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:
0000028725
FRN:
0018223693
Facility ID:
363
Repack Channel:
32 (UHF)
Entity:
Broadcaster
Filing Status:
Submitted
Date Submitted:
11/02/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

GRAY TELEVISION LICENSEE, LLC

999 SECOND STREET S.E.

CHARLOTTESVILLE, VA 22902

United States

+1 (434) 242-1919 robert.folliard@gray.tv 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

Samuel Hariton

Widelity

Samuel Hariton

4031 University Dr

Suite 100

Fairfax, VA 22030

United States

+1 (339) 222-8107 sam.hariton@widelity.com

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan WCAV will replace the existing main transmitter, antenna, and transmission line, installing an interim antenna and transmission line in the process.

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 DHD20P1
Year 2008
Type Solid state
IOT Power Type  
Description  
Power capacity  
Solid State Cooling Air
Solid State Power Capacity 5.5 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? No
Manufacturer
Model UAXTE-16R44
Transmitter Type Solid state
IOT Power Type  
Other  
Power capacity  
Solid State Cooling Air
Solid State Power Capacity 9.6 kw
Other Transmitter Type  
Justification for New Transmitter Lack of availability for replacement parts makes supporting the current transmitter impossible

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power
Rigid Conduit and Wiring Yes
Size 2 inches
Length 50.0 feet
Other Electrical Service Yes
Description The new transmitter will require reconfiguration of the electrical service on site. The electrical work cost has been estimated based on verbal guidance from local electrical contractors.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 10 tons
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

Information not provided.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top-mount single
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: 155.00 kW
Manufacturer
Model Trasar - ATW18H4-HTCX-19H
Year 2004

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Type Class Full Power
Mounting Top-mount single
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 207.00 kW
Manufacturer
Model TFU-20Ett/VP-R C170
Year 2018
Justification for New Antenna Existing antenna is single channel antenna that cannot be retuned to new channel, must replace.

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 New
Number of channels supported 2
Frequencies of channels supported RF channel
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? No
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 6 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

Enter a list of RF channel numbers.

RF Channel Number
32
35

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Test Transition

Model RTT675 6 1/8" Test Transition

Top Plate Adapter

Adapter for top of tower to match antenna bolt pattern

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? No
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Type Class Full Power
Mounting Side-mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels/Bays 8
Lower Limit 500.00 MHz
Upper Limit 584.00 MHz
Design power capacity in use 100.0 %
Other Antenna Type N/A
ERP: 79.00 kW
Manufacturer
Model TUA04 8/32 H-1
Year 2017
Justification for New Antenna Interim antenna needed to broadcast through transition period.

Interim 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? Broadband
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? 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

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 Utilize Existing
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 Dielectric
Type Rigid
Diameter 6 1/8 inches
Segment Length 20'
Other Segment Length
Number of parallel runs 1
Length 240 feet per run

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 3 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 250 feet per run
Justification for New Transmission Line Transmission line for the interim antenna

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

UHF Inside RF System

UHF Inside RF System including switching

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 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) 37° 59' 03.0" N-
Longitude (NAD83) 078° 28' 52.0" W-
Overall Structure Height 189.40 feet
Support Structure Height 149.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 1455.00 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner Gray Television, Inc.
Date Constructed 01/01/2004

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
47705 WAHU-CD DTV

Other Types of Users

Users
WVAW-LD 4687

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

Name Description

Corrosion Risk Analysis

Corrosion risk analysis of existing tower

Tower Structural Analysis

Structural analysis of existing tower

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 900
Explanation Strategic Support
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 Yes
Additional Field Engineering Service Yes
Number of Days 2
Justification Vendor to provide support for deployment of equipment on site. See Gates Air quote Q-75022

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 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? No
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $351,527.08 $350,577.08 N/A $325,553.08 N/A
Total for all systems $1,931,159.08 $1,664,598.22 N/A $733,023.33 N/A
Primary Transmitter UAXTE-16R44 $351,527.08 $350,577.08 $325,553.08
Other Electrical Service: The new transmitter will require reconfiguration of the electrical service on site. The electrical work cost has been estimated based on verbal guidance from local electrical contractors. $3,706.00 $3,706.00 N/A $3,706.00 N/A
10 Ton system $37,900.00 $37,000.00 N/A $13,226.00 N/A
2" Rigid Conduit and Wiring (Cost per foot) $1,300.00 $1,250.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 9.6 kW $308,621.08 $308,621.08 Q-76099 $308,621.08 N/A

Components

Actual Information Description File Name
Other Electrical Service: The new transmitter will require reconfiguration of the electrical service on site. The electrical work cost has been estimated based on verbal guidance from local electrical contractors.

