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:
1104
Service:
DCA
Call Sign:
WCBZ-CD
Channel:
18 (UHF)
File Number:
0000028282
FRN:
0018086967
Date Submitted:
10/07/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

Columbus Broadcasting Corporation

Doing Business As: Columbus Broadcasting Corporation

Mark Hiner

PO Box 325

Etna, OH 43018

United States

+1 (614) 547-1722 mark@yourtv22.com Corporation

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

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 WMNO intends to move it's transmitter site to another location as the present tower owner will not agree to the tower mods required in order for WMNO to be in compliance with EIA 222G.

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 DCA5000
Year 2015
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 0.5 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 TRN-5X-U-38-C
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 3.3 kW
Justification for New Transmitter Existing transmitter cannot be converted to repacked channel per manufacturer as the supplier no longer sells or has equipment to directly replace the existing transmitter.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 2 inches
Length 30.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 5 tons
Other Size N/A tons
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 100.0 square feet
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? 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 Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 15.0 kW
Manufacturer
Model ALP12L2-HSOC
Year 2015

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? No
New Antenna Manufacturer and Types Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 15.0 kW
Manufacturer
Model DLP-12B
Year 2018
Justification for New Antenna Existing antenna cannot be retuned from channel 28 to channel 18. A new antenna will be required.

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? Yes
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 Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Foam
Diameter 1 5/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 150 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Air
Diameter 1 5/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 450 feet per run
Justification for New Transmission Line Existing transmission line will be on-air while new facilities for new channel 18 are being built. New location facility will require new transmission line in order to remain constantly on the air.

Primary 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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Add 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? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1018015
Coordinates (NAD83) Latitude (NAD83) 40° 06' 53.8" N-
Longitude (NAD83) 082° 58' 55.3" W-
Overall Structure Height 291.01 feet
Support Structure Height 285.10 feet
Ground Elevation Above Mean Sea Level (AMSL) 919.94 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner New Par
Date Constructed 08/06/2008


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: No 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.

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Move Equipment
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? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 40° 37' 39.21" N-
Longitude (NAD83) 083° 07' 47.7" W-
Overall Structure Height 51.80 feet
Support Structure Height 51.80 feet
Ground Elevation Above Mean Sea Level (AMSL) 296.90 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Radio Communications of Ohio
Date Constructed 06/20/1978


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 reimbursement filing, expense tracking, vendor coordination, progress reporting, budget creation, budget review, budget tracking, daisy-chain monitoring and all other activities necessary
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 No
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

Information not provided.

Other Expenses

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

Information not provided.

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 $234,230.00 $126,934.73 N/A $30,478.39 N/A
Total for all systems $641,780.00 $534,047.79 N/A $97,184.98 N/A
Primary Transmitter TRN-5X-U-38-C $234,230.00 $126,934.73 $30,478.39
Other -- Building Addition Size: 100.0 $6,000.00 $6,000.00 N/A $94.37 N/A
Other -- HVAC Service Type: H Size:5 (Other) $19,250.00 $19,250.00 N/A N/A N/A
2" Rigid Conduit and Wiring (Cost per foot) $780.00 $750.00 N/A $192.46 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW $155,600.00 $50,934.73 Please see Estimated Cost Justification WCBZ-CD-110-1st Primary Transmitter - UHF Air Cooled Solid State v0 $30,191.56 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
Other -- Building Addition Size: 100.0

Component Description:
SS Color Scan / Sq. Ft
Amount:
$55.76

Component Description:
SS Color Scan / Sq. Ft.
Amount:
$17.16

Component Description:
SS Color Scan / Sq. Ft
Amount:
$21.45
Other -- HVAC Service Type: H Size:5 (Other) Information not provided.
2" Rigid Conduit and Wiring (Cost per foot)

Component Description:
Parts to complete transmitter conduit work
Amount:
$19.52

Component Description:
Parts and wiring supplies for transmitter
Amount:
$136.62

Component Description:
Parts for transmission line hangers
Amount:
$9.64

Component Description:
Parts for transmitting grounding and AC wiring
Amount:
$26.68
Switchgear - industrial 800 amp Information not provided.
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW

