:
July 2021 Technical PM - QComm - INV 120012
Amount:
$308.00

Component Description:
Technical PM
Amount:
$770.00

Component Description:
Technical Project Management.
Amount:
$2,464.00

Component Description:
August 2021 Technical PM - Qcomm - INV 230034
Amount:
$770.00

Component Description:
Technical PM
Amount:
$924.00
Displacement Window Filings

Component Description:
Costs for displacement window filings.
Amount:
$1,500.00

Component Description:
Displacement filings
Amount:
$1,500.00
A and E Walk Information not provided.
Permit pickup Information not provided.
Additional Field Engineering Service, 5 Days Information not provided.
Comprehensive coverage verification via field study, if needed

Component Description:
Field measurements
Amount:
$20,000.00
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

Component Description:
License to cover filings for KVQT-LD.
Amount:
$1,000.00
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:
Engineer License to cover filings
Amount:
$1,000.00

Component Description:
License to Cover Filings
Amount:
$1,000.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
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:
399 Follow Up Work
Amount:
$1,339.80

Component Description:
PM Paperwork
Amount:
$2,171.40

Component Description:
399 Follow Up Work
Amount:
$539.00

Component Description:
June 2021 PM hours - Anywave - INV FA2107-1021
Amount:
$1,724.80

Component Description:
Paperwork PM
Amount:
$3,295.60

Component Description:
PM Paperwork
Amount:
$2,633.40

Component Description:
Oct 2021 PM - Anywave - INV FA2112-1220
Amount:
$877.80

Component Description:
Paperwork PM
Amount:
$2,664.20

Component Description:
Paperwork PM
Amount:
$1,724.80

Component Description:
PM Paperwork
Amount:
$2,448.60

Component Description:
PM Paperwork
Amount:
$1,724.80

Component Description:
399 Follow Up Work
Amount:
$954.80

Component Description:
Paperwork PM
Amount:
$2,333.10

Component Description:
Form 399 assistance 02/01 - 03/18/2022
Amount:
$154.00

Component Description:
PM Paperwork
Amount:
$1,724.80

Component Description:
Dec 2021 PM - Anywave - INV FA2202-1259
Amount:
$1,362.90

Component Description:
Form 399 Assistance
Amount:
$500.00

Component Description:
PM Paperwork
Amount:
$2,910.60

Component Description:
Jan 2020 PM - Anywave - INV FA2002-0538
Amount:
$539.00

Component Description:
Paperwork PM
Amount:
$800.80

Component Description:
Nov 2021 PM - Anywave - INV FA2202-1281
Amount:
$154.00

Component Description:
July 2021 PM - Anywave - INV FA2109-1105
Amount:
$1,062.60

Component Description:
Sept 2021 PM - Anywave - INV FA2110-1153
Amount:
$985.60

Component Description:
Paperwork PM
Amount:
$2,833.60

Component Description:
Aug 2021 PM - Anywave - INV FA2109-1080
Amount:
$1,155.00

Component Description:
Prepare and process 399
Amount:
$500.00
Prepare/ Review 399 reimbursement form

Component Description:
399 Submittal
Amount:
$2,500.00

Component Description:
399 Form assistance
Amount:
$2,500.00
Project management of the transition

Component Description:
Technical PM and 399 assistance 05.22
Amount:
$1,830.00

Component Description:
Technical PM and 399 assistance - 02.22
Amount:
$2,355.00

Component Description:
Technical PM and 399 assistance - 03.22
Amount:
$4,905.00

Component Description:
Technical PM and 399 assistance 04.22
Amount:
$2,435.00
NEPA and SHPO compliance Information not provided.
Leasing audit 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 $20,378.30 $20,378.30 N/A $6,168.30 N/A
Total for all systems $789,838.67 $635,174.67 N/A $341,982.26 N/A
Other Expenses $20,378.30 $20,378.30 $6,168.30
Land Study $1,590.00 $1,590.00 Land study per MSW INV 7474 $1,590.00 N/A
Equipment Storage $5,000.00 $5,000.00 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 $4,578.30 $4,578.30 actual cost of invoices $4,578.30 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,500.00 $2,500.00 4-6 yard disposal bin on site to capture all waste from the on site system integration and tower vendors. 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 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,110.00 N/A N/A N/A

Components

Actual Information Description File Name
Land Study

Component Description:
Land Mobile interference study - MSW - INV 7474
Amount:
$1,590.00
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges

Component Description:
Receiving Equipment and Delivery and Handling.
Amount:
$4,000.00

Component Description:
Delivery equipment rental fee
Amount:
$578.30
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 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $789,838.67 $635,174.67 $341,982.26

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.

Chuck Johnson

COO


06/15/2022

Attachments

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