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:
15320
Service:
DTV
Call Sign:
WRUA
Channel:
16 (UHF)
File Number:
0000028418
FRN:
0006360143
Date Submitted:
08/28/2017

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

EASTERN TELEVISION CORPORATION

Doing Business As: EASTERN TELEVISION CORPORATION

Lilliam Perez

P.O. BOX 310

BAYAMON, PR 00960

United States

+1 (787) 999-1473 perezlilliam7@gmail.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

Alejandro Luciano , PE .

Alejandro Luciano PE

Alejandro Luciano PE

PO Box 194528

SAN JUAN, PR 00919

United States

+1 (787) 717-6984 aluciano@aluciano.com

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan xyz

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 DVTX-UHF-04M37
Year 2007
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 3.0 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 TMU9
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 3.0 kW
Justification for New Transmitter Existing transmitter manufacturer is no longer in business. Without manufacturer support it is unknown if the existing can be re-tuned from channel 33 to channel 16.

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 Yes
Size 2 inches
Length 30.0 feet
Other Electrical Service Yes
Description Transmitter breaker at main panel
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 5 tons
Other Size N/A tons
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 150.0 square feet
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Interim Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Interim
Description of Use N/A
Change Type Purchase
Manufacturer
Model SLIM4 02 UHF SD PCM PPT
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.2 kW
Justification for New Transmitter Due to space limitations the existing transmitter must be removed to make space for the new Ch. 16 transmitter. An interim small transmitter is needed for WRUA to remain on the air while the new transmitter installation is completed.

Interim 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 Yes
Size 2 inches
Length 30.0 feet
Other Electrical Service Yes
Description Main panel transmitter breaker
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
Inside RF System Is an additional interior RF system required to support this interim transmitter? No

Interim Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

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? Yes
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 ALP16M8-HSPR-33
Year 2007

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
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: 34.1 kW
Manufacturer
Model PSIMP16AW16EP
Year 2017
Justification for New Antenna Existing Ch. 33 antenna can't be re-channeled to channel 16, WRUA repack assigned 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? No
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? Yes
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

ADJACENT CH FILTER

Because WRUA on channel 16 is physically and electronically adjacent to WMTJ on channel 15, both antennas are within 60 feet of each other at about same height above ground, there is a possibility of mutual coupling between the channel 15 and 16 signals.

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
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? Yes
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels/Bays 8
Lower Limit 470.00 MHz
Upper Limit 600.00 MHz
Design power capacity in use 50.0 %
Other Antenna Type N/A
ERP: 20.0 kW
Manufacturer
Model 772550
Year 2017
Justification for New Antenna Due to tower space limitations the relocation of the present 16 bays antenna to another location on the tower is nearly impossible. A smaller antenna is needed to remain on the air while the new Ch. 16 antenna is installed.

Interim Antenna

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Other Antenna Costs

Section Question Response
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 an 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

Interim Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? Yes

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Air
Diameter 3 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 275 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 Air
Diameter 3 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 275 feet per run
Justification for New Transmission Line The existing transmission line, will be used as interim to remain on the air on ch. 33 while installation of the new channel 16 transmission system including a new transmission line is completed.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Connectors and Adapters

Connectors and Adapters

Tower Equipment And Rigging Costs

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Section Question Response
Tower Equipment or Rigging Costs Changes Do you have tower equipment or rigging costs changes? Yes

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Terrain Constrained
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? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1011469
Coordinates (NAD83) Latitude (NAD83) 18° 18' 29.0" N-
Longitude (NAD83) 065° 47' 40.0" W-
Overall Structure Height 259.18 feet
Support Structure Height 1.64 feet
Ground Elevation Above Mean Sea Level (AMSL) 3296.22 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner PUERTO RICO TELEPHONE COMPANY, INC
Date Constructed 01/01/1982

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
11620 WLUZ FM
51428 WRXD FM
2174 WMTJ DTV
73901 WORO-DT DTV

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for undocumented/poorly documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: Major Reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Terrain constrained
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 780
Explanation Due to economic hardship WRUA does not have the in-house personnel to perform the repack management services.
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 Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
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 Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Station Employees Time

Station Employees Time Dedicated to WRUA Repack functions

Quarterly Progress Reports.

Quarterly Repack Progress Report

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? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

