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:
0000028704
FRN:
0007201627
Facility ID:
49711
Repack Channel:
21 (UHF)
Entity:
Broadcaster
Filing Status:
Submitted
Date Submitted:
10/03/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

LILLY BROADCASTING OF PENNSYLVANIA LICENSE SUBSIDIARY, LLC

Doing Business As: LILLY BROADCASTING OF PENNSYLVANIA LICENSE SUBSIDIARY, LLC

Kevin T. Lilly

3514 STATE STREET

ERIE, PA 16508

United States

+1 (814) 454-5201 KEVIN@LILLYTV.COM Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan Relocate from ASR #1221626 to ASR #1055828. Construct post-repack facilities at alternate location. No interim facilities required. Install new transmitter, RF system, transmission line and antenna on post-repack channel 21 pursuant to CP authorization.

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 HU3750AD Innovator HX
Year 2007
Type Solid state
IOT Power Type  
Description  
Power capacity  
Solid State Cooling Air
Solid State Power Capacity 3.75 kw
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 THU9-10 EVO
Transmitter Type Solid state
IOT Power Type  
Other  
Power capacity  
Solid State Cooling Liquid
Solid State Power Capacity 12.5 kw
Other Transmitter Type  
Justification for New Transmitter The existing transmitter cannot be retuned to operate on channel 16. The manufacturer is no longer supporting the equipment. The power increase is required due to antenna gain.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) No
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring No
Size
Length
Other Electrical Service No
Description  
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 5 tons
Other Size  
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 1200.0 square feet
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

RF Interconnect

Interconnect between RF System and transmission line

Removal of Existing Equipment

Removal of existing transmitters and equipment / Site Prep

Antennas

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Section Question Response
Antenna Related Expenses Do you have antenna related expenses? Yes

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side-mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 75.00 kW
Manufacturer
Model TLP-24M (C)
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? No
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Type Class Full Power
Mounting Top-mount stacked
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: 96.00 kW
Manufacturer
Model ATC-BCE416O-V0-21
Year 2018
Justification for New Antenna The existing antenna is a coaxial slot antenna that is channel-specific and not usable on channel 21.

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? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 3 1/8 inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

2 FT Antenna Mounting Wedding Cake Adapter

2ft Antenna Mounting Wedding Cake Adapter

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
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 700 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 3 1/8 inches
Segment Length 19 ½ '
Other Segment Length
Number of parallel runs 1
Length 800 feet per run
Justification for New Transmission Line A new transmission line is recommended by the antenna manufacturer due to age.

Primary 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 Move Equipment
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
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 Yes
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 1221626
Coordinates (NAD83) Latitude (NAD83) 42° 03' 52.2" N-
Longitude (NAD83) 080° 00' 18.2" W-
Overall Structure Height 843.17 feet
Support Structure Height 800.52 feet
Ground Elevation Above Mean Sea Level (AMSL) 1374.66 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Vertical Bridge Towers, LLC
Date Constructed 07/01/1966

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
24970 WICU-TV DTV

Other Types of Users

Users
Public safety
Cellular users

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.

Primary Tower

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Add 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 Yes
Is tower documented for structural analysis? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 42° 02' 16.0" N-
Longitude (NAD83) 080° 03' 43.0" W-
Overall Structure Height 749.33 feet
Support Structure Height 699.79 feet
Ground Elevation Above Mean Sea Level (AMSL) 1346.11 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner Lilly Broadcasting of Pennsylvania, LLC
Date Constructed 09/01/1981

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
28774 WCTL FM
24970 WICU-TV DTV

Other Types of Users

Users
W254AJ
W32DH-D

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 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 The station's attorney will manage the reimbursement filings, review engineering applications, and engage in any additional coordination that is needed for WSEE to accomplish its repack transition.
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 Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
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 Yes
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

Information not provided.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? Yes
Is Remediation needed? Yes
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 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

