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:
37005
Service:
DTV
Call Sign:
KARZ-TV
Channel:
14 (UHF)
File Number:
0000028767
FRN:
0009961889
Date Submitted:
01/30/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

NEXSTAR BROADCASTING, INC.

Elizabeth Ryder

545 E. JOHN CARPENTER FREEWAY

SUITE 700

IRVING, TX 75062

United States

+1 (972) 373-8800 eryder@nexstar.tv Corporation

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Elizabeth Ryder

General Counsel

Nexstar Broadcasting, Inc.

Elizabeth Ryder

545 E. John Carpenter Freeway

Suite 700

Irving, TX 75062

United States

+1 (972) 373-8800 eryder@nexstar.tv

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan See attached Engineering Technical Statement and MEI Exhibits

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 DCX2
Year 1997
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 40 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? Yes
Manufacturer
Model HPTV-PRLX-U14
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 27.5 kW
Justification for New Transmitter ERP (H-pol Only): 525 kW RMS Gain: 27.20 (multiplier) AZ Pat Gain (H-pol): N/A (Omni) TX Line Loss: 78.9% (efficiency) TPO (Post-Filter): 24.5 kW (HPTV-PRLX-U15) 1-Step-Up Allowance: HPTV-PRLX-U16

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) Yes
Transformer (480V) Yes
Power 500 kVA
Rigid Conduit and Wiring Yes
Size 3 inches
Length 400.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 5 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 500.0 square feet
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

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? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting 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: 1000.0 kW
Manufacturer
Model TFU-34JSC-R 03
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: 525.0 kW
Manufacturer
Model TFU-29JTH/VP-R O6SP
Year 2018
Justification for New Antenna Station's licensed main antenna cannot be re-tuned and must be replaced for new channel assignment.

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 6 1/8 inches 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

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 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 980 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? Yes
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 1300 feet per run
Justification for New Transmission Line Existing tower must either be replaced or an alternate site must be used. The proposed alternate site will result in significant cost savings to the FCC and new transmission line is much cheaper than a new tower and all costs associated with it.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Line Layout

Transmission line layout required to verify location of line run inside the face of the tower and to verify no obstacles and number of elbows required.

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? Terrain Constrained
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1036555
Coordinates (NAD83) Latitude (NAD83) 34° 47' 57.0" N-
Longitude (NAD83) 092° 29' 30.0" W-
Overall Structure Height 1266.39 feet
Support Structure Height 1194.21 feet
Ground Elevation Above Mean Sea Level (AMSL) 954.71 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Mission Broadcasting, Inc.
Date Constructed 01/01/1983

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
11951 KLRT-TV DTV

Primary Tower

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Tower Modification Costs

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

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Terrain constrained
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Top Plate Mods

Existing top-plate and/or bolt pattern may not work for new top-mount antenna

Interim Tower

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Tower Construction Costs

Section Question Response
Construct New Tower Use Interim
Description of Use N/A
Height 1000.00 feet
Justification for New Tower Existing tower for licensed KARZ will become the interim location since an alternate site with an existing tower must be used as the permanent location for the KARZ post-transition facility (see attached KGA Engineering Technical Statement for details).

Interim 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

Interim Tower

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Other Tower Expenses Not Listed

Name Description

Interim Equipment Removal

After the assigned phase is complete, the existing antenna, transmission line and transmitter used by the licensed facility must be removed and disposed of since the existing licensed facility will be used as the interim while the alt site is built-out.

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 1000
Explanation It will be necessary to schedule and coordinate multiple vendors, complete progress reports, and update Schedule 399. Station does not have available personnel or personnel trained in project management for such complex projects.
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 No
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 20
Justification $5,400 per site visit including expenses x 20 days. It is necessary to survey the site, plan the equipment, develop specifications for purchasing, & oversee multiple vendor RF projects. Station does not have available personnel trained in such services.

