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:
73152
Service:
DTV
Call Sign:
WJZY
Channel:
25 (UHF)
File Number:
0000027837
FRN:
0005047105
Date Submitted:
10/15/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

Fox Television Stations, LLC

Ann West Bobeck

400 N. CAPITOL STREET, NW

SUITE 890

WASHINGTON, DC 20001

United States

+1 (202) 824-6503 ann.bobeck@fox.com 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

Dennis Wallace

Managing Partner

Meintel, Sgrignoli & Wallace, LLC

Dennis Wallace

1282 Smallwood Drive

Suite 372

Waldorf, MD 20603

United States

+1 (202) 251-7589 Dennis.Wallace@mswdtv.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 WJZY will remove the existing top mount antenna and transmission line and install a new antenna and transmission line in its place.

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 CD3200P2
Year 2005
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 60 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 THU9EVO-72
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 106 kW
Justification for New Transmitter New transmitter is required. Current transmitter is obsolete and no longer supported by its manufacturer. See quote 0928_quote_xmtr_upgrade regarding upgrade cost

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) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service Yes
Description New Transmitter Electrical Installation. See quote 0928_WJZY FOX CHARLOTTE TRANSMITTER SITE ELECTRICAL MODIFICATIONS Quote.
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

STL related equipment

Relocation of equipment from old to new building. See 0928_Micro move and ethernet switch quote

Remote Control Wiring

Wire up remote control to new transmitter.

Installation

Transmitter Installation. Includes upgrade cost. See 0928_xmtr_install_upgrade quote.

Air Conditioner Backup Power

Install transformer and breaker for backup power to air conditioning. See 0928_PO X20-66 Data Power Source quote.

Pre-Install Site Survey

Preliminary survey to determine needs for install.

Removal of Existing Equipment

Remove existing equipment

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? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model ATW30H5-HSO-47H
Year 2008

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? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? Yes
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: 1000.0 kW
Manufacturer
Model ATW25H5-ETO4-25H
Year 2019
Justification for New Antenna New antenna required for new channel. See quote 0928_quote_antenna_upgrade for upgrade cost

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?
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?
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Bad Weather days

Days where no work could be performed due to weather. Tower crew idle.

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 Rigid
Diameter 8 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 2090 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 Rigid
Diameter 8 3/16 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 2090 feet per run
Justification for New Transmission Line existing transmission line is incorrect length for operation on new channel. Transmission line must be replaced.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Waveguide Switch

Waveguide RF Switch

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 Move Equipment
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex?
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? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1006705
Coordinates (NAD83) Latitude (NAD83) 35° 21' 44.5" N-
Longitude (NAD83) 081° 09' 18.3" W-
Overall Structure Height 1943.55 feet
Support Structure Height 1887.44 feet
Ground Elevation Above Mean Sea Level (AMSL) 805.76 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Fox Television Stations, LLC
Date Constructed 01/01/1986

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
70097 WGTB-CD DTV
74194 WHQC FM
53975 WNKS FM
20624 WMYT-TV DTV
6586 WPEG FM

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Other
Helicopter Services Required Are helicopter services required? Yes

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 650
Explanation Project Management of repack project with outside consulting and project management services. Coordinate Tower work with tenants.
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 2
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 2
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 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

Information not provided.

Other Expenses

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

Other Expenses

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Other Expenses Not Listed

Name Description

Prepare FCC Quarterly Progress Reports

FCC Progress reports. Prepare and file. See attached quote.