State Services Tax

Local Services Tax 4 percent

State and City Sales Tax

Local Sales Tax 11.5 percent

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 $294,560.00 $287,500.00 N/A $0.00 N/A
Total for all systems $1,668,557.99 $1,605,472.99 N/A $0.00 N/A
Interim Transmitter SLIM4 02 UHF SD PCM PPT $127,780.00 $121,750.00 $0.00
Other Electrical Service: Main panel transmitter breaker $1,000.00 $1,000.00 Based on previous experience at the site, the site remote location in a Rain Forest, the difficulty of getting contractors to that site. N/A N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $120,000.00 The expected price will be approximately half of the predetermined cost. The final pricing will be submitted as soon as available N/A N/A
2" Rigid Conduit and Wiring (Cost per foot) $780.00 $750.00 N/A N/A N/A
Primary Transmitter TMU9 $166,780.00 $165,750.00 $0.00
Other -- Building Addition Size: 150.0 $6,000.00 $6,000.00 Based on previous experience at the site, the site remote location in a Rain Forest, the difficulty of getting contractors to that site. N/A N/A
5 Ton system $20,250.00 $19,250.00 N/A N/A N/A
Other Electrical Service: Transmitter breaker at main panel $1,750.00 $1,750.00 Based on previous experience at the site, the site remote location in a Rain Forest and the difficulty of getting contractors to that site N/A N/A
2" Rigid Conduit and Wiring (Cost per foot) $780.00 $750.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 3.0 kW $138,000.00 $138,000.00 The catalog does not have predetermined pricing for a 3.0 kW air cooled solid state transmitter. The price is estimated based on the 2.5 kW and the 4 kW pricing. N/A N/A

Components

Information not provided.

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 $88,720.00 $87,800.00 N/A $0.00 N/A
Total for all systems $1,668,557.99 $1,605,472.99 N/A $0.00 N/A
Interim Antenna 772550 $26,730.00 $26,400.00 $0.00
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
UHF – Broadband Panel, Side Mount Auxiliary/Interim, 20 horizontally polarized $20,000.00 $20,000.00 Based on the Catalog pricing of $8000.00 for a 4 panels system. The requested is an 8 panels 4 bays system. N/A N/A
Primary Antenna PSIMP16AW16EP $61,990.00 $61,400.00 $0.00
ADJACENT CH FILTER $12,000.00 $12,000.00 An adjacent channel filter is needed for WRUA Ch. 16 transmitter no to be affected by the physically and electronically adjacent WMTJ on channel 15, both antennas to be within 60 feet of each other at about same height above ground. N/A N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
UHF - High Power, Side Mount, basic slot antenna, 34 kW input, directional,, elliptically or circularly polarized $38,000.00 $38,000.00 Based on previous experience with PSI elliptic polarized antennas. Final pricing will be submitted as soon as a final quote is available N/A N/A

Components

Information not provided.

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $20,225.00 $19,400.00 N/A $0.00 N/A
Total for all systems $1,668,557.99 $1,605,472.99 N/A $0.00 N/A
Primary Transmission Line $20,225.00 $19,400.00 $0.00
Connectors and Adapters $4,000.00 $4,000.00 Based on previous experience. Some connectors and/or adapters will be needed to interconnect the Interim transmitter to the interim antenna. N/A N/A
Flexible Air Transmission Line - dielectric, 3" $16,225.00 $15,400.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $868,300.00 $825,000.00 N/A $0.00 N/A
Total for all systems $1,668,557.99 $1,605,472.99 N/A $0.00 N/A
Primary Tower TOWER $868,300.00 $825,000.00 $0.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $400,000.00 N/A N/A N/A
Major tower reinforcement/modifications $421,000.00 $400,000.00 N/A N/A N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $25,000.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $225,762.74 $215,387.74 N/A $0.00 N/A
Total for all systems $1,668,557.99 $1,605,472.99 N/A $0.00 N/A
Outside Professional Services $225,762.74 $215,387.74 $0.00
Station Employees Time $34,987.74 $34,987.74 Estimated amount expenses for station personnel repack dedicated time. See attached WRUA Local Goods and Services Taxes Excel worksheet N/A N/A
Quarterly Progress Reports. $2,150.00 $2,150.00 Estimated amount for the preparation of the quarterly repack progress reports N/A N/A
RF Exposure Measurements $21,050.00 $20,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $4,000.00 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 $4,100.00 $3,000.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $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
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $2,000.00 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 N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 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 N/A N/A
Project management of the transition $123,240.00 $117,000.00 N/A N/A N/A

Components

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 $170,990.25 $170,385.25 N/A $0.00 N/A
Total for all systems $1,668,557.99 $1,605,472.99 N/A $0.00 N/A
Other Expenses $170,990.25 $170,385.25 $0.00
Equipment Delivery and Handling Charges $25,000.00 $25,000.00 Based on previous experience at that site, the site remote location, difficult accessibility and located on a rain forest N/A N/A
State and City Sales Tax $66,878.25 $66,878.25 State and City Sales Tax 11.5% See attached WRUA Local Service and Goods Taxes worksheet for justification. N/A N/A
State Services Tax $31,922.00 $31,922.00 State Services Tax 4% Se attached WRUA Local Service and Goods Taxes Worksheet justification N/A N/A
MVPD Notification of Channel Change $5,000.00 $5,000.00 Based on previous experience. N/A N/A
Develop and air announcement of upcoming channel change $12,000.00 $12,000.00 Based on previous experience during the analog to digital transition N/A N/A
Equipment Storage $5,000.00 $5,000.00 Based on previous experience during the analog to digital transition N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $5,000.00 $5,000.00 Based on previous experience at that site, the site remote location, difficult accessibility and located on a rain forest N/A N/A
Local Zoning $7,000.00 $7,000.00 Estimated fees of the local authority for obtaining permits for the tower work needed. N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 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
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,668,557.99 $1,605,472.99 $0.00

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.

Alejandro Luciano

Repack Project Manager


08/28/2017

Attachments

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