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:
62182
Service:
DTV
Call Sign:
KETC
Channel:
17 (UHF)
File Number:
0000028165
FRN:
0002549566
Date Submitted:
09/10/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

ST. LOUIS REGIONAL PUBLIC MEDIA, INC.

Doing Business As: ST. LOUIS REGIONAL PUBLIC MEDIA, INC.

3655 OLIVE STREET

ST. LOUIS, MO 63108

United States

+1 (314) 512-9145 rskalski@ketc.org Not-for-Profit

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

Greg Best

Consulting Engineer

Greg Best Consulting Inc.

16100 Outlook Ave.

Stilwell, KS 66085

United States

+1 (816) 792-2913 gbconsulting54@gmail.com

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 Please see the attached KETC Transition Plan.

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 Diamond
Year 2002
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 8 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? No
Manufacturer
Model ULTXE20
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 12 kW
Justification for New Transmitter Per the manufacturer the existing transmitter is not supported for conversion to new channel. Transmitter TPO has been selected on the basis of the lower gain of the antenna. Liquid cooling was chosen due to extra HVAC unit & operating cost of air cooling

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) 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

Information not provided.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top 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: 142.5 kW
Manufacturer
Model DIELECTRIC TFU-24DSB
Year 2009

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? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 88.6 kW
Manufacturer
Model TFU-20GTH O4
Year 2017
Justification for New Antenna Existing coaxial slot antenna is not designed to operate on repacked channel.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? 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? 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

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? 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 1100 feet per run

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Rigid BB Line section.

One section of 6" BB line is needed to adapt the existing line to the new antenna.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? 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 1003920
Coordinates (NAD83) Latitude (NAD83) 38° 28' 56.0" N-
Longitude (NAD83) 090° 23' 53.0" W-
Overall Structure Height 1073.15 feet
Support Structure Height 1000.97 feet
Ground Elevation Above Mean Sea Level (AMSL) 576.11 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner St. Louis Regional Public Media Inc.
Date Constructed 11/11/2010

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
56512 WXOS FM
72390 WIL-FM FM

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? No
Number of Hours N/A
Explanation N/A
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility 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 Yes
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

Name Description

FCC-Required Reporting

Prepare and file FCC required progress reports on Schedule 387 on a quarterly basis.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change 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? No
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

Additional Legal Fees

Per legal counsel, additional legal fees for top market PBS station with tenants on tall tower requiring extra coordination with project manager.

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 $577,850.00 $549,200.00 N/A $334,156.44 N/A
Total for all systems $1,424,200.00 $1,353,650.00 N/A $763,298.96 N/A
Primary Transmitter ULTXE20 $577,850.00 $549,200.00 $334,156.44
3" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $4,900.00 N/A $0.00 N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $24,300.00 N/A $6,733.75 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $494,500.00 $470,000.00 N/A $327,422.69 N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $13,700.00 N/A N/A N/A

Components

Actual Information Description File Name
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 150 KVA

Component Description:
Please see attached variance explanation. Reimbursement for line D, Electrical. All other lines will be reimbursed under a different cost line.
Amount:
$6,733.75
Switchgear - industrial 800 amp Information not provided.
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW

Component Description:
Total invoice $1,393.78 reimbursable under this category.
Amount:
$1,393.78

Component Description:
Please see the attached variance explanation. Reimbursement for everything except line D, Electrical, which was requested on a different cost line.
Amount:
$326,028.91
Service entrance 3 phase/800 amp/208 volt 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 $296,230.00 $281,400.00 N/A $194,934.00 N/A
Total for all systems $1,424,200.00 $1,353,650.00 N/A $763,298.96 N/A
Primary Antenna TFU-20GTH O4 $296,230.00 $281,400.00 $194,934.00
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,400.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $275,000.00 N/A $188,534.00 N/A

Components

Actual Information Description File Name
Sweep test of existing antenna

Component Description:
Please see variance details on attachment. Line 6 of the invoice is being requested on this cost line. Lines 1,3,4,& 5 will be requested on a separate cost line. Line 2 is not reimbursable.
Amount:
$6,400.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Please see variance details on attachment. Lines 1,3,4,& 5 are being requested on this cost line. Line 6 of the invoice is being requested on a separate cost line. Line 2 is not reimbursable.
Amount:
$188,534.00

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 $300.00 $300.00 N/A $0.00 N/A
Total for all systems $1,424,200.00 $1,353,650.00 N/A $763,298.96 N/A
Primary Transmission Line $300.00 $300.00 $0.00
Rigid BB Line section. $300.00 $300.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $381,100.00 $362,000.00 N/A $212,276.27 N/A
Total for all systems $1,424,200.00 $1,353,650.00 N/A $763,298.96 N/A
Primary Tower TOWER $381,100.00 $362,000.00 $212,276.27
Tall Tower (greater than 500') $210,500.00 $200,000.00 N/A $201,796.27 Additional expense incurred due to fees related to un-anticipated weather days.
Structural engineering tower load study for well documented tower $12,600.00 $12,000.00 N/A $10,480.00 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:
Invoice 1 of 2 - represents deposit to begin work.
Amount:
$132,660.00

Component Description:
Invoice 2 of 2 - represents final invoice following completion of work.
Amount:
$69,136.27
Structural engineering tower load study for well documented tower

Component Description:
Feasibility Tower Analysis
Amount:
$5,200.00

Component Description:
Services rendered in connection with a re-run structure analysis to determine pole/tower adequacy - Please note that the email chain will serve as the proposal (as noted in the body of the email)
Amount:
$5,280.00
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 $145,170.00 $137,750.00 N/A $14,232.85 N/A
Total for all systems $1,424,200.00 $1,353,650.00 N/A $763,298.96 N/A
Outside Professional Services $145,170.00 $137,750.00 $14,232.85
FCC-Required Reporting $5,000.00 $5,000.00 Prepare and file FCC- required progress reports on Schedule 387. $3,198.50 N/A
RF Exposure Measurements $21,050.00 $20,000.00 N/A N/A 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 $2,403.00 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 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 $2,166.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $4,950.35 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 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
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A $202.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $1,313.00 N/A

