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:
68444
Service:
DCA
Call Sign:
WDWO-CD
Channel:
22 (UHF)
File Number:
0000028067
FRN:
0026907345
Date Submitted:
08/14/2019

Applicant Information

Back to Top

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

HC2 STATION GROUP INC.

RENEE ILHARDT

450 PARK AVENUE

30TH FLOOR

NEW YORK, NY 10022

United States

+1 (954) 606-5486 RILHARDT@HC2BROADCASTING.COM Corporation

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

Back to Top

Preparer Contact Name and Information

Applicant Address Phone Email

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

Back to Top
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 WDWO will transition from ch. 18 service to ch. 22 service at its current operating facilities (ASR 1007996). There are other stations that operate from this facility, however, WDWO will not be sharing transmission equipment with any of those stations.

Transmitters

Back to Top
Section Question Response
Transmitter Related Expenses Do you have transmitter related expenses? Yes

Primary Transmitter

Back to Top

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 TRN-5X-U-48-C
Year 2019
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 4.08 kW

Primary Transmitter

Back to Top

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 TRN-5X-U-28-C
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 4.08 kW
Justification for New Transmitter Existing transmitter will have difficulties moving to the new frequency due to poor support from the manufacturer.

Primary Transmitter

Back to Top

Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring No
Size N/A
Length N/A
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? 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

Back to Top

Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

Back to Top

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 Class A
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: 15.0 kW
Manufacturer
Model ALP16L2-HSOC
Year 2006

Primary Antenna

Back to Top

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 Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Circular
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: 15.0 kW
Manufacturer
Model ATC-BCC416M-V3-22
Year 2017
Justification for New Antenna Existing antenna is channel specific and not retunable to channel 22.

Primary Antenna

Back to Top

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? No
Broadband or Single Channel? N/A
Feed Line Size N/A
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? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

Back to Top

Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

Back to Top

New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Type Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Slot
Number of Stations Supported 1
Number of Panels/Bays 8
Lower Limit 470.00 MHz
Upper Limit 862.00 MHz
Design power capacity in use 100.0 %
Other Antenna Type N/A
ERP: 15.0 kW
Manufacturer
Model 75010066
Year 2018
Justification for New Antenna Required to maintain on air signal continuity of station during main antenna replacement operations

Interim Antenna

Back to Top

Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for an 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

Interim Antenna

Back to Top

Other Antenna Cost Not Listed

Name Description

Unloading expense

Rigging fee to unload antenna system components upon delivery

Transmission Line

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

Primary Transmission Line

Back to Top

Existing Transmission Line

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

Primary Transmission Line

Back to Top

Other Transmission Line Expenses Not Listed

Name Description

Interim transmission line

interim transmission line

Interim Transmission Line

Back to Top

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 910 feet per run
Justification for New Transmission Line Required to install and operate interim antenna system

Interim Transmission Line

Back to Top

Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

Back to Top
Section Question Response
Tower Equipment or Rigging Costs Changes Do you have tower equipment or rigging costs changes? Yes

Primary Tower

Back to Top

Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
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? Yes
ASR Number 1007996
Coordinates (NAD83) Latitude (NAD83) 42° 29' 01.0" N-
Longitude (NAD83) 083° 18' 44.0" W-
Overall Structure Height 1052.81 feet
Support Structure Height 998.35 feet
Ground Elevation Above Mean Sea Level (AMSL) 697.17 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Tower, LLC
Date Constructed 01/01/1968

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
51570 WKBD-TV DTV
5800 WPXD-TV DTV

Primary Tower

Back to Top

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: Serious Reinforcements needed

Primary Tower

Back to Top

Tower Rigging Costs

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

Primary Tower

Back to Top

Other Tower Expenses Not Listed

Name Description

Tower Mapping

Tower mapping required by American Tower during this transition. Please see attached invoice from American Tower 460205111

Outside Professional Services Costs

Back to Top
Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 400
Explanation Outside consulting engineering, legal work, and accounting services, as well as project management for regional and comprehensive repack execution.
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 No
Quantity N/A
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 No
Quantity N/A
NEPA Section 106 environmental review Yes
Environmental Assessment Yes
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

Back to Top

Other Professional Services Expenses Not Listed

Name Description

Permit Drawing package

Tower permit drawing package required by American Tower Corp in regard to tower modifications

Site coordination

Site coordination fee required by American Tower Corp in regard to tower modifications, installation scheduling and construction coordination

Construction Project Management ATC Tower Mods

Construction management fee required by American Tower Corp in regard to tower modifications allocated to WDWO

Ground Building Permit Drawing Package

Building and Ground drawing package required by American Tower Corp in regard to tower modifications

Other Expenses

Back to Top
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 Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

Back to Top

Other Expenses Not Listed

Information not provided.

