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:
18753
Service:
DTV
Call Sign:
WVIZ
Channel:
35 (UHF)
File Number:
0000027479
FRN:
0005277538
Date Submitted:
06/12/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

IDEASTREAM

Doing Business As: IDEASTREAM

KEVIN E. MARTIN

IDEA CENTER

1375 EUCLID AVENUE

CLEVELAND, OH 44115

United States

+1 (216) 916-6455 kevin.martin@ideastream.org Not-for-Profit

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Jerrold Francis Wareham

Repack Coordinator

ideastream

JERRY WAREHAM

IDEA CENTER

1375 EUCLID AVENUE

CLEVELAND, OH 44115

United States

+1 (216) 916-6120 jerry.wareham@ideastream.org

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 WVIZ must replace its main antenna and transmitter in order to move it its new channel. It will need to install interim facilities in order to be able to replace the main facility. See attached narrative.

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 Innovator
Year 2009
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 15 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 CTX724
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 20.0 kW
Justification for New Transmitter The new transmitter is required because WVIZ will need a minimum of 19.7 kW tpo for higher ERP on the new channel. The current transmitter is orphaned and no longer supported by the manufacturer. Parts are in very limited supply or not available.

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 N/A
Length N/A
Other Electrical Service Yes
Description Necessary conduit, wiring and fuse disconnects as quoted by electrical contractor.
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

Transmitter Site Suvey

Survey of transmitter site to determine exact facility needs

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 Top Mount
Antenna position in stack Top
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: 150.0 kW
Manufacturer
Model TFU-10GTH-R C170
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? 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? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Top
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: 181.0 kW
Manufacturer
Model TFU-10GTH-R C170 SP
Year 2019
Justification for New Antenna Existing main antenna is a coaxial slot antenna that is channel specific and cannot be reused on 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? 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? 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

Information not provided.

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? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Slot
Number of Stations Supported 1
Number of Panels/Bays 8
Lower Limit 470.00 MHz
Upper Limit 698.00 MHz
Design power capacity in use 40.0 %
Other Antenna Type N/A
ERP: 150.0 kW
Manufacturer
Model TFU-8WB-R
Year 2019
Justification for New Antenna WVIZ needs an interim antenna for operation . while it replaces the primary antenna

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 Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1350 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 Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1350 feet per run
Justification for New Transmission Line Current transmission line has 19.5" segment lengths which will not work for the WVIZ assigned repack Ch. 35.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Flexible Air
Diameter 4 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 1000 feet per run
Justification for New Transmission Line WVIZ will need an interim transmission line for operation while it replaces its primary transmission line.

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

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 1265403
Coordinates (NAD83) Latitude (NAD83) 41° 23' 09.9" N-
Longitude (NAD83) 081° 41' 20.7" W-
Overall Structure Height 912.06 feet
Support Structure Height 912.06 feet
Ground Elevation Above Mean Sea Level (AMSL) 1040.01 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner 6600 Broadview LLC
Date Constructed 06/05/2009

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
73195 WKYC 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: Minor Reinforcements needed

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 200
Explanation Project manager needed to manage all work required coordinate vendor and contractor specification development, selection of list for bid solicitation, bid evaluation, vendor/contractor selection/contracting and contract enforcement.
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 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 No
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

Information not provided.

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 Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application No
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)? 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

Employee Time

Time needed by ideastream employees to work on the transition to a new channel.

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 $733,250.00 $698,000.00 N/A $0.00 N/A
Total for all systems $2,044,687.00 $1,869,803.00 N/A $35,569.25 N/A
Primary Transmitter CTX724 $733,250.00 $698,000.00 $0.00
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW $684,000.00 $650,000.00 N/A N/A N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $24,300.00 N/A N/A N/A
Other Electrical Service: Necessary conduit, wiring and fuse disconnects as quoted by electrical contractor. $15,700.00 $15,700.00 See attached electrical quote. N/A N/A
Transmitter Site Suvey $8,000.00 $8,000.00 Survey of transmitter site to determine needs 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 $392,360.00 $290,936.00 N/A $0.00 N/A
Total for all systems $2,044,687.00 $1,869,803.00 N/A $35,569.25 N/A
Interim Antenna TFU-8WB-R $96,130.00 $91,400.00 $0.00
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized $89,400.00 $85,000.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
Primary Antenna TFU-10GTH-R C170 SP $296,230.00 $199,536.00 $0.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $193,136.00 Quoted cost of antenna from the manufacturer with the upgrade cost related to vertical polarization removed from the overall cost. See attached quote. N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A 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 $346,700.00 $329,200.00 N/A $0.00 N/A
Total for all systems $2,044,687.00 $1,869,803.00 N/A $35,569.25 N/A
Interim Transmission Line $74,000.00 $70,000.00 $0.00
Flexible Air Transmission Line - dielectric, 4" $74,000.00 $70,000.00 N/A N/A N/A
Primary Transmission Line $272,700.00 $259,200.00 $0.00
Rigid Transmission Line - copper, 6 1/8" $272,700.00 $259,200.00 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 $381,100.00 $362,000.00 N/A $0.00 N/A
Total for all systems $2,044,687.00 $1,869,803.00 N/A $35,569.25 N/A
Primary Tower TOWER $381,100.00 $362,000.00 $0.00
Structural engineering tower load study for well documented tower $12,600.00 $12,000.00 N/A N/A N/A
Tall Tower (greater than 500') $210,500.00 $200,000.00 N/A N/A N/A
Minor tower reinforcement/modifications $158,000.00 $150,000.00 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 $62,310.00 $61,250.00 N/A $6,858.75 N/A
Total for all systems $2,044,687.00 $1,869,803.00 N/A $35,569.25 N/A
Outside Professional Services $62,310.00 $61,250.00 $6,858.75
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $702.00 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
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 - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A N/A N/A
Project management of the transition $31,600.00 $30,000.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $5,000.00 Required to revise and resubmit Form 399 at the request of the FCC $4,356.75 Required to revise and resubmit 399 at the request of the FCC
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $900.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $900.00 N/A