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 $3,045,246.94 $2,518,321.94 N/A $1,068,079.94 N/A
Total for all systems $4,854,866.94 $4,001,105.54 N/A $1,579,861.68 N/A
Primary Transmitter THU9EVO-72 $3,045,246.94 $2,518,321.94 $1,068,079.94
Pre-Install Site Survey $15,237.50 $15,237.50 Site survey with drawing package. Preliminary survey to determine needs for install. $15,237.50 N/A
Removal of Existing Equipment $15,000.00 $15,000.00 Remove existing equipment. See attached quote. N/A N/A
Air Conditioner Backup Power $9,250.00 $9,250.00 Install transformer and breaker for backup power to air conditioning. See attached quote 0928_PO X20-66 Data Power Source. N/A N/A
Installation $94,880.00 $94,880.00 Transmitter installation. Includes upgrade cost. See quote 0928_xmtr_install_upgrade. N/A N/A
Remote Control Wiring $3,600.00 $3,600.00 Wire existing remote control to new transmitter. See Attached Quote N/A N/A
Other Electrical Service: New Transmitter Electrical Installation. See quote 0928_WJZY FOX CHARLOTTE TRANSMITTER SITE ELECTRICAL MODIFICATIONS Quote. $269,000.00 $269,000.00 See quote 0928_WJZY FOX CHARLOTTE TRANSMITTER SITE ELECTRICAL MODIFICATIONS N/A N/A
UHF - Liquid Cooled Solid State Transmitter 86.8 . 106 kW $2,630,000.00 $2,103,075.00 Cost reflects like-for-like transmitter with upgrade. See 0928 revised narrative and quote 0928_Quote_xmtr_upgrade. $1,052,842.44 N/A
STL related equipment $8,279.44 $8,279.44 Relocation of STL waveguide and purchase of IT Switches to relocate in new building. See quote 0928_Micro move and ethernet switch N/A N/A

Components

Actual Information Description File Name
Pre-Install Site Survey

Component Description:
50% of full site survey w/drawing package prior to install.
Amount:
$15,237.50
Removal of Existing Equipment Information not provided.
Air Conditioner Backup Power Information not provided.
Installation Information not provided.
Remote Control Wiring Information not provided.
Other Electrical Service: New Transmitter Electrical Installation. See quote 0928_WJZY FOX CHARLOTTE TRANSMITTER SITE ELECTRICAL MODIFICATIONS Quote. Information not provided.
UHF - Liquid Cooled Solid State Transmitter 86.8 . 106 kW

Component Description:
50% downpayment for Rohde and Schwarz transmitter. Includes variance report for upgraded transmitter.
Amount:
$658,026.50

Component Description:
Rohde and Schwarz Transmitter 30% downpayment. Includes variance report to address upgrade.
Amount:
$394,815.94
STL related equipment 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 $300,780.00 $229,425.00 N/A $130,174.00 N/A
Total for all systems $4,854,866.94 $4,001,105.54 N/A $1,579,861.68 N/A
Primary Antenna ATW25H5-ETO4-25H $300,780.00 $229,425.00 $130,174.00
Sweep test of existing antenna $6,730.00 $6,250.00 N/A $3,750.00 N/A
Bad Weather days $4,550.00 $4,550.00 Days where no work could be performed due to weather. Tower crew idle. $4,550.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $218,625.00 Cost includes upgrade. See 0928_Quote_antenna_upgrade. $121,874.00 N/A

Components

Actual Information Description File Name
Sweep test of existing antenna

Component Description:
ERI TV system sweep. 30% prior to shipping.
Amount:
$1,875.00

Component Description:
ERI TV system sweep. 30% downpayment 30 days ARO.
Amount:
$1,875.00
Bad Weather days

Component Description:
ERI installation Weather Delay costs.
Amount:
$4,550.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
ERI Antenna variance 30% downpayment prior to shipping
Amount:
$60,937.00

Component Description:
ERI Antenna variance 30% downpayment ARO
Amount:
$60,937.00

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 $747,730.00 $526,993.60 N/A $300,824.46 N/A
Total for all systems $4,854,866.94 $4,001,105.54 N/A $1,579,861.68 N/A
Primary Transmission Line $747,730.00 $526,993.60 $300,824.46
Waveguide Switch $22,500.00 $22,500.00 Waveguide RF Switch and controller N/A N/A
Rigid Transmission Line - copper, 8 3/16" $725,230.00 $504,493.60 See quote 0928_Quote_antenna_upgrade. $300,824.46 N/A

Components

Actual Information Description File Name
Waveguide Switch Information not provided.
Rigid Transmission Line - copper, 8 3/16"

Component Description:
ERI Transmission line variance 30% downpayment prior to shipping
Amount:
$150,412.23