Cost Information

Back to Top

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 $262,050.00 $237,234.09 N/A $52,031.65 N/A
Total for all systems $1,910,594.00 $969,856.52 N/A $396,100.10 N/A
Primary Transmitter TRN-5X-U-28-C $262,050.00 $237,234.09 $52,031.65
Transformer 3 phase/480v - 150 KVA $25,550.00 $6,734.09 N/A $6,734.09 N/A
UHF - Air Cooled Solid State Transmitter 4 - 6 kW $236,500.00 $230,500.00 N/A $45,297.56 N/A

Components

Actual Information Description File Name
Transformer 3 phase/480v - 150 KVA

Component Description:
Transmitter related cost. #3900-01
Amount:
$6,734.09
UHF - Air Cooled Solid State Transmitter 4 - 6 kW

Component Description:
Transmitter related cost. #19270
Amount:
$1,048.56

Component Description:
Transmitter cost, upgrade excluded. #7113-01
Amount:
$44,249.00

Cost Information

Back to Top

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 $67,060.00 $62,520.00 N/A $11,860.00 N/A
Total for all systems $1,910,594.00 $969,856.52 N/A $396,100.10 N/A
Interim Antenna 75010066 $34,030.00 $32,400.00 $0.00
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $25,000.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
Unloading expense $1,000.00 $1,000.00 N/A N/A N/A
Primary Antenna ATC-BCC416M-V3-22 $33,030.00 $30,120.00 $11,860.00
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $23,720.00 See quote from Kathrein $11,860.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF - Lower Power Side Mount, Class A One Station antenna -- basic Information not provided.
Sweep test of existing antenna Information not provided.
Unloading expense Information not provided.
UHF - Lower Power Side Mount, Class A One Station antenna -- basic

Component Description:
Antenna related cost, upgrade excluded. #PO000124-INV
Amount:
$11,860.00
Sweep test of existing antenna Information not provided.

Cost Information

Back to Top

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 $34,840.00 $33,930.00 N/A $0.00 N/A
Total for all systems $1,910,594.00 $969,856.52 N/A $396,100.10 N/A
Interim Transmission Line $21,840.00 $20,930.00 $0.00
Flexible Foam Transmission Line - dielectric, 1 5/8" $21,840.00 $20,930.00 N/A N/A N/A
Primary Transmission Line $13,000.00 $13,000.00 $0.00
Interim transmission line $13,000.00 $13,000.00 required for installation of interim antenna system N/A N/A

Components

Information not provided.

Cost Information

Back to Top

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 $1,294,527.00 $481,427.00 N/A $287,104.00 N/A
Total for all systems $1,910,594.00 $969,856.52 N/A $396,100.10 N/A
Primary Tower GTOWER $1,294,527.00 $481,427.00 $287,104.00
Tower Rigging and Removing the Antenna $11,160.00 $11,160.00 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $11,160.00 N/A
Tower Mapping $8,267.00 $8,267.00 Please see attached American Tower invoice 460205111. $8,267.00 N/A
Tall Tower (greater than 500') $210,500.00 $200,000.00 N/A $11,160.00 N/A
Serious tower reinforcement/modifications $1,052,000.00 $250,000.00 N/A $250,000.00 N/A
Structural engineering tower load study for well documented tower $12,600.00 $12,000.00 N/A $6,517.00 N/A

Components

Actual Information Description File Name
Tower Rigging and Removing the Antenna

Component Description:
Tower related cost. #2367
Amount:
$11,160.00
Tower Mapping

Component Description:
Broadcast Tower Mapping
Amount:
$8,267.00
Tall Tower (greater than 500')

Component Description:
Tower related cost. #2367
Amount:
$11,160.00
Serious tower reinforcement/modifications