Component Description:
Electrical connection for transmitter and surge protector
Amount:
$1,912.00

Component Description:
Electrical Service New 1st Primary Transmitter
Amount:
$1,794.00
10 Ton system

Component Description:
Removal of 5 ton AC system and installation of a 10 ton AC system
Amount:
$4,856.00

Component Description:
Removal of 5 ton AC system and installation of a 10 ton AC System
Amount:
$8,370.00
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
UHF - Air Cooled Solid State Transmitter 9.6 kW

Component Description:
UAXTE-24R44 Transmitter pkg.
Amount:
$308,621.08

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 $649,244.00 $426,569.14 N/A $279,850.28 N/A
Total for all systems $1,931,159.08 $1,664,598.22 N/A $733,023.33 N/A
Interim Antenna TUA04 8/32 H-1 $247,222.00 $148,656.00 $136,432.00
UHF – Broadband Panel, Side Mount Auxiliary/Interim, 79 horizontally polarized $0.00 $0.00 N/A N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $22,550.00 $11,600.00 N/A $9,280.00 N/A
UHF – Broadband Panel, Side Mount Auxiliary/Interim, 79 horizontally polarized $122,032.00 $122,032.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***JEHQ1328-3 $122,032.00 N/A
Elbow complex, broadband, at antenna input, per 3 1/8. feedline (if needed) $9,090.00 $8,624.00 N/A N/A N/A
Sweep test of existing antenna $6,550.00 $6,400.00 N/A $5,120.00 N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized $87,000.00 $0.00 N/A N/A N/A
Primary Antenna TFU-20Ett/VP-R C170 $402,022.00 $277,913.14 $143,418.28
New combiner, cost per channel (without antenna) $80,000.00 $34,284.72 N/A $34,284.72 N/A
Top Plate Adapter $19,552.00 $19,552.00 N/A $10,753.60 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,000.00 $12,768.00 JEHQ1277-01 $5,429.60 N/A
Sweep test of existing antenna $6,550.00 $6,400.00 N/A $3,520.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $281,500.00 $202,488.42 N/A $89,430.36 N/A
Test Transition $2,420.00 $2,420.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF – Broadband Panel, Side Mount Auxiliary/Interim, 79 horizontally polarized Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
Side mount brackets New Interim Antenna
Amount:
$2,900.00

Component Description:
Side mount brackets New Interim Antenna
Amount:
$2,900.00

Component Description:
Interim Antenna, Side Mount Bracket
Amount:
$3,480.00
UHF – Broadband Panel, Side Mount Auxiliary/Interim, 79 horizontally polarized

Component Description:
UHF Broadband Panel, Side mount aux/interim antenna
Amount:
$45,762.00

Component Description:
UHF Broadband panel, side mount aux/interim TV antenna TUA04 8/32 H-1 WCAV
Amount:
$38,135.00

Component Description:
UHF Broadband panel, side mount aux/interim TV Ant TUA04 8/32 H-1
Amount:
$38,135.00
Elbow complex, broadband, at antenna input, per 3 1/8. feedline (if needed) Information not provided.
Sweep test of existing antenna

Component Description:
Sweep test
Amount:
$1,600.00

Component Description:
Sweep test
Amount:
$1,600.00

Component Description:
Interim Antenna Sweep Test
Amount:
$1,920.00
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized Information not provided.
New combiner, cost per channel (without antenna)

Component Description:
Combiner
Amount:
$34,284.72
Top Plate Adapter

Component Description:
Top plate adapter New Primary Antenna
Amount:
$5,865.60

Component Description:
New Primary Antenna Top Plate Adapter
Amount:
$4,888.00
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Elbow complex New Primary Antenna
Amount:
$2,961.60

Component Description:
New Primary Antenna Elbow Complex
Amount:
$2,468.00
Sweep test of existing antenna

Component Description:
Sweep test New Primary Antenna
Amount:
$1,920.00

Component Description:
New Primary Antenna Sweep
Amount:
$1,600.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
UHF High Power Top Mount TV Antenna
Amount:
$46,169.85

Component Description:
Primary Antenna; UHF High Power Top Mount (200-1000 kW) TV Antenna
Amount:
$38,474.88

Component Description:
V-Pol adder Primary Antenna
Amount:
$4,785.63
Test Transition 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 $154,250.00 $156,562.00 N/A $12,332.67 N/A
Total for all systems $1,931,159.08 $1,664,598.22 N/A $733,023.33 N/A
Interim Transmission Line $154,250.00 $156,562.00 $12,332.67
Flexible Air Transmission Line - dielectric, 3" $14,250.00 $16,562.00 JEHQ1328-03 $8,128.47 N/A
UHF Inside RF System $140,000.00 $140,000.00 N/A $4,204.20 N/A
Primary Transmission Line $0.00 $0.00 $0.00

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 3"

Component Description:
New Tx line
Amount:
$2,540.15

Component Description:
Interim Transmission Line
Amount:
$3,048.17

Component Description:
New Transmission line
Amount:
$2,540.15
UHF Inside RF System

Component Description:
New Primary Transmission Line Accessories
Amount:
$1,911.00

Component Description:
Inside RF system New Interim Transmission Line
Amount:
$2,293.20