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 Yes
Non-zoning permits No
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? 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

Sales Tax

Sales and use tax on goods and services

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,209,050.00 $973,505.00 N/A $731,529.75 N/A
Total for all systems $7,186,023.00 $4,233,416.00 N/A $1,025,188.43 N/A
Primary Transmitter HPTV-PRLX-U14 $1,209,050.00 $973,505.00 $731,529.75
5 Ton system $20,250.00 $19,700.00 Additional HVAC required for operation of new transmitter at an alternate site with a full-service 1,000 kW ERP facility already in operation. N/A N/A
Other -- Building Addition Size: 500.0 $120,000.00 $120,000.00 Based on industry standard rate of $240 per sq ft. Additional building modifications may be required for heat exchanger pads, transformer space, interim line feed-through, etc. and shelter to protect such equipment from the environment. N/A N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $715,505.00 See attached Comark quote $679,729.75 N/A
Switchgear - industrial 800 amp $38,200.00 $37,150.00 N/A $18,575.00 N/A
Transformer 3 phase/480v - 500 KVA $48,400.00 $47,100.00 N/A $23,550.00 N/A
3" Rigid Conduit and Wiring (Cost per foot) $20,800.00 $20,000.00 N/A $9,675.00 N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $14,050.00 N/A N/A N/A

Components

Actual Information Description File Name
5 Ton system Information not provided.
Other -- Building Addition Size: 500.0 Information not provided.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
Transmitter, installment #2, Item 1 and Shipping/Offloading and Placement costs; see also sales tax
Amount:
$321,977.25

Component Description:
System and Shipping, installment #1
Amount:
$357,752.50
Switchgear - industrial 800 amp

Component Description:
Transmitter electrical services, installment #1
Amount:
$18,575.00
Transformer 3 phase/480v - 500 KVA

Component Description:
Transmitter electrical services, installment #1
Amount:
$23,550.00
3" Rigid Conduit and Wiring (Cost per foot)

Component Description:
Transmitter electrical services installment #1
Amount:
$9,675.00
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 $308,530.00 $300,050.00 N/A $0.00 N/A
Total for all systems $7,186,023.00 $4,233,416.00 N/A $1,025,188.43 N/A
Primary Antenna TFU-29JTH/VP-R O6SP $308,530.00 $300,050.00 $0.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $281,500.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,550.00 N/A N/A N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $12,000.00 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 $275,100.00 $268,600.00 N/A $0.00 N/A
Total for all systems $7,186,023.00 $4,233,416.00 N/A $1,025,188.43 N/A
Primary Transmission Line $275,100.00 $268,600.00 $0.00
Rigid Transmission Line - copper, 6 1/8" $262,600.00 $256,100.00 N/A N/A N/A
Line Layout $12,500.00 $12,500.00 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 $4,389,800.00 $1,714,100.00 N/A $169,300.00 N/A
Total for all systems $7,186,023.00 $4,233,416.00 N/A $1,025,188.43 N/A
Interim Tower $2,865,500.00 $230,000.00 $0.00
Tall Tower (greater than 500') $210,500.00 $205,000.00 N/A N/A N/A
Interim Equipment Removal $25,000.00 $25,000.00 N/A N/A N/A
New tower between 1000' and 1500' without elevator, presumptive soil conditions $2,630,000.00 $0.00 Station has decided to build-out at an alternate site instead of building a new replacement tower which will result in significant cost savings for the FCC. N/A N/A
Primary Tower TOWER $1,524,300.00 $1,484,100.00 $169,300.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $25,600.00 N/A $24,300.00 N/A
Serious tower reinforcement/modifications $1,052,000.00 $1,024,000.00 N/A $145,000.00 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $409,500.00 N/A N/A N/A
Top Plate Mods $25,000.00 $25,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Tall Tower (greater than 500') Information not provided.
Interim Equipment Removal Information not provided.
New tower between 1000' and 1500' without elevator, presumptive soil conditions Information not provided.
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Structural Analysis and Engineering Report
Amount:
$6,000.00

Component Description:
Perform structural analysis and mapping.
Amount:
$8,500.00

Component Description:
Structural reanalysis
Amount:
$1,800.00

Component Description:
Perform a Structural Analysis and prepare engineering report.
Amount:
$8,000.00
Serious tower reinforcement/modifications

Component Description:
Tower modifications, installment #1; see also sales tax
Amount:
$130,000.00

