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:
13989
Service:
DTV
Call Sign:
WAVE
Channel:
36 (UHF)
File Number:
0000025187
FRN:
0018223693
Date Submitted:
10/07/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

GRAY TELEVISION LICENSEE, LLC

Robert Folliard

4370 PEACHTREE ROAD, NE

ATLANTA, GA 30319

United States

+1 (404) 504-9828 allfcclms@gray.tv Limited Liability Company

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. Yes
Briefly describe transition plan Install interim antenna/ Line Remove top mounted antenna and install new antenna. Connect to existing dual broadband lines Install new main and backup transmitters. Combiner, Line, Antenna and tower systems cost divided 50% with WLKY

Transmitters

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

Auxiliary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Emergency Backup
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 Ranger
Year 2009
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1.1 kW

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model UAXTE-2R 37
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.2 kW
Justification for New Transmitter Existing transmitter can not be retuned EOL letter attached

Auxiliary 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 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

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

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 Sigma
Year 2003
Type Inductive Output Tube
IOT Power Type Single
Power Capacity 30 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-50
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 30.05 kW
Justification for New Transmitter Existing transmitter can not be retuned Headroom analysis attached

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 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

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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? Yes
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 2
Number of Panels 51
Design power capacity in use 50.0 %
Lower Limit 545.00 MHz
Upper Limit 695.00 MHz
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model ABBP14H4-HTOC5-26/51
Year 2003

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

Facility ID Call Sign
53939 WLKY

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? Yes
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 2
Number of Panels/Bays 14
Lower Limit 470.00 MHz
Upper Limit 605.00 MHz
Design power capacity in use 50.0 %
Other Antenna Type N/A
ERP: 890.0 kW
Manufacturer
Model TUM30-AP-S4-14/56H-R-2-T
Year 2019
Justification for New Antenna Existing antenna can not be retuned Sweep data and ERI response attached

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? Yes
Type New
Number of channels supported 2
Frequencies of channels supported RF channel
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? Yes
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?
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

Enter a list of RF channel numbers.

RF Channel Number
14
36

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

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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? Yes
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Slot
Number of Stations Supported 2
Number of Panels/Bays 24
Lower Limit 470.00 MHz
Upper Limit 680.00 MHz
Design power capacity in use 100.0 %
Other Antenna Type N/A
ERP: 680.0 kW
Manufacturer
Model TFU-WB24
Year 2019
Justification for New Antenna Transition side mount antenna needed to enable removal of existing top mount antenna and installation of new repack channel capable antenna.

Interim 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? 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

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change 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? Yes
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer Andrew
Type Rigid
Diameter 7 3/16 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 2
Length 1000 feet per run

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

Facility ID Call Sign
53939 WLKY

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Rigid
Diameter 6 1/8 inches
Segment Length Broadband
Other Segment Length
Number of parallel runs 1
Length 950 feet per run
Justification for New Transmission Line Interim during new antenna installation

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 No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1230057
Coordinates (NAD83) Latitude (NAD83) 38° 22' 08.4" N-
Longitude (NAD83) 085° 49' 47.6" W-
Overall Structure Height 960.95 feet
Support Structure Height 899.92 feet
Ground Elevation Above Mean Sea Level (AMSL) 982.93 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner P & B Towers LLC
Date Constructed 03/11/2015

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
53939 WLKY DTV

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for 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 595
Explanation Pattern analysis Antenna Spec Transmitter Spec Building drawings Installation Supervision Accounting Internal Legal
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 No
Address transition timing and coordination issues w/ other stations and wireless providers No
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements 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 No
Non-zoning permits No
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)? No
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

Security

Armed security provided by vendor to the equipment shelter site

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 $1,200,500.00 $1,095,207.52 N/A $670,807.52 N/A
Total for all systems $3,199,026.26 $3,200,822.81 N/A $959,558.75 N/A
Primary Transmitter ULXTE-50 $1,010,750.00 $974,340.72 $657,654.82
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $931,672.26 Per GatesAir Quote Q-74086 Primary Transmitter Upgrade Headroom analysis attached $653,771.61 N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $6,368.46 Per Estimated Cost Justification WAVE-110-1st Primary Transmitter - 3 Phase, 480 V, 150 KVA Transformer v0 Per GatesAir Quote Q-73547 (estimates is the quoted amount minus the amount already reimbursed under the primary transmitter category) $3,883.21 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
Auxiliary Transmitter UAXTE-2R 37 $189,750.00 $120,866.80 $13,152.70
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $60,266.80 Quote attached (GA-00021721) $13,152.70 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $24,300.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
Transmitter
Amount:
$434,479.84

