Go to the Federal Communications Commission homepage at www.fcc.gov

FCC Form 399: Incentive Auction Relocation Reimbursement Fund System

Approved by OMB 3060-1178
Go to the Federal Communications Commission homepage at www.fcc.gov

(REFERENCE COPY - Not for submission)FCC Form 399: Incentive Auction Relocation Reimbursement Fund System

File Number:
0000026714
FRN:
0001587583
Facility ID:
10242
Repack Channel:
23 (UHF)
Entity:
Broadcaster
Filing Status:
Submitted
Date Submitted:
11/20/2017

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

HEARST STATIONS INC.

Doing Business As: HEARST STATIONS INC.

C/O BROOKS, PIERCE ET AL.

P.O. BOX 1800

RALEIGH, NC 27602

United States

+1 (919) 839-0300 mprak@brookspierce.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. Yes
Briefly describe transition plan see attached transition plan document

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  
Ownership Owned
Owner  
Site  
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model Sigma CD3200P2
Year 2005
Type Inductive Output Tube
IOT Power Type Two
Description  
Power capacity 50 kw
Solid State Cooling  
Solid State Power Capacity  
Other Transmitter Type  

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Description of Use  
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model ULXTE-40
Transmitter Type Solid state
IOT Power Type  
Other  
Power capacity  
Solid State Cooling Liquid
Solid State Power Capacity 25.3 kw
Other Transmitter Type  
Justification for New Transmitter Existing IOT transmitter cannot be converted to post-transition channel, see GatesAir EOL and HTV IOT to Solid-State Justification statements. An IOT replacement is more expensive than proposed SS transmitter. See attached Comark IOT Transmitter quote.

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) Yes
Power 150 kVA
Rigid Conduit and Wiring No
Size
Length
Other Electrical Service Yes
Description See attached quote for transmitter installation electrical service
HVAC Service Does the replacement transmitter require HVAC Service? No
Type
Size
Other Size  
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size
Channel 14 Costs Is an RF Consulting Engineer needed?
Is a channel 14 Mask Filer needed?
Is additional field engineering time needed?
Number of Days  

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Shipping

transmitter shipping

Transmitter de-install

old transmitter removal

RF Accessories

Additional RF components required for transmitter operation and integration into current RF environment

Sales Tax

sales tax

Electrical Accessories

Surge protection required by manufacturer

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 Retune Existing
Antenna Use Primary (Main)
Description of Use N/A
Ownership Leased
Owner American Tower Corp.
Site N/A
Is the existing antenna shared with another station or stations? Yes
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top-mount stacked
Antenna position in stack Bottom
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 3
Number of Panels 80
Design power capacity in use 45.0 %
Lower Limit 502.00 MHz
Upper Limit 678.00 MHz
Other Antenna Type N/A
ERP: 600.00 kW
Manufacturer Dielectric
Model DeltastarTUG-05-16/80H-2-B
Year 2003

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
51499 KMAX-TV
33875 KCRA-TV

Primary Antenna

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Adjustment to Existing Antenna

Section Question Response
Sweep Test of Existing Antenna Do you need a sweep test of existing antenna? Yes

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? Yes
Type Additional Module
Number of channels supported 3
Frequencies of channels supported RF channel
Frequency N/A

Enter a list of RF channel numbers.

RF Channel Number
23
24
35

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Auxiliary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Auxiliary (Backup)
Description of Use backup to main antenna
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: 790.00 kW
Manufacturer
Model TFU-24DSB-C170
Year 2010

Auxiliary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Auxiliary (Backup)
Description of Use Aux and interim use
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and 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/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 425.00 kW
Manufacturer
Model TFU-28DSC-RO4
Year 2019
Justification for New Antenna Current antenna is channel specific and cannot be used on post-transition channel. Antenna must be replaced.

Auxiliary 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? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 7 3/16 inches
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

Auxiliary Antenna

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Other Antenna Cost Not Listed

Name Description

Sales Tax

Antenna sales tax

Shipping

Antenna shipping

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 Utilize Existing
Use Primary (Main)
Description of Use N/A
Ownership Leased
Owner American Tower Corp.
Site N/A
Is the existing transmission line shared with another station or stations? Yes
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer Dielectric
Type Rigid
Diameter 7 3/16 inches
Segment Length Broadband
Other Segment Length
Number of parallel runs 1
Length 2200 feet per run

Facility ID's and Call Signs of all stations with whom the transmission line is shared.

