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:
42124
Service:
DTV
Call Sign:
WCIA
Channel:
34 (UHF)
File Number:
0000028700
FRN:
0009961889
Date Submitted:
08/15/2019

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. No
Briefly describe transition plan Channel 48 - 34 Existing Tx and antenna is used during transition period. Install new antenna and 7inch line and take old batwing with two 3 inch lines off the tower. Modify tower as needed for new TFU30GTH and T-Line. Remove old VHF xmtr in building and

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 DCX
Year 2009
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 50 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 THU9evo-24
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 25.5 kW
Justification for New Transmitter Existing transmitter cannot be converted to repacked channel per manufacturer. See attached from Comark on IOT transmitters.

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) No
Power N/A
Rigid Conduit and Wiring Yes
Size 3 inches
Length 100.0 feet
Other Electrical Service No
Description N/A
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? Yes
Size 100.0 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-32DSB-R O3
Year 2006

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
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: 1000.0 kW
Manufacturer
Model TFU-27ETT/VP-R 04
Year 2019
Justification for New Antenna Existing coaxial slot antenna is not designed to operate on repacked channel.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
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 6 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna?
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Feed Through Complex

Feed Through Complex

Mounting Wedding Cake Adapter

Mounting Wedding Cake Adapter

Feed Through Complex

Feed Through Complex

Bury Mount Adapter

Bury Mount Adapter

Mounting Wedding Cake Adapter

Mounting Wedding Cake Adapter

Bury Mount Adapter

Bury Mount Adapter

Transmission Line

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Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? Yes

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type 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 1000 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 7 3/16 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 1000 feet per run
Justification for New Transmission Line Existing 20 ft section coax is not designed to operate for long length transmission line on repacked channel.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Transmission line sweep test

Transmission line sweep test

Reducer 7-75 to 6-75

Reducer 7-75 to 6-75

Test Transition

Test Transition

Transmission Line 7-75

Transmission Line 7-75

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? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1016057
Coordinates (NAD83) Latitude (NAD83) 40° 06' 21.0" N-
Longitude (NAD83) 088° 27' 00.0" W-
Overall Structure Height 984.90 feet
Support Structure Height 884.50 feet
Ground Elevation Above Mean Sea Level (AMSL) 722.10 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Nexstar Broadcasting, Inc.
Date Constructed 01/01/1953


Primary Tower

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Tower Modification Costs

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

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 173
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 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 No
RF exposure measurements No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? No
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 $1,009,800.00 $652,317.00 N/A $148,104.25 N/A
Total for all systems $2,506,479.50 $2,050,619.00 N/A $425,737.91 N/A
Primary Transmitter THU9evo-24 $1,009,800.00 $652,317.00 $148,104.25
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $13,700.00 N/A N/A N/A
Other -- Building Addition Size: 100.0 $5,000.00 $5,000.00 N/A N/A N/A
3" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $4,900.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $592,417.00 See Rohde & Schwarz quote 207017.0 total cost $690,567 less upgrade ($98,150) $148,104.25 N/A

Components

Actual Information Description File Name
Switchgear - industrial 800 amp Information not provided.
Service entrance 3 phase/800 amp/208 volt Information not provided.
Other -- Building Addition Size: 100.0 Information not provided.
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
Transmitter, installment #1, less upgrade cost
Amount:
$148,104.25

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 $436,448.00 $339,326.00 N/A $149,816.70 N/A
Total for all systems $2,506,479.50 $2,050,619.00 N/A $425,737.91 N/A
Primary Antenna TFU-27ETT/VP-R 04 $436,448.00 $339,326.00 $149,816.70
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,700.00 $10,710.00 See Dielectric quote DMS146-4 $4,819.50 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
Feed Through Complex $11,250.00 $11,250.00 See Dielectric quote DMS146-4 $5,062.50 N/A
Bury Mount Adapter $84,443.00 $84,443.00 See Dielectric quote DMS146-4 $37,999.35 N/A
Mounting Wedding Cake Adapter $30,825.00 $30,825.00 See Dielectric quote DMS146-4 $13,871.25 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $195,698.00 See Dielectric quote DMS146-4, total cost $221,123 less vpol ($25,425) $88,064.10 N/A

Components

Actual Information Description File Name
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Elbow complex, installment #1, line 5 of invoice
Amount:
$4,819.50
Sweep test of existing antenna Information not provided.
Feed Through Complex

Component Description:
Feed through complex, installment #1, line 4 of invoice
Amount:
$5,062.50
Bury Mount Adapter

Component Description:
Bury Mount Adapter, installment #1, line 3 of invoice
Amount:
$37,999.35
Mounting Wedding Cake Adapter

Component Description:
Mounting Wedding Cake Adapter, installment #1, line 2 of invoice
Amount:
$13,871.25
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Antenna, installment #1, line 1 of invoice
Amount:
$88,064.10