Component Description:
Design structural modifications as required by structural analysis results and prepare modification working drawings and Technical Specification Notes.
Amount:
$15,000.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) Information not provided.
Top Plate Mods 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 $300,920.00 $295,540.00 N/A $21,483.00 N/A
Total for all systems $7,186,023.00 $4,233,416.00 N/A $1,025,188.43 N/A
Outside Professional Services $300,920.00 $295,540.00 $21,483.00
Additional Field Engineering Service, 20 Days $108,000.00 $108,000.00 $5,400 per site visit including expenses x 20 days. It is necessary to survey the site, plan the equipment, develop specifications for purchasing, & oversee multiple vendor RF projects. Station does not have available personnel trained in such services. N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,120.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,535.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,535.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,070.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,170.00 N/A $4,025.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,560.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,560.00 N/A N/A N/A
Project management of the transition $158,000.00 $154,000.00 N/A $17,458.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,305.00 N/A N/A N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,050.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,585.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,050.00 N/A N/A N/A

Components

Actual Information Description File Name
Additional Field Engineering Service, 20 Days 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

Component Description:
Repack plan and revision, 399 form info, channel search
Amount:
$3,500.00

Component Description:
Revise storyboard if needed, interference study, create CP and recalculate ERP if COR changed, transition plan document, create 399, coverage maps, and upload draft docs to ASANA.
Amount:
$525.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form Information not provided.
Project management of the transition

Component Description:
Project management services various
Amount:
$9,770.50

Component Description:
Project management services 5.26.18 through 6.29.18
Amount:
$2,400.00

Component Description:
Project Management for Structural Analysis and Tower Modifications. Services from January 1, 2018 through January 26, 2018.
Amount:
$1,200.00

Component Description:
Project Management for Structural Analysis and Tower Modifications including consultants Kessler and Gehman Associates. Services from January 27, 2018 through February 23, 2018.
Amount:
$1,350.00

Component Description:
Project Management for Structural Analysis and Tower Modifications. Services from June 30, 2018 through July 27, 2018.
Amount:
$1,125.00

Component Description:
Project Management for Structural Analysis and Tower Modifications. Services from March 31, 2018 through April 27, 2018.
Amount:
$450.00

Component Description:
Project Management for Structural Analysis and Tower Modifications. Services from October 27, 2017 through December 31, 2017.
Amount:
$1,162.50
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
ASR modification (prepare FCC Form 854) 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 $406,373.00 $399,821.00 N/A $102,875.68 N/A
Total for all systems $7,186,023.00 $4,233,416.00 N/A $1,025,188.43 N/A
Other Expenses $406,373.00 $399,821.00 $102,875.68
Sales Tax $283,293.00 $283,293.00 Sales and use tax on goods and services based on state tax rate of 9%. $72,875.68 N/A
Develop and air announcement of upcoming channel change $3,500.00 $3,500.00 Costs to develop and produce spots and crawls for viewer notifications. N/A N/A
Equipment Storage $25,000.00 $25,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $25,000.00 $25,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $30,000.00 $30,000.00 Original building cleanout was $5000 per USA Commercial Estimate 7. The tower failed at that building resulting in the need to move towers. Additional cleanout required $25000 per USA Commercial Estimate 11. $30,000.00 N/A
DTV Medical Facility Notification $11,550.00 $5,000.00 N/A N/A N/A
MVPD Notification of Channel Change $2,500.00 $2,500.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $333.00 N/A N/A N/A
Local Zoning $25,000.00 $25,000.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $195.00 N/A N/A N/A

Components

Actual Information Description File Name
Sales Tax

Component Description:
Sales tax on tower modifications materials and services
Amount:
$11,700.00

Component Description:
Sales tax on transmitter system, installment #2
Amount:
$28,977.95

Component Description:
Sales tax on transmitter system, installment #1
Amount:
$32,197.73
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)

Component Description:
Removal of equipment to prepare for installation of new transmitter on site.
Amount:
$25,000.00

Component Description:
Removal and disposal of all old equipment, electrical components, transmission lines and grid systems on existing transmitter site with quote
Amount:
$5,000.00
DTV Medical Facility Notification Information not provided.
MVPD Notification of Channel Change Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
Local Zoning Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $7,186,023.00 $4,233,416.00 $1,025,188.43

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.

Elizabeth Ryder

General Counsel


01/30/2019

Certification

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Section Question Response
Submission of Actual Cost Documentation Statements

WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (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 AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733).

  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.

  2. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct.

  3. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

  4. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  5. 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 (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) .

  6. 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.

  7. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.

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

  9. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a prerequisite 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.

Elizabeth Ryder

General Counsel


01/30/2019

Attachments

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