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:
62424
Service:
DTV
Call Sign:
KCDT
Channel:
18 (UHF)
File Number:
0000026396
FRN:
0001631738
Date Submitted:
12/26/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

STATE BOARD OF EDUCATION, STATE OF IDAHO

Doing Business As: IDAHO PUBLIC TELEVISION

Technology Director

1455 NORTH ORCHARD STREET

ATTN: RICHARD VAN GENDEREN

BOISE, ID 83706

United States

+1 (208) 373-7220 Dutch@idahoptv.org Government Entity

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

Richard Van Genderen

Director of Technology

State Board of Education, State of Idaho dba Idaho Public Television

Director of Technology

Idaho Public Television

1455 N. Orchard Street

Boise, ID 83706

United States

+1 (208) 373-7220 dutch@idahoptv.org

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan Install interim Aux.antenna and move KCDT-45 and K26LJ-D over to it at reduced output power. (Requires STA) Then decommission existing KCDT-45 antenna and damaged transmission line. Install new UHF wideband antenna and 3 1/8" rigid line on tower.

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 DHD15P1
Year 2002
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 3.75 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 UAXTE-8
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 4.8 kW
Justification for New Transmitter Current transmitter is 15 years old and not re-tuneable to new assigned lower frequency.

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 N/A
Rigid Conduit and Wiring Yes
Size 1.5 inches
Length 20.0 feet
Other Electrical Service Yes
Description Will have to add a couple of standard 110V circuits for operation of the dual exciters.
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

2-port UHF channel combiner

A new 2 port UHF channel combiner will be required. We currently utilize one and it is not tuneable to the new assigned channel.

Stringent Mask filter

New Stringent Mask filter for new channel assignment

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? Yes
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 Broadband Panel
Number of Stations Supported 2
Number of Panels 8
Design power capacity in use 60.0 %
Lower Limit 626.00 MHz
Upper Limit 806.00 MHz
Other Antenna Type N/A
ERP: 55.0 kW
Manufacturer
Model 881-8
Year 2002

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

Facility ID Call Sign
61953 K26LJ-D

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? Yes
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 Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 2
Number of Panels/Bays 8
Lower Limit 494.00 MHz
Upper Limit 548.00 MHz
Design power capacity in use 38.0 %
Other Antenna Type N/A
ERP: 36.1 kW
Manufacturer
Model TFU8-WB
Year 2018
Justification for New Antenna Existing antenna is broadband, but for upper UHF frequencies which KCDT will not be authorized to operate on. A new antenna must be employed for the new lower UHF 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? Yes
Type New
Number of channels supported 2
Frequencies of channels supported Upper and lower frequency
Frequency 494.0 MHz - 548.0 MHz
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? Broadband
Feed Line Size 3 1/8 inches 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? Yes
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

Line Adapters

Adapters to go from 3 inch line to 1.5 inch line for proposed aux antenna.

Aux.Temp Antenna

Proposed 2 panel medium power light weight antenna array to be used while tower work being performed for new full power antenna.

Flexible foam core heliax

To connect Aux/Temp antenna to combiner; 1 5/8" heliax and mounting hardware.

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? Yes
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Air
Diameter 3 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 105 feet per run

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

Facility ID Call Sign
61953 K26LJ-D

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
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 105 feet per run
Justification for New Transmission Line Existing line is ice damaged and should be replaced.

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 Foam
Diameter 1 5/8 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 75 feet per run
Justification for New Transmission Line This line will connect auxiliary antenna to existing combiner in the effort to keep signals on the air while new antenna and line are installed on tower. It is smaller since the aux antenna has lower power capacity than full power replacement antenna.

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Hangers- Grounding kit

Will require line hangers and 2 grounding kits for this heliax line.