Component Description:
MYAT 90 DEG. 7/8" ELBOW UNFLANGED
Amount:
$166.38

Component Description:
Parts for transmitter installation
Amount:
$8.02

Component Description:
Parts for transmitter installation
Amount:
$90.07

Component Description:
Parts used for transmitter installation
Amount:
$35.34

Component Description:
DTV FULL SERVICE MASK
Amount:
$2,863.81

Component Description:
Parts for transmitter installation
Amount:
$44.64

Component Description:
"Additional shipping charges not included on Invoice 0425902 Estimated shipping charge$671.95, Actual shipping charge: $766.56"
Amount:
$94.61

Component Description:
ANDREW 7/8" EIA FLANGE FOR LDF4-50
Amount:
$235.92

Component Description:
Parts for transmitter grounding
Amount:
$12.10

Component Description:
RECEIVE, STORE, DELIVER AND SET TRANSMITTER.
Amount:
$1,575.00

Component Description:
Parts used for transmitter installation
Amount:
$11.00

Component Description:
ANDREW 7/8" FOAM DIELECTRIC HELIAX
Amount:
$586.97

Component Description:
Parts for transmitter installation
Amount:
$12.64

Component Description:
3.3kW CH18 Transmitter
Amount:
$24,319.83

Component Description:
Parts used for transmitter installation
Amount:
$27.01

Component Description:
ANDREW 4"BOOT ASSEMBLY FOR 3" CABLE
Amount:
$56.76

Component Description:
Parts for transmitter installation
Amount:
$26.25

Component Description:
Parts for transmitter installation
Amount:
$25.21
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 $33,030.00 $31,400.00 N/A $10,593.83 N/A
Total for all systems $641,780.00 $534,047.79 N/A $97,184.98 N/A
Primary Antenna DLP-12B $33,030.00 $31,400.00 $10,593.83
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $25,000.00 N/A $10,593.83 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF - Lower Power Side Mount, Class A One Station antenna -- basic

Component Description:
Parts for coax passthrough
Amount:
$9.23

Component Description:
SCATTER STUDY FOR STANDARD LEG OF FACE MOUNTS.
Amount:
$2,700.00

Component Description:
ANTENNA UHF LOWER POWER SIDE MOUNT
Amount:
$2,952.67

Component Description:
Downpayment for antenna order
Amount:
$4,912.50

Component Description:
Parts to hang and secure coax cable
Amount:
$19.43
Sweep test of existing antenna

Component Description:
Day labor including travel to sweep antenna prior to operation commencement.
Amount:
$1,250.00

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 $14,850.00 $29,203.06 N/A $15,939.32 N/A
Total for all systems $641,780.00 $534,047.79 N/A $97,184.98 N/A
Primary Transmission Line $14,850.00 $29,203.06 $15,939.32
Flexible Air Transmission Line - dielectric, 1 5/8" $14,850.00 $29,203.06 Per Estimated Cost Justification WCBZ-CD-310-Primary Transmission Line-Flexible Air Dielectric Transmission Line v0 $15,939.32 N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 1 5/8"

