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:
60357
Service:
DTV
Call Sign:
WOST
Channel:
20 (UHF)
File Number:
0000027995
FRN:
0026907345
Date Submitted:
08/26/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

HC2 STATION GROUP, INC.

RENEE ILHARDT

295 MADISON AVENUE, 12TH FLOOR

NEW YORK, NY 10017

United States

+1 (954) 606-5486 RILHARDT@HC2BROADCASTING.COM Corporation

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 existing transmitter with a frequency agile transmitter, replace the mask filter, and replace the antenna with a broadband antenna. The tower will also need to be replaced to accommodate the new antenna.

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 LU1500ARD
Year 2009
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1.5 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model UAXTE-4R37
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.5 kW
Justification for New Transmitter Current transmitter is re-tunable, but not frequency agile and there is no backup to allow the station to remain on the air during the testing period. See attachment.

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 Yes
Description Disconnect existing transmitter and connect new one. Expect to be able to use existing breaker box.
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? No
Size N/A
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

Tuner

Tuner

Connectors for Test Equipment

Connectors for Test Equipment

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? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting 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: 50.0 kW
Manufacturer
Model SWEDL12BFRR/22
Year 2009

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? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 50.0 kW
Manufacturer
Model PSIUHY16-20
Year 2017
Justification for New Antenna Existing antenna is not re-tunable to the new channel. The new antenna works for both the current channel and the new channel.

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

Modify Antenna Brackets

Modify Antenna Brackets

Antenna Assembly and Installation

Antenna Assembly and Installation

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 Foam
Diameter 1 5/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 150 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 Flexible Foam
Diameter 1 5/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 250 feet per run
Justification for New Transmission Line The existing tower will not accommodate the new antenna. So as to avoid taking the station off the air for an indefinite period of time, we plan is to install a new broadband antenna on the new tower.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Feedline Connectors

Feedline Connectors

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 Construct New
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 18° 18' 43.82" N-
Longitude (NAD83) 067° 11' 22.6" W-
Overall Structure Height 80.00 feet
Support Structure Height 80.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 1150.00 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner CMCG Puerto Rico LLC
Date Constructed 01/01/1999


Primary Tower

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Tower Construction Costs

Section Question Response
Construct New Tower Use Primary (Main)
Description of Use N/A
Is this a request for upgraded equipment? No
Height 1228.00 feet
Justification for New Tower Existing tower will not accommodate new antenna and comply with Rev G. The tower engineers estimated that a new tower would be less expensive than strengthening the existing tower. See attached tower study.

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

Name Description

Tower Structural Analysis

Tower Structural Analysis

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 300
Explanation Onsite project manager plus subcontractors, equipment, and labor.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 27
Justification Engineering project design, antenna inspection, and field services.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Internal Employee Time Costs

Internal Employee Time Costs

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 Yes
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? No
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

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $148,708.02 $130,773.09 N/A $130,773.09 N/A
Total for all systems $3,894,349.59 $369,453.62 N/A $293,017.52 N/A
Primary Transmitter UAXTE-4R37 $148,708.02 $130,773.09 $130,773.09
Connectors for Test Equipment $1,459.77 $1,459.77 N/A $1,459.77 N/A
Other Electrical Service: Disconnect existing transmitter and connect new one. Expect to be able to use existing breaker box. $20,398.25 $20,398.25 N/A $20,398.25 N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $108,065.07 N/A $108,065.07 N/A
Tuner $850.00 $850.00 N/A $850.00 N/A

Components

Actual Information Description File Name
Connectors for Test Equipment

Component Description:
Connectors for test equipment. #122508
Amount:
$1,459.77
Other Electrical Service: Disconnect existing transmitter and connect new one. Expect to be able to use existing breaker box.