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 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) No
Others Types of Users Yes
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 47° 43' 53.66" N-
Longitude (NAD83) 116° 43' 50.7" W-
Overall Structure Height 93.00 feet
Support Structure Height 80.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 4062.00 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Idaho Public Television
Date Constructed 06/01/1991


Other Types of Users

Users
WISP
LPFM x 3
LPTV x 4

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

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? No
Number of Hours N/A
Explanation N/A
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application No
For Auxiliary Facility N/A
For Main Facility N/A
Prepare and file Form FCC License to Cover Application No
For Auxiliary Facility N/A
For Main Facility N/A
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 No
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service Yes
Number of Days 4
Justification Installation of new transmitter by factory technician.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Tower Structural Study

Inventory and structural study of existing and proposed loading with new antennas.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning No
Non-zoning permits No
BLM or NFS Coordination Yes
FCC Construction Permit Minor Change No
FCC License to Cover Application No
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 $256,800.00 $165,300.00 N/A $0.00 N/A
Total for all systems $1,072,514.00 $523,288.00 N/A $29,126.22 N/A
Primary Transmitter UAXTE-8 $256,800.00 $165,300.00 $0.00
UHF - Air Cooled Solid State Transmitter 4 - 6 kW $236,500.00 $145,000.00 N/A N/A N/A
1.5" Rigid Conduit and Wiring $800.00 $800.00 N/A N/A N/A
Other Electrical Service: Will have to add a couple of standard 110V circuits for operation of the dual exciters. $500.00 $500.00 N/A N/A N/A
Stringent Mask filter $5,500.00 $5,500.00 N/A N/A N/A
2-port UHF channel combiner $13,500.00 $13,500.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $197,679.00 $149,779.00 N/A $6,453.00 N/A
Total for all systems $1,072,514.00 $523,288.00 N/A $29,126.22 N/A
Primary Antenna TFU8-WB $197,679.00 $149,779.00 $6,453.00
Flexible foam core heliax $1,500.00 $1,500.00 N/A N/A N/A
Aux.Temp Antenna $15,000.00 $15,000.00 N/A $5,899.00 N/A
Line Adapters $2,999.00 $2,999.00 N/A N/A N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 N/A N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $10,500.00 N/A N/A N/A
UHF - High Power, Side Mount, broadband panel, 8 bay,, 36 kW input, directional,, elliptically or circularly polarized $49,500.00 $49,500.00 N/A $554.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
New combiner, cost per channel (without antenna) $84,200.00 $50,000.00 N/A N/A N/A
Elbow complex, broadband, at antenna input, per 3 1/8. feedline (if needed) $9,340.00 $8,880.00 N/A N/A N/A

Components

Actual Information Description File Name
Flexible foam core heliax Information not provided.
Aux.Temp Antenna

Component Description:
Scala Broadband Cavity Backslot Antenna
Amount:
$5,899.00
Line Adapters Information not provided.
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
UHF - High Power, Side Mount, broadband panel, 8 bay,, 36 kW input, directional,, elliptically or circularly polarized

Component Description:
Scala Bullet
Amount:
$26.00

Component Description:
Scala FMTV EIA Fine Matching Unit Connections
Amount:
$528.00
Sweep test of existing antenna Information not provided.
New combiner, cost per channel (without antenna) Information not provided.
Elbow complex, broadband, at antenna input, per 3 1/8. feedline (if needed) 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 $15,150.00 $24,402.00 N/A $1,325.00 N/A
Total for all systems $1,072,514.00 $523,288.00 N/A $29,126.22 N/A
Interim Transmission Line $2,550.00 $2,475.00 $1,325.00
Flexible Foam Transmission Line - dielectric, 1 5/8" $1,800.00 $1,725.00 N/A $1,325.00 N/A
Hangers- Grounding kit $750.00 $750.00 N/A N/A N/A
Primary Transmission Line $12,600.00 $21,927.00 $0.00
Rigid Transmission Line - copper, 3 1/8" broadband $12,600.00 $21,927.00 Manufacturer quote, includes hangers and grounding, entry port, etc. N/A N/A

Components

Actual Information Description File Name
Flexible Foam Transmission Line - dielectric, 1 5/8"