Component Description:
ULXTE-40 per Quote Q-73547
Amount:
$87,716.71

Component Description:
ULXTE-40 Transmitter per Quote Q-73547
Amount:
$131,575.06
Transformer 3 phase/480v - 150 KVA

Component Description:
WAVE-110-1st Primary Transmitter - 3 Phase, 480 V, 300 KVA Transformer
Amount:
$3,883.21
Switchgear - industrial 800 amp Information not provided.
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
UAXTE-2-E
Amount:
$5,261.08

Component Description:
Transmitter, Mask Filter Saystem, Electrical, Installation & Proof
Amount:
$7,891.62
Switchgear - industrial 800 amp Information not provided.
Transformer 3 phase/480v - 150 KVA 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 $1,142,110.00 $1,310,422.23 N/A $162,690.74 N/A
Total for all systems $3,199,026.26 $3,200,822.81 N/A $959,558.75 N/A
Interim Antenna TFU-WB24 $157,180.00 $156,850.00 $0.00
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $0.00 N/A
UHF - High Power, Side Mount, basic slot antenna, 24 bay,, 680 kW input, directional,, horizontally polarized $150,450.00 $150,450.00 Dielectric quote attached N/A N/A
Primary Antenna TUM30-AP-S4-14/56H-R-2-T $984,930.00 $1,153,572.23 $162,690.74
Combiner output splitting/switching for dual feed lines, if applicable $126,000.00 $139,350.00 Quote attached N/A N/A
New combiner, cost per channel (without antenna) $84,200.00 $488,072.23 Please see the attached Gatesair invoice # JW30004540-1 and Quote Q-76155 in document COMB WAVE GatesAir Q-76155 and Combiner Plan Proposal $162,690.74 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
UHF - High Power Top Mount (200-1000 kW), Two Station broadband panel antenna, elliptically or circularly polarized $768,000.00 $519,750.00 Please see WAVE Primary Antenna revised 700083CMZ-3.pdf N/A N/A

Components

Actual Information Description File Name
Sweep test of existing antenna

Component Description:
Repack Sweep
Amount:
$6,400.00
UHF - High Power, Side Mount, basic slot antenna, 24 bay,, 680 kW input, directional,, horizontally polarized Information not provided.
Combiner output splitting/switching for dual feed lines, if applicable Information not provided.
New combiner, cost per channel (without antenna)

Component Description:
Combiner RF Accessories Stage 2,3,5 Services
Amount:
$162,690.74
Sweep test of existing antenna Information not provided.
UHF - High Power Top Mount (200-1000 kW), Two Station broadband panel antenna, elliptically or circularly polarized Information not provided.

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $220,400.00 $141,311.80 N/A $163.82 N/A
Total for all systems $3,199,026.26 $3,200,822.81 N/A $959,558.75 N/A
Interim Transmission Line $220,400.00 $141,311.80 $163.82
Rigid Transmission Line - copper, 6 1/8" broadband $220,400.00 $141,311.80 Quote attached $163.82 N/A
Primary Transmission Line $0.00 $0.00 $0.00

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 6 1/8" broadband

Component Description:
Nitrogen Industrial 200 CGA 580
Amount:
$163.82

Component Description:
9" dia x 8" thick coredrill wall
Amount:
$250.00

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 $381,100.00 $362,000.00 N/A $70,438.50 N/A
Total for all systems $3,199,026.26 $3,200,822.81 N/A $959,558.75 N/A
Primary Tower GTOWER $381,100.00 $362,000.00 $70,438.50
Structural engineering tower load study for well documented tower $12,600.00 $12,000.00 N/A $5,662.50 N/A
Tall Tower (greater than 500') $210,500.00 $200,000.00 N/A $64,776.00 N/A
Minor tower reinforcement/modifications $158,000.00 $150,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Structural engineering tower load study for well documented tower

