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:
38584
Service:
DTV
Call Sign:
KMCT-TV
Channel:
22 (UHF)
File Number:
0000026258
FRN:
0028580298
Date Submitted:
01/06/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

KMCT HOLDINGS, LLC

Doing Business As: KMCT HOLDINGS, LLC

Dante Thompson

3409 RUTHERFORD RD EXT.

TAYLORS, SC 29687

United States

+1 (864) 244-1616 programming@wggs16.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

Joseph C Chautin III

Hardy, Carey, Chautin & Balkin, LLP

1080 West Causeway Approach

Mandeville, LA 70471

United States

+1 (985) 629-0777 jchautin@hardycarey.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 KMCT will be moving from frequency 38 to 22. We have contracted with an engineering firm and installation engineers to make this move. The installation engineer will handle all equipment installs along with the tower work needed.

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 SBTXUREA1500
Year 2015
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1.5 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 TMU9
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 3.0 kW
Justification for New Transmitter Current transmitter cannot be retuned to repack channel. Changes on this transmitter represent the minimal possible adjustment to accommodate the new channel and reach the previous market.

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

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

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Add 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 this antenna currently shared with any other stations? No
Is this antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting 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: 20.0 kW
Manufacturer
Model PSILP12OI
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? Yes
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 Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 25.0 kW
Manufacturer
Model DLP12B
Year 2018
Justification for New Antenna Existing antenna is cut for current channel and cannot be retuned.

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 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 400 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? Yes
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 400 feet per run
Justification for New Transmission Line Both systems will set up side by side during testing and transition. Minimize down time for channel move

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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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? 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? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1296986
Coordinates (NAD83) Latitude (NAD83) 32° 30' 21.2" N-
Longitude (NAD83) 092° 08' 55.6" W-
Overall Structure Height 344.81 feet
Support Structure Height 339.89 feet
Ground Elevation Above Mean Sea Level (AMSL) 68.90 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner Branch Towers, LLC
Date Constructed 10/05/2015


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.

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 200
Explanation General project managment including, Pattern analysis, antenna spec, transmitter spec, installation, supervision
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Additional Attorney's Fees

To handle form 387 and other legal expenses.

Engineering Services Other Matters

Other Matters

Other Expenses

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

Other Expenses

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Other Expenses Not Listed

Name Description

Station Coordination

American Tower invoice for capital contribution for coordination with other stations

Attorney Fees - Other

Other attorney fees for the transition

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 $348,058.81 $180,881.52 N/A $163,843.91 N/A
Total for all systems $564,351.97 $484,616.76 N/A $382,650.31 N/A
Primary Transmitter TMU9 $348,058.81 $180,881.52 $163,843.91
Service entrance 3 phase/800 amp/208 volt $14,400.00 $21,040.00 Invoice 1928 from RLH ELECTRIC, LLC $11,630.06 N/A
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW $155,600.00 $32,767.31 This 3rd transmitter component is due to a bug in the LMS software. Cost Estimate is the remainder of the 4 quotes ($159,841.52) minus what was paid in the first 2 components ($127,074.21). The 4 quotes have been previously uploaded to LMS. $25,139.64 N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $75,015.40 ***System Notice: Estimate adjusted and locked because line has been superseded.***Estimate 1820 from Ultranet Wireless LLC DBA Kentuckiana Broadcast Technical Services. $75,015.40 11/29 Do not upload invoices to this transmitter, please use UHF - Air Cooled Solid State Transmitter 3.0 kW
UHF - Air Cooled Solid State Transmitter 3.0 kW $52,058.81 $52,058.81 ***System Notice: Estimate adjusted and locked because line has been superseded.***Please see attached quotes: 19009 and 1809R from SJ Ramer Associates as well as Ultranet Wireless, LLC Estimate #1820 and Air Service Professionals invoice I6470. There four have been combined and uploaded into LMS. $52,058.81 x

Components

Actual Information Description File Name
Service entrance 3 phase/800 amp/208 volt

Component Description:
Labor and materials to add a 3 phase 208 volt service to the transmitter building and hook up new 3 phase transmitter
Amount:
$7,340.00

Component Description:
Install 3ph primary pole w/3 pot 25 bv to serve customer 120-208
Amount:
$11,630.06
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW

Component Description:
Please deny this invoice
Amount:
N/A

Component Description:
Please deny this invoice.
Amount:
N/A

Component Description:
Primary Transmitter
Amount:
$9,436.64

Component Description:
Primary Transmitter
Amount:
$15,703.00
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
Louisiana State Sales Taxes
Amount:
$10,005.69

Component Description:
Please reject this invoice
Amount:
N/A

Component Description:
Downpayment for transmitter package
Amount:
$65,009.71
UHF - Air Cooled Solid State Transmitter 3.0 kW