Facility ID Call Sign
51499 KMAX-TV
33875 KCRA-TV

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Auxiliary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Backup
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 Rigid
Diameter 7 3/16 inches
Segment Length 19 ½ '
Other Segment Length
Number of parallel runs 1
Length 1800 feet per run

Auxiliary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Auxiliary (Backup)
Description of Use backup
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 7 3/16 inches
Segment Length 20'
Other Segment Length
Number of parallel runs 1
Length 1800 feet per run
Justification for New Transmission Line Current transmission line segment length is not compatible with post-transition channel and must be replaced.

Auxiliary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Sales Tax

estimated sales tax based on California and local sales tax rate of 8.25%

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 Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1015686
Coordinates (NAD83) Latitude (NAD83) 38° 15' 54.0" N-
Longitude (NAD83) 121° 29' 28.0" W-
Overall Structure Height 2000.30 feet
Support Structure Height 1904.83 feet
Ground Elevation Above Mean Sea Level (AMSL) 0.00 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Hearst Stations Inc.
Date Constructed 10/01/1985

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
33875 KCRA-TV DTV
52953 KSPX-TV DTV
51499 KMAX-TV 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 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 N/A
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Tower Consulting

Tower consulting and tower project management

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 380
Explanation Need RF and design experience not available in-house.
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 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 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 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 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

Transmitter Site Survey

Transmitter planning survey & transmitter building drawings

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning No
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application No
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? No
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? No
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

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 $1,212,152.00 $1,116,107.00 N/A $311,118.13 N/A
Total for all systems $2,918,105.00 $2,367,653.00 N/A $573,418.98 N/A
Primary Transmitter ULXTE-40 $1,212,152.00 $1,116,107.00 $311,118.13
Electrical Accessories $1,943.00 $1,943.00 Required by transmitter manufacturer. See GatesAir quote. N/A N/A
Sales Tax $81,133.00 $81,133.00 sales tax per GatesAir transmitter quote N/A N/A
RF Accessories $76,222.00 $76,222.00 Additional RF components required for replacement transmitter operation. See GatesAir transmitter quote, page 7. N/A N/A
Transmitter de-install $25,489.00 $25,489.00 Old transmitter must be removed in order to completely install replacement. See GatesAir quote N/A N/A
Shipping $11,000.00 $11,000.00 Transmitter shipping N/A N/A
Other Electrical Service: See attached quote for transmitter installation electrical service $69,465.00 $69,465.00 transmitter installation electrical service per attached quote N/A N/A
Transformer 3 phase/480v - 150 KVA $24,900.00 $5,870.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $922,000.00 $844,985.00 N/A $311,118.13 N/A

Components

Actual Information Description File Name
Electrical Accessories Information not provided.
Sales Tax Information not provided.
RF Accessories Information not provided.
Transmitter de-install Information not provided.
Shipping Information not provided.
Other Electrical Service: See attached quote for transmitter installation electrical service Information not provided.
Transformer 3 phase/480v - 150 KVA Information not provided.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
Deposit on Transmitter
Amount:
$95,853.94

Component Description:
Second Deposit on Transmitter
Amount:
$215,264.19

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 $354,427.00 $331,635.00 N/A $228,894.50 N/A
Total for all systems $2,918,105.00 $2,367,653.00 N/A $573,418.98 N/A
Primary Antenna DeltastarTUG-05-16/80H-2-B $86,550.00 $86,400.00 $0.00
Adding a module to existing combiner (without antenna) $80,000.00 $80,000.00 N/A N/A N/A
Sweep test of existing antenna $6,550.00 $6,400.00 N/A N/A N/A
UHF - High Power Top Mount Three Station broadband panel antenna horizontally polarized $0.00 $0.00 Current antenna reused for post-transition channel. No changes required. N/A N/A
Auxiliary Antenna TFU-28DSC-RO4 $267,877.00 $245,235.00 $228,894.50
Shipping $24,437.00 $24,437.00 Shipping per attached Dielectric quote. $24,437.00 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $22,550.00 $23,200.00 Side mount brackets per attached Dielectric quote $23,200.00 N/A
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized $184,500.00 $164,560.00 Per Dielectric Quote $164,560.00 N/A
Sales Tax $16,340.00 $16,340.00 estimated sales tax based on California and local sales tax rate 8.25% N/A N/A
Elbow complex, single channel, at antenna input, per 7 3/16. feedline (if needed) $13,500.00 $10,298.00 N/A $10,297.50 N/A
Sweep test of existing antenna $6,550.00 $6,400.00 N/A $6,400.00 N/A

Components

Actual Information Description File Name
Adding a module to existing combiner (without antenna) Information not provided.
Sweep test of existing antenna Information not provided.
UHF - High Power Top Mount Three Station broadband panel antenna horizontally polarized Information not provided.
Shipping