Component Description:
MYAT 3 1/8 to 1 5/8 TAPER REDUCER
Amount:
$1,076.34

Component Description:
Low PIM 7/16 DIN Male to 7/16
Amount:
$136.67

Component Description:
BDI DIGITAL RF SENSOR PACKAGE
Amount:
$3,627.47

Component Description:
MYAT 1 5/8" FLANGE ADAPTER
Amount:
$144.17

Component Description:
ANDREW 5' /2 -HOLE GROUNDING KIT
Amount:
$397.63

Component Description:
BIRD QC CONN 1-5/8" FIXED EIA FLNG.
Amount:
$251.42

Component Description:
ANDREW 1 5/8" EIA (M) STRAIGHT
Amount:
$367.60

Component Description:
MYAT 3 1/8 to 1 5/8 TAPER REDUCER
Amount:
$355.48

Component Description:
SWR 7/8" 20' LINE SECTION UNFLANGED
Amount:
$2,543.84

Component Description:
MCI 1 5/8" MOTORIZED COAX SW./4PORT
Amount:
$2,572.41

Component Description:
MYAT 1 5/8" FLANGE ADAPTER
Amount:
$328.84

Component Description:
MYAT 1 5/8" UNFLANGED 90deg ELBOW
Amount:
$4,137.45

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 $181,000.00 $172,000.00 N/A $9,116.69 N/A
Total for all systems $641,780.00 $534,047.79 N/A $97,184.98 N/A
Primary Tower TOWER $96,800.00 $92,000.00 $9,116.69
Short Tower (less than 500') $84,200.00 $80,000.00 The new tower will have to be rigged and the transmission line and antenna will be installed. Tower crew will assist in the sweep test. $5,016.69 N/A
Structural engineering tower load study for well documented tower $12,600.00 $12,000.00 N/A $4,100.00 N/A
Primary Tower TOWER $84,200.00 $80,000.00 $0.00
Short Tower (less than 500') $84,200.00 $80,000.00 The existing tower will have to be rigged and all equipment removed. N/A N/A

Components

Actual Information Description File Name
Short Tower (less than 500')

Component Description:
Parts for coax installation on tower
Amount:
$28.57

Component Description:
Work complete 3/12/19: Antenna/line install
Amount:
$3,299.80

Component Description:
Work complete 5/6/19: Remove antenna and line
Amount:
$1,688.32
Structural engineering tower load study for well documented tower

Component Description:
Channel 28 Customer Structural ATC Site #/Name: 81865 WORTHINGTON OH2
Amount:
$1,500.00

Component Description:
Channel 28 PE Letter ATC Site #/Name:81865 WORTHINGTON OH2
Amount:
$750.00

Component Description:
WCBZ-CD Channel 28 RF-NIER/MPE Report ATC Site #/Name: 81865 WORTHINGTON OH2
Amount:
$1,850.00
Short Tower (less than 500') 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 $149,980.00 $152,425.00 N/A $29,656.75 N/A
Total for all systems $641,780.00 $534,047.79 N/A $97,184.98 N/A
Outside Professional Services $149,980.00 $152,425.00 $29,656.75
RF Exposure Measurements $21,050.00 $20,000.00 It is expected that the tower owner will require measurements to be made at time of installation. 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 $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 N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
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 $3,962.50 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 N/A N/A
Project management of the transition $94,010.00 $99,675.00 Widelity Strategic support quote $25,694.25 N/A

Components

Actual Information Description File Name
RF Exposure Measurements 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

Component Description:
Prof. Services
Amount:
$522.00
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 Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
WMNO-Engineering Repack Service performed by Greg Best
Amount:
$700.00

Component Description:
Consulting - Per Hour (Quantity)
Amount:
$550.00

Component Description:
WMNO- Engineering Repack Service performed by Greg Best
Amount:
$1,662.50

Component Description:
FOR WORK PERFORMED FROM DECEMBER 1, 2017 TO JULY 31, 2018
Amount:
$850.00

Component Description:
FOR WORK PERFORMED FROM NOVEMBER 1, 2018 TO FEBRUARY 28, 2019
Amount:
$200.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form Information not provided.
Project management of the transition

Component Description:
Project Management
Amount:
$6,815.20

Component Description:
Retainer for WCBZ-CD, Facility ID 1104 work
Amount:
$1,000.00

Component Description:
Consulting - Per Hour (Quantity)
Amount:
$1,150.00

Component Description:
Project Management
Amount:
$3,441.65

Component Description:
$5,879.85
Amount:
$5,879.85

Component Description:
Project Management
Amount:
$201.25

Component Description:
Project Management
Amount:
$8,206.30

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 $28,690.00 $22,085.00 N/A $1,400.00 N/A
Total for all systems $641,780.00 $534,047.79 N/A $97,184.98 N/A
Other Expenses $28,690.00 $22,085.00 $1,400.00
MVPD Notification of Channel Change $1,000.00 $1,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $1,000.00 $1,000.00 Cost for production house to produce an announcement 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) $2,500.00 $2,500.00 N/A N/A N/A
Non-zoning permits $5,000.00 $5,000.00 Obtain building permits from local jurisdictions $1,200.00 N/A
Local Zoning $5,000.00 $5,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $5,000.00 N/A $200.00 N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Non-zoning permits

Component Description:
Zoning application
Amount:
$1,200.00
Local Zoning Information not provided.
DTV Medical Facility Notification

Component Description:
Postage for Medical Notification Mailing
Amount:
$200.00
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $641,780.00 $534,047.79 $97,184.98

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. Yes
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.

Mark A Hiner

President


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.

Mark A Hiner

President


10/07/2019

Attachments

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