Component Description:
Transmitter
Amount:
$43,339.81

Component Description:
Please deny this invoice
Amount:
N/A

Component Description:
Please deny this invoice.
Amount:
N/A

Component Description:
Installed 2-2.5 ton Mitsubishi mini splits for the television control transmitter station.
Amount:
$8,719.00

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 $24,463.16 $28,283.16 N/A $20,247.28 N/A
Total for all systems $564,351.97 $484,616.76 N/A $382,650.31 N/A
Primary Antenna DLP12B $24,463.16 $28,283.16 $20,247.28
Sweep test of existing antenna $6,730.00 $10,550.00 SJ Ramer Associates Invoice #19019 $10,550.00 N/A
UHF - High Power, Side Mount, basic slot antenna, 25 kW input, directional,, elliptically or circularly polarized $9,697.28 $9,697.28 This amount is the total estimated cost for the actual equipment being installed. Quotes and invoices have been uploaded. $1,661.40 per invoices submitted
UHF - High Power, Side Mount, basic slot antenna, 25 kW input, directional,, horizontally polarized $8,035.88 $8,035.88 ***System Notice: Estimate adjusted and locked because line has been superseded.***This is for an equivalent replacement of the Channel 38 antenna for Channel 22. This is not an equipment upgrade. $8,035.88 N/A

Components

Actual Information Description File Name
Sweep test of existing antenna

Component Description:
KMCT-210-Primary Antenna - Sweep Test
Amount:
$4,550.00

Component Description:
Primary Antenna - Sweep Test
Amount:
$6,000.00
UHF - High Power, Side Mount, basic slot antenna, 25 kW input, directional,, elliptically or circularly polarized

Component Description:
UHF - Lower Power Side Mount
Amount:
$1,661.40
UHF - High Power, Side Mount, basic slot antenna, 25 kW input, directional,, horizontally polarized

Component Description:
Primary Antenna - UHF Side Mount Directional H-POL
Amount:
$4,017.94

Component Description:
Primary Antenna - UHF Side Mount Directional H-POL
Amount:
$4,017.94

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 $9,600.00 $9,200.00 N/A $5,321.12 N/A
Total for all systems $564,351.97 $484,616.76 N/A $382,650.31 N/A
Primary Transmission Line $9,600.00 $9,200.00 $5,321.12
Flexible Foam Transmission Line - dielectric, 1 5/8" $9,600.00 $9,200.00 N/A $5,321.12 N/A

Components

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

Component Description:
New Transmission Line
Amount:
$2,157.14

Component Description:
Primary Transmission Line - Flexible Foam 1 5/8"
Amount:
$634.84

Component Description:
New Transmission Line
Amount:
$2,157.14

Component Description:
Flex Hanger Snap IN 1 5/8 Foam SSH-158
Amount:
$372.00

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $96,800.00 $81,617.08 N/A $69,395.65 N/A
Total for all systems $564,351.97 $484,616.76 N/A $382,650.31 N/A
Primary Tower GTOWER $96,800.00 $81,617.08 $69,395.65
Structural engineering tower load study for well documented tower $12,600.00 $12,000.00 N/A $2,000.00 N/A
Short Tower (less than 500') $84,200.00 $69,617.08 Ultranet Wireless, LLC invoice 459917 $67,395.65 N/A

Components

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

Component Description:
Broadcast structural
Amount:
$2,000.00
Short Tower (less than 500')

Component Description:
Tubular Arm Pipe Mount 80" Fac; 3-1/2" x 48" Scheduled 40 Galv
Amount:
$2,221.43

Component Description:
Mobilization, Tower Labor, Parts
Amount:
$67,395.65

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 $61,680.00 $169,935.00 N/A $123,447.35 N/A
Total for all systems $564,351.97 $484,616.76 N/A $382,650.31 N/A
Outside Professional Services $61,680.00 $169,935.00 $123,447.35
Project management of the transition $31,600.00 $148,185.00 Please see Estimated Cost Justification KMCT-510-Project Management v0 $117,657.35 N/A
Engineering Services Other Matters $500.00 $500.00 Per Du Treil Invoice 241006 $500.00 N/A
Additional Attorney's Fees $1,500.00 $1,500.00 Cost to support attorney fees for form 387 and other legal needs $975.00 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $725.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $1,340.00 N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $2,000.00 Per Du Treil Invoice 241005 $2,000.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $2,000.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $250.00 N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Project Management
Amount:
$23,400.00

Component Description:
Bookkeeping
Amount:
$480.00

Component Description:
Project Management
Amount:
$3,894.35

Component Description:
Project Management
Amount:
$8,700.00

Component Description:
Engineering Services
Amount:
$2,800.00

Component Description:
Project Management
Amount:
$4,718.00

Component Description:
Project Management
Amount:
$2,019.65

Component Description:
Project Management
Amount:
$2,407.75

Component Description:
Project Management
Amount:
$2,764.65

Component Description:
"PO LINE 1 - NTP Billable KMCT-TV FID:38584 ATC Tower 204618 WEST MONROE BROADCAST REPACK"
Amount:
$9,480.00