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 $530,500.00 $497,500.00 N/A $71,650.00 N/A
Total for all systems $1,931,159.08 $1,664,598.22 N/A $733,023.33 N/A
Primary Tower GTOWER $530,500.00 $497,500.00 $71,650.00
Major tower reinforcement/modifications $409,500.00 $400,000.00 N/A $64,650.00 N/A
Tower Structural Analysis $12,000.00 $12,000.00 Catalog amount $5,500.00 N/A
Corrosion Risk Analysis $1,500.00 $1,500.00 See invoice $1,500.00 N/A
Short Tower (less than 500') $81,900.00 $80,000.00 N/A N/A N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $25,600.00 $4,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Major tower reinforcement/modifications

Component Description:
Installation of reinforcement materials
Amount:
$3,200.00

Component Description:
Reinforcing Materials, Installation and freight.
Amount:
$10,200.00

Component Description:
Reinforcing Materials, Installation and freight
Amount:
$15,857.50

Component Description:
Reinforcing materials, Installation and freight.
Amount:
$26,057.50

Component Description:
Reinforcing analysis and design
Amount:
$3,000.00

Component Description:
Six anodes for WCAV-TV
Amount:
$2,805.00

Component Description:
Six (6) Anodes
Amount:
$3,530.00
Tower Structural Analysis

Component Description:
Structural Analysis
Amount:
$3,000.00

Component Description:
Engineering Evaluation/Feasibility Analysis
Amount:
$1,250.00

Component Description:
Engineering evaluation/feasibility analysis.
Amount:
$1,250.00
Corrosion Risk Analysis

Component Description:
Corrosion Risk Analysis
Amount:
$750.00

Component Description:
Corrosion Risk Analysis
Amount:
$750.00
Short Tower (less than 500') Information not provided.
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study 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 $198,660.00 $193,870.00 N/A $42,912.30 N/A
Total for all systems $1,931,159.08 $1,664,598.22 N/A $733,023.33 N/A
Outside Professional Services $198,660.00 $193,870.00 $42,912.30
Project management of the transition $138,600.00 $135,000.00 N/A $40,078.30 N/A
Additional Field Engineering Service, 2 Days $10,120.00 $10,120.00 Please see quote from Gates Air Q-75022 N/A N/A
Prepare and or review reimbursement form $2,560.00 $2,500.00 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
Perform engineering study for new channel assignment and antenna development $7,170.00 $7,000.00 N/A $1,187.50 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,070.00 $3,000.00 N/A $1,450.00 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 request for Special Temporary Authorization $1,535.00 $1,500.00 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 $196.50 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 request for Special Temporary Authorization $3,585.00 $3,500.00 N/A N/A N/A
RF Exposure Measurements $20,500.00 $20,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Project Management
Amount:
$3,016.85

Component Description:
Project Management
Amount:
$217.50

Component Description:
Project Management
Amount:
$3,437.25

Component Description:
Project Management
Amount:
$4,055.65

Component Description:
Project Mgt
Amount:
$28.20

Component Description:
Project Management
Amount:
$2,398.70

Component Description:
Project Management
Amount:
$2,454.15

Component Description:
Project Management
Amount:
$3,560.10

Component Description:
Project Mgt
Amount:
$770.80

Component Description:
Project Mgt
Amount:
$2,381.30

Component Description:
Project Mgt
Amount:
$2,461.05

Component Description:
Project Management
Amount:
$1,990.60

Component Description:
Project Mgt
Amount:
$802.25

Component Description:
Transition Related Project Management Costs
Amount:
$1,350.00

Component Description:
Project Mgt
Amount:
$913.95

Component Description:
Project management
Amount:
$2,517.65

Component Description:
Project Management
Amount:
$2,073.10

Component Description:
Project management
Amount:
$2,580.65

Component Description:
Project Management
Amount:
$1,740.00

Component Description:
Project managment
Amount:
$1,328.55
Additional Field Engineering Service, 2 Days Information not provided.
Prepare and or review reimbursement form Information not provided.
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:
Perform engineering study for new channel assignment
Amount:
$812.50

Component Description:
Perform engineering study for new channel assignment
Amount:
$375.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
CP Application engineering cost
Amount:
$1,450.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Work on and file initial repack CP
Amount:
$196.50
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.
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 $46,978.00 $39,520.00 N/A $725.00 N/A
Total for all systems $1,931,159.08 $1,664,598.22 N/A $733,023.33 N/A
Other Expenses $46,978.00 $39,520.00 $725.00
MVPD Notification of Channel Change $1,500.00 $1,500.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $5,000.00 $5,000.00 N/A $725.00 N/A
Equipment Delivery and Handling Charges $10,200.00 $10,200.00 N/A 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
DTV Medical Facility Notification $11,250.00 $3,805.00 N/A N/A N/A
Non-zoning permits $3,500.00 $3,500.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $15,000.00 $15,000.00 N/A N/A N/A

Components

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

Component Description:
Professional services
Amount:
$725.00
Equipment Delivery and Handling Charges Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
DTV Medical Facility Notification Information not provided.
Non-zoning permits 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 $1,931,159.08 $1,664,598.22 $733,023.33

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.

Robert Folliard

Assistant Secretary


11/02/2018

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.

Robert Folliard

Assistant Secretary


11/02/2018

Attachments

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