Components

Actual Information Description File Name
FCC-Required Reporting

Component Description:
Total invoice $431.00. The first two lines ($207) are reimbursable under this category. The last two lines ($224) are reimbursable under "Addl. Legal Fees.
Amount:
$207.00

Component Description:
Total inv $2,350.50. Lines 1 ($50.50), 4 ($252.50) and 6 ($151.50) are reimbursable under this category. All other lines reimbursable under other categories.
Amount:
$454.50

Component Description:
Entire invoice reimbursable under this category ($56.00)
Amount:
$56.00

Component Description:
Total inv $4,059. Lines 2-7 ($2,042) are reimbursable under this category. All other lines reimbursable under other categories.
Amount:
$2,042.00

Component Description:
Total invoice $151.50. The second line ($50.50) is reimbursable under this category. The first line ($101) is reimbursable under "Addl. Legal Fees".
Amount:
$50.50

Component Description:
Total inv $35 is reimbursable under this category.
Amount:
$35.00

Component Description:
Entire invoice reimbursable under this category ($353.50)
Amount:
$353.50
RF Exposure Measurements Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Total inv $4,059. Line 1 ($202) is reimbursable under this category. All other lines reimbursable under other categories.
Amount:
$202.00

Component Description:
Total inv $2,958.50. Lines 1-6 and 9-13 ($2,201) are reimbursable under this category. All other lines reimbursable under other categories.
Amount:
$2,201.00
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

Component Description:
Total inv $4,059. Lines 8-12 ($1,815) are reimbursable under this category. All other lines reimbursable under other categories.
Amount:
$1,815.00

Component Description:
Entire invoice reimbursable under this category ($351)
Amount:
$351.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Entire invoice is reimbursable under this category ($1,372.50)
Amount:
$1,372.50

Component Description:
Entire invoice is reimbursable under this category ($151.50)
Amount:
$151.50

Component Description:
Entire invoice is reimbursable under this category ($3,274.85)
Amount:
$3,274.85

Component Description:
The second line of this invoice is the only reimbursable portion. The remainder of the lines will not be submitted for reimbursement.
Amount:
$151.50
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 Information not provided.
Perform engineering study for new channel assignment and antenna development Information not provided.
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Total inv $2,350.50. Line 14 ($202) is reimbursable under this category. All other lines reimbursable under other categories.
Amount:
$202.00
Prepare and or review reimbursement form

Component Description:
Total inv $2,350.50. Line 7 ($252.50) is reimbursable under this category. All other lines reimbursable under other categories.
Amount:
$252.50

Component Description:
Total inv $252.50 is reimbursable under this category.
Amount:
$252.50

Component Description:
Total inv $808 is reimbursable under this category.
Amount:
$808.00

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 $23,550.00 $23,000.00 N/A $7,699.40 N/A
Total for all systems $1,424,200.00 $1,353,650.00 N/A $763,298.96 N/A
Other Expenses $23,550.00 $23,000.00 $7,699.40
Additional Legal Fees $5,000.00 $5,000.00 Per legal counsel, additional legal fees required due to legal consultations with stations staff and consultants regarding interim operations on tall tower, as well as coordinating planned transition with multiple tenants. $2,608.90 N/A
MVPD Notification of Channel Change $2,000.00 $2,000.00 N/A $1,161.50 N/A
Develop and air announcement of upcoming channel change $1,000.00 $1,000.00 N/A N/A N/A
Equipment Storage $1,000.00 $1,000.00 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
Local Zoning $1,000.00 $1,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $3,929.00 N/A

Components

Actual Information Description File Name
Additional Legal Fees

Component Description:
All line items on invoice are reimbursable ($606.40) under Additional Legal Fees
Amount:
$606.40

Component Description:
Total invoice $151.50. The first line ($101) is reimbursable under this category. The last line ($50.50) is reimbursable under "FCC Required Reporting".
Amount:
$101.00

Component Description:
Total invoice $431.00. The last two lines ($224) are reimbursable under this category. The first two lines ($207) are reimbursable under "FCC Req'd Reporting".
Amount:
$224.00

Component Description:
Total inv $2,350.50. Lines 7 ($454.50) and 9 ($101) are reimbursable under this category. All other lines reimbursable under other categories.
Amount:
$555.50

Component Description:
Total inv $2,350.50. Line 8 ($303) is reimbursable under this category. All other lines reimbursable under other categories.
Amount:
$303.00

Component Description:
Entire invoice reimbursable under this category ($819)
Amount:
$819.00
MVPD Notification of Channel Change

Component Description:
Total inv $2,350.50. Lines 2 ($404), 3 ($454.50) and 5 ($303) are reimbursable under this category. All other lines reimbursable under other categories.
Amount:
$1,161.50
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Local Zoning Information not provided.
DTV Medical Facility Notification

Component Description:
Total inv $2,350.50. Lines 8 ($101) and 10 ($78) are reimbursable under this category. All other lines reimbursable under other categories.
Amount:
$179.00

Component Description:
Total inv $3,750 is reimbursable under this category.
Amount:
$3,750.00

Component Description:
FCC Medicial Notifications
Amount:
$3,750.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,424,200.00 $1,353,650.00 $763,298.96

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.

Denise Kahle

Controller


09/10/2019

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.

Denise Kahle

Controller


09/10/2019

Attachments

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