Component Description:
Tower Reinforcement/Modifications
Amount:
$250,000.00
Structural engineering tower load study for well documented tower

Component Description:
Broadcast Structural
Amount:
$6,517.00

Cost Information

Back to Top

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 $226,327.00 $132,060.43 N/A $42,905.93 N/A
Total for all systems $1,910,594.00 $969,856.52 N/A $396,100.10 N/A
Outside Professional Services $226,327.00 $132,060.43 $42,905.93
Ground Building Permit Drawing Package $4,700.00 $4,700.00 N/A N/A N/A
Construction Project Management ATC Tower Mods $4,167.00 $4,167.00 N/A $4,162.50 N/A
Site coordination $2,500.00 $2,500.00 N/A $2,500.00 N/A
RF Exposure Measurements $21,050.00 $15,000.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $25,000.00 N/A N/A N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $10,000.00 N/A N/A N/A
NEPA Section 106 environmental review, if needed $6,310.00 $6,000.00 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 engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A 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
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A N/A N/A
Project management of the transition $63,200.00 $36,243.43 Updated cost of estimated amount per FCC requirement. $36,243.43 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Permit Drawing package $4,700.00 $4,700.00 N/A N/A N/A

Components

Actual Information Description File Name
Ground Building Permit Drawing Package Information not provided.
Construction Project Management ATC Tower Mods

Component Description:
Construction Project Management of ATC Tower Mods
Amount:
$4,162.50
Site coordination

Component Description:
Site Coordination
Amount:
$2,500.00
RF Exposure Measurements Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet Information not provided.
NEPA Section 106 environmental review, if needed 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 engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Perform engineering study for new channel assignment and antenna development Information not provided.
Project management of the transition

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #473857
Amount:
$2,572.37

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #473451
Amount:
$3,119.41

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 20 stations. #1144
Amount:
$796.10

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1096
Amount:
$714.93

Component Description:
PO Line 1 - NTP Billable Project Mgmt - ATC Site 282675
Amount:
$9,480.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #472232
Amount:
$901.10

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1112
Amount:
$521.40

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #1129
Amount:
$1,758.65

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #1140
Amount:
$1,503.60

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #1134
Amount:
$1,678.60

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #472568
Amount:
$1,235.06

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1118
Amount:
$1,609.03

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #471659
Amount:
$713.16

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1116
Amount:
$1,254.03

Component Description:
Project Management
Amount:
$1,197.35

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #473121
Amount:
$2,044.14

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #1122
Amount:
$1,979.10

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1104
Amount:
$644.80

Component Description:
Project Management
Amount:
$2,520.60
Prepare and or review reimbursement form Information not provided.
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Permit Drawing package Information not provided.

Cost Information

Back to Top

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 $25,790.00 $22,685.00 N/A $2,198.52 N/A
Total for all systems $1,910,594.00 $969,856.52 N/A $396,100.10 N/A
Other Expenses $25,790.00 $22,685.00 $2,198.52
MVPD Notification of Channel Change $2,500.00 $2,500.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $2,000.00 $2,000.00 Cost of in-house spot production and insertion N/A N/A
Equipment Storage $1,000.00 $1,000.00 Estimating $50 per day and 20 days storage the antenna between time of delivery and coordinating tower crew installation with weather, availability and other stations present. N/A N/A
Equipment Delivery and Handling Charges $2,000.00 $2,000.00 N/A $420.75 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 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 - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
Local Zoning $750.00 $750.00 N/A N/A N/A
Non-zoning permits $2,350.00 $2,350.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,000.00 $2,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $8,500.00 N/A $1,777.77 N/A

Components

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

Component Description:
Antenna freight cost. #33509238953
Amount:
$420.75
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
Local Zoning Information not provided.
Non-zoning permits Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
DTV Medical Facility Notification

Component Description:
Medical notification service. #INV-001853
Amount:
$1,777.77

Cost Information

Back to Top

Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,910,594.00 $969,856.52 $396,100.10

Reimbursement Status

Back to Top
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

Back to Top
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.

Henry Turner

Chief Operating Officer


08/14/2019

Certification

Back to Top
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.

Henry Turner

Chief Operating Officer


08/14/2019

Attachments

Back to Top