Component Description:
KQCA; Freight/Shipping; Dielectric
Amount:
$24,437.00
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
KQCA; Side mount Cost; Dielectric
Amount:
$23,200.00
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized

Component Description:
KQCA; Interim Antenna Cost; Dielectric
Amount:
$164,560.00
Sales Tax Information not provided.
Elbow complex, single channel, at antenna input, per 7 3/16. feedline (if needed)

Component Description:
KQCA; Elbow Complex cost; Dielectric
Amount:
$10,297.50
Sweep test of existing antenna

Component Description:
KQCA; Repack Sweep cost: Dielectric
Amount:
$6,400.00

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $534,828.00 $333,647.00 N/A $12,806.35 N/A
Total for all systems $2,918,105.00 $2,367,653.00 N/A $573,418.98 N/A
Primary Transmission Line $0.00 $0.00 $0.00
Auxiliary Transmission Line $534,828.00 $333,647.00 $12,806.35
Rigid Transmission Line - copper, 7 3/16" $509,400.00 $308,219.00 N/A $12,806.35 N/A
Sales Tax $25,428.00 $25,428.00 sales tax based on California and local sales tax rate of 8.25% N/A N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 7 3/16"

Component Description:
KQCA; Rigid Transmission line; Dielectric
Amount:
$12,806.35
Sales Tax 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 $631,800.00 $417,000.00 N/A $0.00 N/A
Total for all systems $2,918,105.00 $2,367,653.00 N/A $573,418.98 N/A
Primary Tower TOWER $631,800.00 $417,000.00 $0.00
Tall Tower (greater than 500') $205,000.00 $200,000.00 N/A N/A N/A
Structural engineering tower load study for well documented tower $12,300.00 $12,000.00 N/A N/A N/A
Major tower reinforcement/modifications $409,500.00 $200,000.00 N/A N/A N/A
Tower Consulting $5,000.00 $5,000.00 tower consulting - quote attached 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 $136,745.00 $121,369.00 N/A $20,600.00 N/A
Total for all systems $2,918,105.00 $2,367,653.00 N/A $573,418.98 N/A
Outside Professional Services $136,745.00 $121,369.00 $20,600.00
Transmitter Site Survey $20,600.00 $20,600.00 Transmitter Site Survey. Quote with description attached. $20,600.00 N/A
RF Exposure Measurements $20,500.00 $20,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,585.00 $3,500.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,305.00 $2,250.00 N/A N/A N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,100.00 $4,000.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,120.00 $5,000.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,535.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,535.00 $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 $2,050.00 $2,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,070.00 $3,000.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,170.00 $7,000.00 N/A N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,560.00 $2,500.00 N/A N/A N/A
Prepare and or review reimbursement form $2,560.00 $2,500.00 N/A N/A N/A
Project management of the transition $58,520.00 $44,519.00 Per attached TI Digital quote N/A N/A
Prepare request for Special Temporary Authorization $1,535.00 $1,500.00 N/A N/A N/A

Components

Actual Information Description File Name
Transmitter Site Survey

Component Description:
KQCA GatesAir Site Survey
Amount:
$20,600.00
RF Exposure Measurements Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
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 Information not provided.
Project management of the transition Information not provided.
Prepare request for Special Temporary Authorization 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 $48,153.00 $47,895.00 N/A $0.00 N/A
Total for all systems $2,918,105.00 $2,367,653.00 N/A $573,418.98 N/A
Other Expenses $48,153.00 $47,895.00 $0.00
MVPD Notification of Channel Change $2,500.00 $2,500.00 Attorney assistance in coordinating MVPD notification N/A N/A
Develop and air announcement of upcoming channel change $2,500.00 $2,500.00 Attorney review to ensure FCC compliance N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,070.00 $1,070.00 N/A N/A N/A
DTV Medical Facility Notification $11,250.00 $11,000.00 N/A N/A N/A
Equipment Storage $30,500.00 $30,500.00 Estimate for 1 year of antenna & line storage N/A N/A
FCC Filing Fees - Form 2100 license to cover application $333.00 $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 $2,918,105.00 $2,367,653.00 $573,418.98

Construction Status

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Question Response
Is construction complete? 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.

Susan Triana

Sr. Accounting Manager, Projects


11/20/2017

Certification

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Section Question Response
Submission of Actual Cost Documentation 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.

  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 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).

  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 certifies that the cost information/documents submitted reflect costs actually incurred.

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

  7. 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.

Susan Triana

Sr. Accounting Manager, Projects


11/20/2017

Attachments

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