Component Description:
Electrical to install transmitter. #2486
Amount:
$20,398.25
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
Transmitter costs. #121398
Amount:
$108,065.07

Component Description:
Transmitter costs. #121398
Amount:
$108,065.07
Tuner

Component Description:
Tuner. #1868-3
Amount:
$850.00

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $111,855.00 $43,405.86 N/A $43,405.86 N/A
Total for all systems $3,894,349.59 $369,453.62 N/A $293,017.52 N/A
Primary Antenna PSIUHY16-20 $111,855.00 $43,405.86 $43,405.86
Modify Antenna Brackets $1,000.00 $1,000.00 N/A $1,000.00 N/A
Antenna Assembly and Installation $14,725.00 $14,725.00 N/A $14,725.00 N/A
Sweep test of existing antenna $6,730.00 $0.00 Replacing existing antenna. Do not expect to need this. N/A N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized $89,400.00 $27,680.86 N/A $27,680.86 N/A

Components

Actual Information Description File Name
Modify Antenna Brackets

Component Description:
WOST antenna brackets modification. #2484
Amount:
$1,000.00
Antenna Assembly and Installation

Component Description:
Crane rental to install antenna. #07162018-ERE
Amount:
$7,500.00

Component Description:
Antenna assembly and installation. #07292018-TP
Amount:
$7,225.00
Sweep test of existing antenna Information not provided.
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized

Component Description:
Antenna costs. #1868
Amount:
$26,325.82

Component Description:
Antenna parts and jumper. #1868-1
Amount:
$1,355.04

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 $9,716.22 $13,495.57 N/A $13,495.57 N/A
Total for all systems $3,894,349.59 $369,453.62 N/A $293,017.52 N/A
Primary Transmission Line $9,716.22 $13,495.57 $13,495.57
Flexible Foam Transmission Line - dielectric, 1 5/8" $6,000.00 $9,779.35 Please see the attached invoice. $9,779.35 N/A
Feedline Connectors $3,716.22 $3,716.22 N/A $3,716.22 N/A

Components

Actual Information Description File Name
Flexible Foam Transmission Line - dielectric, 1 5/8"

Component Description:
TL costs. #122417
Amount:
$9,779.35
Feedline Connectors

Component Description:
Clamping field flange, anchor connectors, etc. #123787
Amount:
$2,419.84

Component Description:
Myat elbow flanged reinforced inside and outside. #124046
Amount:
$1,296.38

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 $3,447,090.00 $36,950.00 N/A $6,950.00 N/A
Total for all systems $3,894,349.59 $369,453.62 N/A $293,017.52 N/A
Primary Tower TOWER $0.00 $0.00 $0.00
Primary Tower $3,447,090.00 $36,950.00 $6,950.00
Tower Structural Analysis $6,950.00 $6,950.00 N/A $6,950.00 N/A
Tall Tower (greater than 500') $210,500.00 $0.00 N/A N/A N/A
New tower between 1000' and 1500' without elevator, presumptive soil conditions $3,229,640.00 $30,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Tower Structural Analysis

Component Description:
Tower structural analysis. #109907
Amount:
$6,950.00
Tall Tower (greater than 500') Information not provided.
New tower between 1000' and 1500' without elevator, presumptive soil conditions 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 $143,016.75 $120,196.75 N/A $93,345.65 N/A
Total for all systems $3,894,349.59 $369,453.62 N/A $293,017.52 N/A
Outside Professional Services $143,016.75 $120,196.75 $93,345.65
Additional Field Engineering Service, 27 Days $60,104.35 $60,104.35 N/A $60,104.35 N/A
Internal Employee Time Costs $592.40 $592.40 N/A $592.40 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $2,500.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,000.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $2,435.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $5,000.00 N/A N/A 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
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $370.00 N/A
Project management of the transition $47,400.00 $30,000.00 N/A $29,843.90 N/A

Components

Actual Information Description File Name
Additional Field Engineering Service, 27 Days

Component Description:
Field services. #WOST08062018-AB
Amount:
$40,642.11

Component Description:
Inspection trip. #06192017-AB
Amount:
$5,462.24

Component Description:
Inspection trip. #06192017-AB
Amount:
$5,564.31

Component Description:
Project design. #Andy Booth
Amount:
$13,500.00

Component Description:
Field services. #WOST08062018-AB
Amount:
$33,297.36

Component Description:
Project design. #Andy Booth
Amount:
$13,500.00

Component Description:
Antenna inspection trip. #06122018-AB
Amount:
$500.00
Internal Employee Time Costs

