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:
12855
Service:
DTV
Call Sign:
WUCF-TV
Channel:
23 (UHF)
File Number:
0000027360
FRN:
0022163661
Date Submitted:
08/19/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

UNIVERSITY OF CENTRAL FLORIDA

Doing Business As: UNIVERSITY OF CENTRAL FLORIDA

Van Nguyen

12201 RESEARCH PARKWAY

SUITE 501

ORLANDO, FL 32826

United States

+1 (407) 882-1046 VAN.NGUYEN@UCF.EDU 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

The Preparer is same as the reimbursement contact.

 

 

 

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 Replace IOT transmitter with solid state, replace antenna, re-use existing line. Map and analyze tower; design & modify if needed. Flash-cut to new channel upon coordination with other stations in phase 7.

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 Paragon DCXP-2
Year 2003
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 ULXTE-72
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 47.2 kW
Justification for New Transmitter The cost of this new transmitter will be less than the cost of retuning the existing transmitter.

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) Yes
Transformer (480V) Yes
Power 150 kVA
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? 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

Additional Interior RF System

Interior RF system to complete the transmitter installation

2nd Exciter

2nd Exciter with auto switch over to replace existing

Transmitter Decommissioning

Transmitter Decommissioning

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting 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: 950.0 kW
Manufacturer
Model TFU-30DSC-R 3C 152 DC
Year 2003

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? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Side 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 ATW30HS3-ESCX-34H
Year 2019
Justification for New Antenna The existing primary antenna is a single channel slotted coaxial which cannot accommodate the assigned 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? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 6 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Interior Line Sections

Interior 6-1/8" line sections to extend the transmission line to the new transmitter location inside the existing building

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Utilize Existing
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer Dielectric
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 1290 feet per run

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Sweep Tests

Sweep line to insure acceptable with assigned channel

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 Rigid
Diameter 6 1/8 inches
Segment Length 19 ¾ '
Other Segment Length
Number of parallel runs 1
Length 1130 feet per run
Justification for New Transmission Line Required for interim operation

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

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 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 Yes
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1026744
Coordinates (NAD83) Latitude (NAD83) 28° 36' 08.0" N-
Longitude (NAD83) 081° 05' 36.0" W-
Overall Structure Height 1608.25 feet
Support Structure Height 1479.97 feet
Ground Elevation Above Mean Sea Level (AMSL) 64.96 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner WPOZ / Charitable Ministry Support Inc.
Date Constructed 01/01/1992

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
9876 WPOZ FM
12857 WMFE-FM FM

Other Types of Users

Users
Various mwave

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

Name Description

Preliminary Inspection

Tower / Antenna Preliminary Installation Inspection

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 250
Explanation It will be necessary to schedule and coordinate multiple vendors, complete progress reports, and update Schedule 399.
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 Yes
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 No
Additional Field Engineering Service Yes
Number of Days 14
Justification It will be necessary to survey the site, plan the equipment, develop specifications for purchasing, and oversee multiple vendor RF projects.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning No
Non-zoning permits Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application No
FCC Special Temporary Authority Application No
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

Transmitter Training

Transmitter Training

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 $1,649,867.56 $1,478,174.64 N/A $1,347,084.14 N/A
Total for all systems $2,891,053.36 $2,396,594.69 N/A $1,634,671.07 N/A
Primary Transmitter ULXTE-72 $1,649,867.56 $1,478,174.64 $1,347,084.14
Transmitter Decommissioning $21,750.00 $21,750.00 N/A N/A N/A
2nd Exciter $14,950.00 $14,950.00 See attached uploaded Revised Transition Plan November 2018 $14,950.00 N/A
Additional Interior RF System $71,217.56 $71,217.56 See attached uploaded Revised Transition Plan November 2018 $71,217.56 N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $11,279.56 See attached uploaded Revised Transition Plan November 2018 $11,279.56 Invoice No. JW3004486A (Quote Q-79081) for $1,295.94 was a change order due to an additional transmitter part.
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW $1,473,000.00 $1,316,827.52 See attached uploaded Revised Transition Plan November 2018 $1,235,137.02 N/A
Switchgear - industrial 800 amp $38,200.00 $37,150.00 N/A $14,500.00 N/A
3" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $5,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Transmitter Decommissioning Information not provided.
2nd Exciter