Component Description:
Project Management
Amount:
$745.00

Component Description:
Project Management
Amount:
$12,900.00

Component Description:
Project Management
Amount:
$3,311.65

Component Description:
Project Management
Amount:
$2,750.30

Component Description:
Project Management
Amount:
$2,896.10

Component Description:
Project Management
Amount:
$4,255.70

Component Description:
Project Management
Amount:
$6,309.95

Component Description:
Project Management
Amount:
$3,103.85

Component Description:
Project Management KMCT Repack-Mar 2018
Amount:
$8,700.00

Component Description:
Travel Charges
Amount:
$2,500.00

Component Description:
BOOKKEEPING -LIZ ERICKSON
Amount:
$480.00

Component Description:
Project Management
Amount:
$2,840.70

Component Description:
Project Management KMCT Repack-July 2018
Amount:
$16,950.00

Component Description:
Project Management
Amount:
$7,985.40
Engineering Services Other Matters

Component Description:
KMCT-Form 399 work
Amount:
$500.00
Additional Attorney's Fees

Component Description:
Legal Services - Draft Form 399 in LMS
Amount:
$80.00

Component Description:
Legal Services - Review FCC notice regarding first transition progress reports; deadline.
Amount:
$75.00

Component Description:
Repack Legal Expenses
Amount:
$275.00

Component Description:
Load Form 387 quarterly transition progress report in LMS
Amount:
$75.00

Component Description:
KMCT-550-Attorney - Other Expenses Not Listed - Form 387 and other legal needs
Amount:
$150.00

Component Description:
Attorney - License to Cover (Main)
Amount:
$100.00

Component Description:
Prepare draft of Form 387 2nd Qtr 2018 report
Amount:
$75.00

Component Description:
Legal Fees
Amount:
$150.00

Component Description:
Develop and Air Channel Change Announcements
Amount:
$75.00
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

Component Description:
Legal Services - Check status of Form 2100 CP app for KMCT and Form 399
Amount:
$75.00

Component Description:
Review email and American Tower letter to FAWM
Amount:
$650.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Legal Services - Review response from K. Albritton on status of 2100 and 399
Amount:
$875.00

Component Description:
Medical Facility Notification
Amount:
$385.00

Component Description:
Attorney - Construction Permit Application (Main)
Amount:
$80.00
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
KMCT-Form 2100; Exhibits Professional Services
Amount:
$2,000.00
Perform engineering study for new channel assignment and antenna development Information not provided.
Prepare and or review reimbursement form

Component Description:
Tel call from FCC, Review KMCT Form 1876, Memos to client, Review FCC notice, etc.
Amount:
$225.00

Component Description:
Legal Services - Review FCC Incentive Auction Closing Notice
Amount:
$250.00

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $23,750.00 $14,700.00 N/A $395.00 N/A
Total for all systems $564,351.97 $484,616.76 N/A $382,650.31 N/A
Other Expenses $23,750.00 $14,700.00 $395.00
Attorney Fees - Other $1,000.00 $1,000.00 Please see the attached invoice #33303 form Hardy, Carey, Chautin & Balkin, LLP N/A N/A
Station Coordination $2,500.00 $2,500.00 N/A N/A N/A
MVPD Notification of Channel Change $2,500.00 $2,500.00 N/A $0.00 N/A
Develop and air announcement of upcoming channel change $2,500.00 $2,500.00 N/A $212.50 N/A
Equipment Storage $1,200.00 $1,200.00 N/A N/A N/A
Equipment Delivery and Handling Charges $2,500.00 $2,500.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $2,500.00 N/A $182.50 N/A

Components

Actual Information Description File Name
Attorney Fees - Other Information not provided.
Station Coordination

Component Description:
Capital Contribution
Amount:
$2,500.00
MVPD Notification of Channel Change

Component Description:
MVPD Notification
Amount:
$2,000.00
Develop and air announcement of upcoming channel change

Component Description:
Memo to Ken A. and Darryl M.
Amount:
$75.00

Component Description:
Attorney - Construction Permit Application (Main)
Amount:
$137.50
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges Information not provided.
DTV Medical Facility Notification

Component Description:
KMCT-TV Medical Notification
Amount:
$2,091.00

Component Description:
Medical Facility Notification
Amount:
$100.00

Component Description:
Develop and Air Channel Change Announcements
Amount:
$82.50

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $564,351.97 $484,616.76 $382,650.31

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.

Tom Fawbush

General Manager


01/06/2020

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