Component Description:
ERI transmission line variance 30% downpayment ARO
Amount:
$150,412.23

Component Description:
Transmission line system, system sweep and main antenna 30% deposit due with order.
Amount:
$218,810.58

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 $421,000.00 $400,000.00 N/A $0.00 N/A
Total for all systems $4,854,866.94 $4,001,105.54 N/A $1,579,861.68 N/A
Primary Tower TOWER $421,000.00 $400,000.00 $0.00
Tower Helicopter Lift $0.00 $0.00 N/A N/A N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $400,000.00 Catalog N/A N/A

Components

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 $244,390.00 $231,250.00 N/A $69,669.00 N/A
Total for all systems $4,854,866.94 $4,001,105.54 N/A $1,579,861.68 N/A
Outside Professional Services $244,390.00 $231,250.00 $69,669.00
RF Exposure Measurements $21,050.00 $20,000.00 Catalog $19,150.00 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 Catalog $15,237.50 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 Catalog N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 Catalog N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 Catalog N/A N/A
Project management of the transition $102,700.00 $97,500.00 Catalog $35,281.50 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 Catalog N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 Catalog N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 Catalog N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 Catalog N/A N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 Catalog N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 Catalog N/A N/A

Components

Actual Information Description File Name
RF Exposure Measurements

Component Description:
Climbing Inspection w/line layout and tower structural analysis- 50% deposit
Amount:
$9,575.00

Component Description:
Climbing Inspection w/line layout and tower structural analysis- remaining balance due
Amount:
$9,575.00
Comprehensive coverage verification via field study, if needed

Component Description:
Full Site Survey with drawing package- 50% down payment
Amount:
$15,237.50

Component Description:
Please disregard invoice. Placed in incorrect category.
Amount:
N/A
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.
Prepare and or review reimbursement form Information not provided.
Project management of the transition

Component Description:
project management srvs 4/28/18 -5/25/18
Amount:
$1,125.00

Component Description:
Project Management 10/27/18-11/30/18 services
Amount:
$9,397.11

Component Description:
project management srvs 7/28/18 - 8/31/18
Amount:
$975.00

Component Description:
project management srvs 9/29/18 - 10/26/18
Amount:
$4,575.00

Component Description:
project management srvs 5/26/18 - 6/29/18
Amount:
$3,450.00

Component Description:
Project Management 12/1/18-12/31/18 services
Amount:
$1,950.00

Component Description:
project management srvs 9/1/18 - 9/28/18
Amount:
$5,146.29

Component Description:
project management srvs 6/30/18 - 7/27/18
Amount:
$1,650.00

Component Description:
project mgmt. srvs 3/31/18 - 4/27/18
Amount:
$7,013.10
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Perform engineering study for new channel assignment and antenna development Information not provided.
Prepare engineering section of 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 Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.

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 $95,720.00 $95,115.00 N/A $11,114.28 N/A
Total for all systems $4,854,866.94 $4,001,105.54 N/A $1,579,861.68 N/A
Other Expenses $95,720.00 $95,115.00 $11,114.28
Prepare FCC Quarterly Progress Reports $27,030.00 $27,030.00 Prepare and file FCC Progress reports quarterly. See attached vendor quote. N/A N/A
MVPD Notification of Channel Change $5,000.00 $5,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $1,500.00 $1,500.00 N/A N/A N/A
Equipment Storage $10,000.00 $10,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $12,000.00 $12,000.00 N/A $11,114.28 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $15,000.00 $15,000.00 Disposal of old equipment N/A N/A
Non-zoning permits $12,000.00 $12,000.00 Local Permits. N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 Catalog N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 Catalog N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 Catalog N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 Catalog N/A N/A

Components

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

Component Description:
ERI antenna and transmission line freight
Amount:
$11,114.28
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Non-zoning permits Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
DTV Medical Facility Notification Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $4,854,866.94 $4,001,105.54 $1,579,861.68

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.

Angelo Servedio

Vice President Controller


10/15/2019

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.

Angelo Servedio

Vice President Controller


10/15/2019

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