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 $661,100.00 $553,306.00 N/A $112,111.80 N/A
Total for all systems $2,774,898.00 $2,334,741.00 N/A $672,789.30 N/A
Primary Transmitter THU9-10 EVO $661,100.00 $553,306.00 $112,111.80
Removal of Existing Equipment $25,000.00 $25,000.00 Estimate based on prior experience. N/A N/A
RF Interconnect $25,000.00 $25,000.00 Estimate based on prior experience. N/A N/A
Other -- Building Addition Size: 1200.0 $60,000.00 $60,000.00 Building modification required for post-repack build out. Estimate based on prior experience. N/A N/A
5 Ton system $19,700.00 $19,700.00 N/A N/A N/A
Transformer 3 phase/480v - 300 KVA $35,850.00 $35,850.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $481,500.00 $373,706.00 N/A $112,111.80 N/A
Service entrance 3 phase/800 amp/208 volt $14,050.00 $14,050.00 N/A N/A N/A

Components

Actual Information Description File Name
Removal of Existing Equipment Information not provided.
RF Interconnect Information not provided.
Other -- Building Addition Size: 1200.0 Information not provided.
5 Ton system Information not provided.
Transformer 3 phase/480v - 300 KVA Information not provided.
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW

Component Description:
Rohde & Schwarz - Transmitter - 30%
Amount:
$112,111.80
Service entrance 3 phase/800 amp/208 volt 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 $319,630.00 $205,700.00 N/A $102,850.00 N/A
Total for all systems $2,774,898.00 $2,334,741.00 N/A $672,789.30 N/A
Primary Antenna ATC-BCE416O-V0-21 $319,630.00 $205,700.00 $102,850.00
2 FT Antenna Mounting Wedding Cake Adapter $24,000.00 $24,000.00 Estimate based on prior experience. $12,000.00 N/A
Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed) $7,580.00 $7,200.00 N/A $3,600.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $281,500.00 $169,500.00 N/A $84,750.00 N/A
Sweep test of existing antenna $6,550.00 $5,000.00 N/A $2,500.00 N/A

Components

Actual Information Description File Name
2 FT Antenna Mounting Wedding Cake Adapter

Component Description:
Alive Telecom - Antenna - Wedding Cake - 50% Invoice
Amount:
$12,000.00
Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed)

Component Description:
Alive Telecom - Antenna - Elbow Complex - 50% Invoice
Amount:
$3,600.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Alive Telecom - Antenna - 50% Invoice
Amount:
$84,750.00
Sweep test of existing antenna

Component Description:
Alive Telecom - Antenna - Antenna Sweep - 50% Invoice
Amount:
$2,500.00

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 $120,700.00 $112,100.00 N/A $62,600.00 N/A
Total for all systems $2,774,898.00 $2,334,741.00 N/A $672,789.30 N/A
Primary Transmission Line $120,700.00 $112,100.00 $62,600.00
Rigid Transmission Line - copper, 3 1/8" $80,800.00 $80,800.00 N/A $31,300.00 N/A
Flexible Air Transmission Line - dielectric, 3" $39,900.00 $31,300.00 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $31,300.00 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 3 1/8"

Component Description:
Alive - Transmission Line - 50% Invoice
Amount:
$31,300.00
Flexible Air Transmission Line - dielectric, 3"

Component Description:
Alive Telecom-Transmitter Line-August 2018-50%
Amount:
$31,300.00

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 $845,100.00 $845,100.00 N/A $391,670.00 N/A
Total for all systems $2,774,898.00 $2,334,741.00 N/A $672,789.30 N/A
Primary Tower TOWER $205,000.00 $205,000.00 $0.00
Tall Tower (greater than 500') $205,000.00 $205,000.00 N/A $0.00 N/A
Primary Tower GTOWER $640,100.00 $640,100.00 $391,670.00
Tall Tower (greater than 500') $205,000.00 $205,000.00 N/A $185,000.00 N/A
Major tower reinforcement/modifications $409,500.00 $409,500.00 N/A $185,000.00 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $25,600.00 $25,600.00 N/A $21,670.00 N/A