Component Description:
Line A on the invoice
Amount:
$7,475.00

Component Description:
Line A on invoice
Amount:
$7,475.00
Additional Interior RF System

Component Description:
Line C on invoice
Amount:
$35,608.78

Component Description:
Line C on the invoice
Amount:
$35,608.78
Transformer 3 phase/480v - 150 KVA

Component Description:
Line D on the invoice
Amount:
$4,991.81

Component Description:
Line D on invoice
Amount:
$4,991.81

Component Description:
ULXTE-72. Change Order Quote Q-79081 ASSY, 6-1/8 XFMR FLG, 50 to 75.
Amount:
$1,295.94
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW

Component Description:
For Line A ($584,280.215) plus Line B ($33,288.295) and minus Line E ($40,845.250 paid in previous 50% down payment, invoice JW30004486-1). Line E (total $81,690.50) will be invoiced at completion.
Amount:
$576,723.26

Component Description:
Lines A, B, and E on invoice
Amount:
$658,413.76
Switchgear - industrial 800 amp

Component Description:
Invoicing for Switch Gear and Materials
Amount:
$14,500.00
3" Rigid Conduit and Wiring (Cost per foot) 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 $294,064.80 $275,850.05 N/A $165,510.04 N/A
Total for all systems $2,891,053.36 $2,396,594.69 N/A $1,634,671.07 N/A
Primary Antenna ATW30HS3-ESCX-34H $294,064.80 $275,850.05 $165,510.04
Interior Line Sections $20,134.80 $20,134.80 See attached uploaded Revised Transition Plan November 2018 $12,080.88 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $10,860.00 See attached uploaded Revised Transition Plan November 2018 $6,516.00 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $6,855.25 See attached uploaded Revised Transition Plan November 2018 $4,113.16 N/A
Sweep test of existing antenna $6,730.00 $6,250.00 See attached uploaded Revised Transition Plan November 2018 $3,750.00 N/A
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, directional,, elliptically or circularly polarized $231,750.00 $231,750.00 See attached uploaded Revised Transition Plan November 2018 $139,050.00 N/A

Components

Actual Information Description File Name
Interior Line Sections

Component Description:
Transmission Line System;30% payment 30 days ARO
Amount:
$6,040.44

Component Description:
Transmission Line System
Amount:
$6,040.44
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
ATW30HS3-ESCX-34H & Mounts;30% payment 30 days ARO
Amount:
$3,258.00

Component Description:
ATW30HS3-ESCX-34H & Mounts
Amount:
$3,258.00
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Transmission Line System;30% payment 30 days ARO
Amount:
$2,056.58

Component Description:
Transmission Line System
Amount:
$2,056.58
Sweep test of existing antenna

Component Description:
System Sweep;30% payment 30 days ARO
Amount:
$1,875.00

Component Description:
System Sweep
Amount:
$1,875.00
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, directional,, elliptically or circularly polarized

Component Description:
ATW30HS3-ESCX-34H & Mounts;30% payment 30 days ARO
Amount:
$69,525.00

Component Description:
ATW30HS3-ESCX-34H & Mounts
Amount:
$69,525.00

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 $234,660.00 $6,400.00 N/A $4,172.00 N/A
Total for all systems $2,891,053.36 $2,396,594.69 N/A $1,634,671.07 N/A
Interim Transmission Line $228,260.00 $0.00 $0.00
Rigid Transmission Line - copper, 6 1/8" $228,260.00 $0.00 Not Needed. See attached uploaded Revised Transition Plan November 2018 N/A N/A
Primary Transmission Line $6,400.00 $6,400.00 $4,172.00
Sweep Tests $6,400.00 $6,400.00 N/A $4,172.00 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 6 1/8" Information not provided.
Sweep Tests

Component Description:
Provide line sweeping and diagnostics with report on two transmission line systems.
Amount:
$3,675.00