Component Description:
WAVE-410-Existing Primary Tower - Structural Engineering Tower Load Study
Amount:
$162.50

Component Description:
Tower Service - Mapping of WAVE Tower for Repack
Amount:
$5,500.00
Tall Tower (greater than 500')

Component Description:
Customer deposit for Repack Interim Antenna Installation Services
Amount:
$34,925.00

Component Description:
Interim Antenna Installation
Amount:
$29,851.00
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 $203,660.00 $248,425.00 N/A $46,229.71 N/A
Total for all systems $3,199,026.26 $3,200,822.81 N/A $959,558.75 N/A
Outside Professional Services $203,660.00 $248,425.00 $46,229.71
Project management of the transition $94,010.00 $144,675.00 Widelity Strategic Support Quote $41,154.70 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 -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 request for Special Temporary Authorization $2,050.00 $1,500.00 N/A $800.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $2,025.01 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $2,250.00 N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Repack Engineering
Amount:
$795.15

Component Description:
Project Management
Amount:
$1,463.00

Component Description:
Project Management
Amount:
$3,777.30

Component Description:
Project Management
Amount:
$2,713.15

Component Description:
Project Management
Amount:
$2,963.45

Component Description:
Project Management
Amount:
$2,145.70

Component Description:
Project Management
Amount:
$4,384.10

Component Description:
Project Management
Amount:
$1,965.45

Component Description:
Project Management
Amount:
$415.80

Component Description:
Project management
Amount:
$3,142.70

Component Description:
Project Management
Amount:
$2,678.35

Component Description:
Project Management
Amount:
$4,216.85

Component Description:
Project Management
Amount:
$3,158.80

Component Description:
Project Management
Amount:
$3,176.20

Component Description:
Project Management
Amount:
$4,158.70
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 -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 request for Special Temporary Authorization

Component Description:
Consulting Engineer
Amount:
$800.00
Perform engineering study for new channel assignment and antenna development

Component Description:
WAVE-530-RF Eng - Engineering Study for New Channel Assignment
Amount:
$158.34

Component Description:
WAVE-530-RF Eng - Engineering Study for New Channel Assignment
Amount:
$116.67

Component Description:
Engineering study work for new channel assignment and antenna development;
Amount:
$250.00

Component Description:
Engineering study work for new channel assignment and antenna development
Amount:
$1,375.00

Component Description:
Engineering study work for new channel assignment and antenna development
Amount:
$125.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
FCC Form 2100 Construction Permit Application
Amount:
$2,250.00

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 $51,256.26 $43,456.26 N/A $9,228.46 N/A
Total for all systems $3,199,026.26 $3,200,822.81 N/A $959,558.75 N/A
Other Expenses $51,256.26 $43,456.26 $9,228.46
Security $3,386.26 $3,386.26 Armed security provided by vendor to the equipment shelter site. Please see multiple invoices. $3,386.26 N/A
MVPD Notification of Channel Change $0.00 $0.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $3,750.00 Group quote attached N/A N/A
Equipment Delivery and Handling Charges $2,970.00 $2,970.00 On site forklift rental estimate Representative quote attached N/A N/A
Equipment Storage $30,500.00 $30,500.00 Estimate for Dielectric on site antenna storage Dielectric letter attached $5,842.20 N/A
Develop and air announcement of upcoming channel change $2,850.00 $2,850.00 estimate for on air rescan announcement production. Quote attached N/A N/A

Components

Actual Information Description File Name
Security

Component Description:
Guard Services
Amount:
$1,760.86

Component Description:
Security Services
Amount:
$1,625.40
MVPD Notification of Channel Change Information not provided.
DTV Medical Facility Notification Information not provided.
Equipment Delivery and Handling Charges Information not provided.
Equipment Storage

Component Description:
Sale 40 SC 1-Tripper
Amount:
$5,842.20
Develop and air announcement of upcoming channel change Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,199,026.26 $3,200,822.81 $959,558.75

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.

Robert Folliard , III .

Assistant Secretary


10/07/2019

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.

Robert Folliard , III .

Assistant Secretary


10/07/2019

Attachments

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