Component Description:
Andrew Straight Connector for LDF7 & AVA7. Andrew Virtual Foam Cable
Amount:
$1,325.00
Hangers- Grounding kit Information not provided.
Rigid Transmission Line - copper, 3 1/8" broadband 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 $421,000.00 $55,000.00 N/A $0.00 N/A
Total for all systems $1,072,514.00 $523,288.00 N/A $29,126.22 N/A
Primary Tower TOWER $421,000.00 $55,000.00 $0.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $55,000.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $150,890.00 $104,557.00 N/A $20,282.72 N/A
Total for all systems $1,072,514.00 $523,288.00 N/A $29,126.22 N/A
Outside Professional Services $150,890.00 $104,557.00 $20,282.72
Tower Structural Study $10,000.00 $10,000.00 N/A N/A N/A
Additional Field Engineering Service, 4 Days $11,500.00 $11,500.00 N/A N/A N/A
RF Exposure Measurements $21,050.00 $20,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A $270.00 N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A $0.00 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $2,047.00 Increase estimate due to inquiry to seek guidance from FCC regarding new antennae installation $2,047.00 This is for a new auxiliary antenna.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $2,000.00 N/A $8,143.62 Exchanges with antenna manufacturer of proposed replacement antenna for repack. Also construction permit had to be submitted twice.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,010.00 The cost of this invoice was over the estimated cost due to clerical costs such as copies and postage $3,009.25 Copy charges more than expected.
Comprehensive coverage verification via field study, if needed $84,200.00 $40,000.00 N/A $0.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $0.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $6,767.85 Need to open transmission line and install testing equipment for engineers.
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $45.00 N/A

Components

Actual Information Description File Name
Tower Structural Study Information not provided.
Additional Field Engineering Service, 4 Days Information not provided.
RF Exposure Measurements Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Attorney Fees - Prepare & File Request
Amount:
$270.00
Prepare request for Special Temporary Authorization Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application

Component Description:
Consulting engineering services thru 7/18 - draft of inquiry to seek guidance from FCC regarding new antenna installation
Amount:
$732.00

Component Description:
CONSULTING ENGINEERING SERVICES CONCERNING COMMUNICATON WITH ANTENNA MANUFACTURER AND PREP OF EXHIBITS FOR PRELIMINARY DRAFT OF ENGINEERING STATEMENT
Amount:
$1,315.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application

Component Description:
CONSULTING ENGINEERING SERVICES CONCERNING ITEMS ON REPACK
Amount:
$4,172.00

Component Description:
Engineering statement entitled "Engineering Statement....in support of an application to construct repacked facilities.
Amount:
$1,591.62

Component Description:
Contact with FCC staff to present transmission line measurement data
Amount:
$2,380.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Preparation of forms
Amount:
$3,009.25
Comprehensive coverage verification via field study, if needed Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
RF Engineering Consulting Services KCDT
Amount:
$5,767.85

Component Description:
Prepare engineering statement entitled "Engineering Statement...in support of a modification of pending application to construct repacked facilities KCDT...
Amount:
$2,203.90

Component Description:
Opening transmission line and installing testing equipment on the end connector.
Amount:
$1,000.00
Prepare and or review reimbursement form

Component Description:
Review repack transition plan progress report for KCDT
Amount:
$45.00

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $30,995.00 $24,250.00 N/A $1,065.50 N/A
Total for all systems $1,072,514.00 $523,288.00 N/A $29,126.22 N/A
Other Expenses $30,995.00 $24,250.00 $1,065.50
MVPD Notification of Channel Change $500.00 $500.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $1,500.00 $1,500.00 N/A $332.50 N/A
Equipment Storage $2,500.00 $2,500.00 N/A N/A N/A
Equipment Delivery and Handling Charges $10,000.00 $10,000.00 N/A $733.00 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $4,500.00 $4,500.00 N/A N/A N/A
BLM or NFS Coordination $250.00 $250.00 Cost recovery fee for change of use filing on existing lease. N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $0.00 We do not pay filing fees N/A N/A
DTV Medical Facility Notification $11,550.00 $5,000.00 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:
Attachment includes cover letter that was requested by the reviewer. Upcoming Channel Change Announcement. Only $332.50 of the total charges are related to the upcoming channel change announcement. Other charges are programming related.
Amount:
$332.50
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges

Component Description:
Shipping Charges
Amount:
$733.00
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
BLM or NFS Coordination Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
DTV Medical Facility Notification Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,072,514.00 $523,288.00 $29,126.22

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.

Dawn Rose

Senior Financial Specialist


12/26/2018

Attachments

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