Component Description:
Perform system diagnostics for ability to sweep 75 OHM line without tower crew. Set up sample sections and adaptations to determine viability of testing.
Amount:
$497.00

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 $393,100.00 $304,729.00 N/A $100,377.39 N/A
Total for all systems $2,891,053.36 $2,396,594.69 N/A $1,634,671.07 N/A
Primary Tower TOWER $393,100.00 $304,729.00 $100,377.39
Tall Tower (greater than 500') $210,500.00 $135,879.00 See attached uploaded Revised Transition Plan November 2018 $81,527.39 N/A
Structural engineering tower load study for well documented tower $12,600.00 $6,850.00 See attached uploaded Revised Transition Plan November 2018 $6,850.00 N/A
Preliminary Inspection $12,000.00 $12,000.00 See attached uploaded Revised Transition Plan November 2018 $12,000.00 N/A
Minor tower reinforcement/modifications $158,000.00 $150,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Tall Tower (greater than 500')

Component Description:
Installation of Antenna;30% payment 30 days ARO
Amount:
$40,763.69

Component Description:
Installation of Antenna
Amount:
$40,763.70
Structural engineering tower load study for well documented tower

Component Description:
Structural analysis and report
Amount:
$6,850.00
Preliminary Inspection

Component Description:
Pre-Installation Survey
Amount:
$6,000.00

Component Description:
Pre-Installation Survey
Amount:
$6,000.00
Minor tower reinforcement/modifications 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 $186,620.00 $199,250.00 N/A $17,527.50 N/A
Total for all systems $2,891,053.36 $2,396,594.69 N/A $1,634,671.07 N/A
Outside Professional Services $186,620.00 $199,250.00 $17,527.50
Additional Field Engineering Service, 14 Days $28,000.00 $28,000.00 N/A $6,062.50 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $25,000.00 The station's legal representative recommends $25,000 to cover this effort. 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 $0.00 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
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $3,000.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $4,500.00 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
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $2,500.00 N/A
Project management of the transition $39,500.00 $37,500.00 N/A $1,465.00 N/A

Components

Actual Information Description File Name
Additional Field Engineering Service, 14 Days

Component Description:
Other engineering services in connection the repack of WUCF, including preliminary RF system design
Amount:
$6,062.50
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations 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.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepare engineering section of Form FCC Construction Permit Application for Main Facility
Amount:
$3,000.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Perform engineering study for new channel assignment and antenna development
Amount:
$4,500.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
Prepare or Review FCC Form 399 for Reimbursement
Amount:
$2,500.00
Project management of the transition

Component Description:
DTV Repack Services: 2018 Q4 Form 387 Transition Plan Progress Report preparation
Amount:
$150.00

Component Description:
Preparation of FCC Schedule 387 Progress Report
Amount:
$300.00

Component Description:
DTV Repack Services: Prep and submit For 387 Transition Plan Progress Report
Amount:
$150.00

Component Description:
Prepare Schedule 387 Progress Report 4Q2017 during January 1-10, 2018 for WUCF
Amount:
$225.00

Component Description:
DTV Repack Services: Form 387 Transition Plan Progress Report
Amount:
$150.00

Component Description:
Prepare Schedule 387 Progress Report 2018 Q1 during January 1-10, 2018
Amount:
$225.00

Component Description:
Review equipment for 399 Amendment
Amount:
$265.00

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 $132,741.00 $132,191.00 N/A $0.00 N/A
Total for all systems $2,891,053.36 $2,396,594.69 N/A $1,634,671.07 N/A
Other Expenses $132,741.00 $132,191.00 $0.00
Transmitter Training $9,191.00 $9,191.00 N/A N/A N/A
MVPD Notification of Channel Change $2,000.00 $2,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $10,000.00 $10,000.00 N/A N/A N/A
Equipment Storage $25,000.00 $25,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $25,000.00 $25,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $25,000.00 $25,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A N/A N/A
Non-zoning permits $25,000.00 $25,000.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,891,053.36 $2,396,594.69 $1,634,671.07

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.

Jeffrey C Gehman

Engineering Associate


08/19/2019

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