Components

Actual Information Description File Name
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Includes revised cover letter correcting typo in amount of cost as requested. Legal Services 9-27-2017 $78 Memo to client reports due for CP holders and second filing window notice
Amount:
$78.00

Component Description:
Legal Services on 2-10-2017 $78 email exchange with client regarding channel change
Amount:
$78.00

Component Description:
Legal Services on 5-3-2017 $117 email exchanges with consulting engineer regarding FCC release of TV study update
Amount:
$117.00

Component Description:
Legal Services on 6-7-2017 $117 Review of public notice & email to client 6-20-2017 $117 Review draft construction permit modification appliecation and associated emails
Amount:
$234.00

Component Description:
Legal Services on 7-24-2017 $195 Review of CP authorizations
Amount:
$195.00
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Project management of the transition Information not provided.
Prepare and or review reimbursement form

Component Description:
Review of and Reponse to WVIZ 399 Questions .5 $75.00
Amount:
$75.00

Component Description:
Legal Services on 8-4-2017 $117 Rev of 399 revision request 8-7-2017 $117 Rev add documentation 8-11-2017 $41.25 File amended 399 8-11-2017 $312 Review amended 399 8-17-2017 $117 Resp client regard CORES
Amount:
$704.25

Component Description:
Legal Services on 7-5-2017 $117 Resp to client re empl. time reimb 7-6-2017 $156 Review empl. time exhibit 7-10-2017 $49.50 File forms 7-10-2017 $468 Rev final 399 and confirm to file
Amount:
$790.50

Component Description:
Review of FCC Requested 399 Changes, Conference Call and Preparation 4.0 $600
Amount:
$600.00

Component Description:
Legal Services on 5-2-2017 Review of Widelity catalog with client
Amount:
$156.00

Component Description:
- Preliminary Widelity Cost Spreadsheet for WVIZ 1.0 $150.00
Amount:
$150.00

Component Description:
Legal Services on 6-14-2017 $195 Resp to client re reimbursement process 6-19-2017 $117 Resp to client re 399 Users Guide and tower entry 6-20-2017 $195 Review Draft Reimburse App 6-28-2017 $624 Review 399 narr conf call & follow up
Amount:
$1,131.00

Component Description:
-Help Prepare 399 1.0 $150.00 - Review of 399 1.0 $150.00 - 399 Narrative Review and Conference Call 2.0 $300.00 - 399 Questions1.0 $150.00
Amount:
$750.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
WVIZ Repack Call and Data Review 1.5 $225.00
Amount:
$225.00

Component Description:
WVIZ Assignment - Review of Population Loss, Preliminary Antenna Comparison (TUA-C4-08) and Potential Interfering Stations 1.5 $225.00
Amount:
$225.00

Component Description:
WVIZ - Review of Proposed Dielectric Antenna Pattern and Subsequently Revised Pattern. Conference Call to Discuss Status and Options 3.0 $450.00
Amount:
$450.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepare CP Application for WVIZ 6.0
Amount:
$900.00

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 $128,967.00 $128,417.00 N/A $28,710.50 N/A
Total for all systems $2,044,687.00 $1,869,803.00 N/A $35,569.25 N/A
Other Expenses $128,967.00 $128,417.00 $28,710.50
Non-zoning permits $1,000.00 $1,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A N/A N/A
Employee Time $76,617.00 $76,617.00 N/A $28,710.50 N/A
MVPD Notification of Channel Change $1,000.00 $1,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $5,000.00 $5,000.00 N/A N/A N/A
Equipment Storage $5,000.00 $5,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $23,800.00 $23,800.00 Shipping and offloading for transmitter and main and interim antennas and transmission lines. See attached quotes. N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $5,000.00 $5,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Non-zoning permits Information not provided.
DTV Medical Facility Notification Information not provided.
Employee Time

Component Description:
Invoice as requested, summary of hours to be reimbursed by position, labor rate calculation, individual time records, paystubs for the first date and last date for which reimbursement is requested.
Amount:
$28,710.50
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,044,687.00 $1,869,803.00 $35,569.25

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.

Jerrold Francis Wareham

Repack Coordinator


06/12/2018

Attachments

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