Component Description:
Internal time costs. #IL-HC2-09302021-PD
Amount:
$27.04

Component Description:
Internal time costs. #IL-HC2-10012021-RI
Amount:
$565.36
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.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Application for CP for channel change. #008452
Amount:
$2,435.00

Component Description:
Application for CP for channel change. #008452
Amount:
$2,435.00
Perform engineering study for new channel assignment and antenna development Information not provided.
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
Discussion re application and 399 form, review quotes. #008409
Amount:
$370.00

Component Description:
Discussion re application and 399 form, review quotes. #008409
Amount:
$370.00
Project management of the transition

Component Description:
Legal services costs. #676886
Amount:
$480.25

Component Description:
Legal services costs. #690585
Amount:
$5,439.75

Component Description:
Legal services costs. #669555
Amount:
$891.00

Component Description:
Legal services costs. #648174
Amount:
$2,430.00

Component Description:
Legal services costs. #685778
Amount:
$1,186.50

Component Description:
Legal services costs. #651059
Amount:
$405.00

Component Description:
Legal services costs. #656311
Amount:
$1,269.00

Component Description:
Legal services costs. #667300
Amount:
$270.00

Component Description:
Legal services costs. #695142
Amount:
$2,316.50

Component Description:
Legal services costs. #659089
Amount:
$2,280.00

Component Description:
Legal services costs. #687781
Amount:
$1,017.00

Component Description:
Legal services costs. #692622
Amount:
$2,712.00

Component Description:
Legal services costs. #672011
Amount:
$540.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 8 stations. #321
Amount:
$605.00

Component Description:
Legal services costs. #664268
Amount:
$54.00

Component Description:
Legal services costs. #675458
Amount:
$1,404.00

Component Description:
Legal services costs. #682936
Amount:
$1,045.25

Component Description:
Legal services costs. #653715
Amount:
$2,196.00

Component Description:
Legal services costs. #651073
Amount:
$1,412.65

Component Description:
Legal services costs. #662040
Amount:
$1,890.00

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 $33,963.60 $24,632.35 N/A $5,047.35 N/A
Total for all systems $3,894,349.59 $369,453.62 N/A $293,017.52 N/A
Other Expenses $33,963.60 $24,632.35 $5,047.35
MVPD Notification of Channel Change $500.00 $500.00 Legal counsel review of notices N/A N/A
Develop and air announcement of upcoming channel change $2,773.60 $2,773.60 N/A $2,773.60 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,500.00 $2,500.00 Estimate. Impossible to obtain a reasonably binding quote this far in advance. N/A N/A
Local Zoning $15,000.00 $15,000.00 See attached. N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $2,273.75 N/A $2,273.75 N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change

Component Description:
Newspaper ads - channel change. #3779947
Amount:
$277.36

Component Description:
Newspaper ads - channel change. #3779454
Amount:
$277.36

Component Description:
Newspaper ads - channel change. #3781009
Amount:
$277.36

Component Description:
Newspaper ads - channel change. #3779228
Amount:
$277.36

Component Description:
Newspaper ads - channel change. #3780626
Amount:
$277.36

Component Description:
Newspaper ads - channel change. #3779118
Amount:
$277.36

Component Description:
Newspaper ads - channel change. #3780507
Amount:
$277.36

Component Description:
Newspaper ads - channel change. #3779718
Amount:
$277.36

Component Description:
Newspaper ads - channel change. #3781082
Amount:
$277.36

Component Description:
Newspaper ads - channel change. #3779350
Amount:
$277.36
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Local Zoning Information not provided.
FCC Filing Fees - Special Temporary Authorization request 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.
DTV Medical Facility Notification

Component Description:
Notification of revised medical facilities. #INV-001836
Amount:
$438.75

Component Description:
Notification of medical facilities. #INV-001832
Amount:
$1,835.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,894,349.59 $369,453.62 $293,017.52

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. Yes

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.

Michael Voge

Director of Engineering Operations


08/26/2022

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.

Michael Voge

Director of Engineering Operations


08/26/2022

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.

Michael Voge

Director of Engineering Operations


08/26/2022

Attachments

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