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 $348,527.50 $191,191.00 N/A $89,555.96 N/A
Total for all systems $2,506,479.50 $2,050,619.00 N/A $425,737.91 N/A
Primary Transmission Line $348,527.50 $191,191.00 $89,555.96
Transmission Line 7-75 $2,235.00 $2,235.00 See Dielectric quote DMS146-4 $1,005.75 N/A
Reducer 7-75 to 6-75 $2,100.00 $2,100.00 See Dielectric quote DMS146-4 $945.00 N/A
Test Transition $4,792.50 $4,792.50 See Dielectric quote DMS146-4 $2,156.63 N/A
Transmission line sweep test $6,400.00 $6,400.00 Sweep test to determine feasibility of use $6,400.00 N/A
Rigid Transmission Line - copper, 7 3/16" broadband $333,000.00 $175,663.50 See Dielectric quote 900087CMZ $79,048.58 N/A

Components

Actual Information Description File Name
Transmission Line 7-75

Component Description:
Transmission line, installment #1, line 6 of invoice
Amount:
$1,005.75
Reducer 7-75 to 6-75

Component Description:
Reducer, installment #1, line 8 of invoice
Amount:
$945.00
Test Transition

Component Description:
Trans test, installment #1, line 7 of invoice
Amount:
$2,156.63
Transmission line sweep test

Component Description:
Sweep test
Amount:
$6,400.00
Rigid Transmission Line - copper, 7 3/16" broadband

Component Description:
Transmission line, installment #1
Amount:
$79,048.58

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $381,100.00 $541,000.00 N/A $0.00 N/A
Total for all systems $2,506,479.50 $2,050,619.00 N/A $425,737.91 N/A
Primary Tower TOWER $381,100.00 $541,000.00 $0.00
Tall Tower (greater than 500') $210,500.00 $379,000.00 See attached estimate based upon scope of work and costs from service provider. N/A N/A
Minor tower reinforcement/modifications $158,000.00 $150,000.00 N/A N/A N/A
Structural engineering tower load study for well documented tower $12,600.00 $12,000.00 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 $55,414.00 $52,200.00 N/A $15,261.00 N/A
Total for all systems $2,506,479.50 $2,050,619.00 N/A $425,737.91 N/A
Outside Professional Services $55,414.00 $52,200.00 $15,261.00
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Project management of the transition $27,334.00 $25,950.00 N/A $12,548.50 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $2,712.50 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Project management of the transition

Component Description:
Project management services 6.1.19 through 6.28.19
Amount:
$825.00

Component Description:
Project management services 4.27.19 through 5.31.19
Amount:
$2,775.00

Component Description:
Project management services March 2019
Amount:
$32.50

Component Description:
Project management services 3.2.19 through 3.29.19
Amount:
$525.00

Component Description:
Project Management including services from subcontractor Kessler and Gehman Associates for dates 10.27.17through 5.25.18.
Amount:
$1,991.00

Component Description:
Project management services 9.29.18 through 10.26.18
Amount:
$675.00

Component Description:
Project management services 12.1.18 through 12.31.18
Amount:
$225.00

Component Description:
Project management services 6.30.18 through 7.27.18
Amount:
$2,175.00

Component Description:
Project management services 1.1.19 through 1.31.19
Amount:
$225.00

Component Description:
Project Management services 7.28.18 through 9.28.18.
Amount:
$375.00

Component Description:
Project management services 5.26.18 through 6.29.18
Amount:
$675.00

Component Description:
Project management services 10.27.18 through 11.30.18
Amount:
$1,975.00

Component Description:
Project management services 2.1.19 through 3.1.19
Amount:
$75.00
Prepare and or review reimbursement form Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
Repack plan and revision, 399 form info
Amount:
$787.50

Component Description:
Through 7-14-17. Revise Storyboard if needed, interference study, create CP and recalculate ERP if COR changed, transition plan document, create 399, coverage maps, and upload documents to ASANA.
Amount:
$700.00

Component Description:
Service through 11/2/17. Repack Engineering services. Evaluation of expansion options for WCIA for 2nd priority window application.
Amount:
$175.00

Component Description:
Service through end of April 2017. Information gathering, creation of transition plan with definition of initial equipment and service needs. Further research regarding MCI panel antenna patterns.
Amount:
$1,050.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application 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 $275,190.00 $274,585.00 N/A $23,000.00 N/A
Total for all systems $2,506,479.50 $2,050,619.00 N/A $425,737.91 N/A
Other Expenses $275,190.00 $274,585.00 $23,000.00
Sales Tax $230,000.00 $230,000.00 Sales and use tax on goods and services based on IL state rate of 9%. N/A N/A
Develop and air announcement of upcoming channel change $3,500.00 $3,500.00 Develop and produce crawls and spots for viewer notification. N/A N/A
Equipment Storage $1,000.00 $1,000.00 N/A N/A N/A
MVPD Notification of Channel Change $3,500.00 $3,500.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
Local Zoning $1,000.00 $1,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $23,000.00 $23,000.00 Disposal costs per quote from USA Commercial attached $23,000.00 N/A

Components

Actual Information Description File Name
Sales Tax Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
MVPD Notification of Channel Change Information not provided.
DTV Medical Facility Notification Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
Local Zoning Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Disposal costs
Amount:
$23,000.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,506,479.50 $2,050,619.00 $425,737.91

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


08/15/2019

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


08/15/2019

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