Components

Actual Information Description File Name
Tall Tower (greater than 500') Information not provided.
Tall Tower (greater than 500')

Component Description:
Worldwide - 50% Tower - 20% Downpayment
Amount:
$47,000.00

Component Description:
Worldwide - 50% Tower - 3rd Deposit
Amount:
$88,000.00

Component Description:
Worldwide - Tower 50% - 2nd Deposit
Amount:
$50,000.00
Major tower reinforcement/modifications

Component Description:
Worldwide - Tower 50% - 20% Downpayment
Amount:
$47,000.00

Component Description:
Worldwide -- Tower 50% - 3rd Deposit
Amount:
$88,000.00

Component Description:
Worldwide - Tower 50% - 2nd Deposit
Amount:
$50,000.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Worldwide - Tower Mapping - 65% Invoice
Amount:
$14,085.00

Component Description:
Worldwide - Tower Mapping - Final Invoice
Amount:
$5,418.00

Component Description:
Worldwide - Tower Mapping - 10% Invoice
Amount:
$2,167.00

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $166,740.00 $162,850.00 N/A $3,557.50 N/A
Total for all systems $2,774,898.00 $2,334,741.00 N/A $672,789.30 N/A
Outside Professional Services $166,740.00 $162,850.00 $3,557.50
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,050.00 $2,050.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,050.00 $2,050.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $81,900.00 $80,000.00 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 - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,120.00 $5,000.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $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
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 $337.50 N/A
Project management of the transition $30,800.00 $30,000.00 N/A $3,220.00 N/A
RF Exposure Measurements $20,500.00 $20,000.00 N/A N/A N/A

Components

Actual Information Description File Name
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
ASR modification (prepare FCC Form 854) Information not provided.
Comprehensive coverage verification via field study, if needed 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 - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application 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

Component Description:
Assistance with reimbursement requests - Feb 2018, #465104.
Amount:
$202.50

Component Description:
Assistance with reimbursement requests - April 2018, #467309.
Amount:
$135.00
Project management of the transition

Component Description:
Project management services with regard to engineering, accounting, and/or legal work - May 2018, #467739.
Amount:
$67.50

Component Description:
Project management services with regard to engineering, accounting, and/or legal work - July 2018, #469169.
Amount:
$952.50

Component Description:
Project management services with regard to engineering, accounting, and/or legal work - September 2017, #461699 - revised.
Amount:
$100.00

Component Description:
Project management services with regard to engineering, accounting, and/or legal work - August 2017, #461545.
Amount:
$2,100.00
RF Exposure Measurements 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 $72,528.00 $71,585.00 N/A $0.00 N/A
Total for all systems $2,774,898.00 $2,334,741.00 N/A $672,789.30 N/A
Other Expenses $72,528.00 $71,585.00 $0.00
MVPD Notification of Channel Change $5,000.00 $5,000.00 Estimate based on prior experience. N/A N/A
Develop and air announcement of upcoming channel change $10,000.00 $10,000.00 Estimate based on prior experience. N/A N/A
Equipment Storage $1,500.00 $1,500.00 Estimate based on prior experience. N/A N/A
Equipment Delivery and Handling Charges $5,000.00 $5,000.00 Estimate based on prior experience. N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $10,000.00 $10,000.00 Estimate based on prior experience. N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $333.00 $325.00 N/A N/A N/A
AM Pattern Disturbance -- Impact study $7,680.00 $7,500.00 N/A N/A N/A
AM Pattern Disturbance -- Remedy $20,500.00 $20,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,250.00 $11,000.00 N/A 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

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,774,898.00 $2,334,741.00 $672,789.30

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.

Kevin Lilly

Managing Member of Sole Member


10/03/2018

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.

Kevin Lilly

Managing Member of Sole Member


10/03/2018

Attachments

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