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:
23930
Service:
DTV
Call Sign:
WACS-TV
Channel:
7 (High VHF)
File Number:
0000027606
FRN:
0001844976
Date Submitted:
03/05/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

GEORGIA PUBLIC TELECOMMUNICATIONS COMMISSION

Adam Woodlief

260 14TH ST NW

ATLANTA, GA 30318

United States

+1 (404) 685-2410 awoodlief@gpb.org Government Entity

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

Robert Gehman

ConsultingEngineer

Kessler and Gehman Associates, Inc.

507 NW 60th Street

Suite D

Gainesville, FL 32607

United States

+1 (252) 332-3157 bob@kesslerandgehman.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 Map and analyze tower; modify if needed. Replace transmitter and antenna. Add interim antenna and line for continuous operation during primary antenna replacement and for the duration of the assigned phase.

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 PTCD 5P1
Year 2008
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1.8 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model HPTV-PRLX-V7
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 10.1 kW
Justification for New Transmitter Manufacturer of existing transmitter advises that the existing transmitter cannot be re-tuned.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring Yes
Size 3 inches
Length 100.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Standby Exciter and Switch

Standby Exciter with Automatic Change Over Switch

Additional Interior RF System

Interior RF System Existing Transmitter to Interim Transmission line

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 Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 4.7 kW
Manufacturer
Model THV-5A8 R C170
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? 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 Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 4.7 kW
Manufacturer
Model TBD
Year 2018
Justification for New Antenna Single channel antenna cannot accommodate assigned channel

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type 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: 4.7 kW
Manufacturer
Model TBD
Year 2018
Justification for New Antenna An interim antenna is necessary to keep station on the air during primary antenna replacement and for the duration of the assigned phase.

Interim Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for an antenna? Yes
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

Interim Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Utilize Existing
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer ERI
Type Flexible Air
Diameter 3 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 1040 feet per run

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Sweep Line

Sweep line for suitability on assigned channel

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Flexible Air
Diameter 3 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 1010 feet per run
Justification for New Transmission Line An interim transmission line is necessary for the interim antenna to keep station on the air during primary antenna replacement and for the duration of the assigned phase.

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) No
Others Types of Users Yes
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? Yes
ASR Number 1018782
Coordinates (NAD83) Latitude (NAD83) 31° 56' 12.4" N-
Longitude (NAD83) 084° 33' 12.8" W-
Overall Structure Height 1095.79 feet
Support Structure Height 1044.93 feet
Ground Elevation Above Mean Sea Level (AMSL) 473.09 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner GEORGIA PUBLIC TELECOMMUNICATIONS COMMISSION
Date Constructed 03/07/2016


Other Types of Users

Users
GA Forestry
FBI
GBI

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 undocumented/poorly documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: Major 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 60
Explanation It will be necessary to schedule and coordinate multiple vendors, complete progress reports, and update Schedule 399. Station does not have available personnel or personnel trained in project management for such complex projects.
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 Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
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 No
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 22
Justification It will be necessary to survey the site, plan the equipment, develop specifications for purchasing, and oversee multiple vendor RF projects. Station does not have available personnel or personnel trained in such services.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Other Engineering Services

Engineering services not already included in a pre-established OPS section.

Other Legal Services

Legal services not already included in a pre-established OPS section.

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)? 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

System Design and Site Survey

System Design and Site Survey

Electrical Design

Electrical Design

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 $616,450.00 $276,045.00 N/A $110,545.00 N/A
Total for all systems $2,101,520.00 $1,721,465.00 N/A $178,221.00 N/A
Primary Transmitter HPTV-PRLX-V7 $616,450.00 $276,045.00 $110,545.00
Standby Exciter and Switch $25,000.00 $25,000.00 N/A N/A N/A
Additional Interior RF System $75,000.00 $75,000.00 N/A N/A N/A
3" Rigid Conduit and Wiring (Cost per foot) $5,200.00 $4,900.00 N/A N/A N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $24,300.00 N/A N/A N/A
High VHF - Liquid Cooled Solid State Transmitter 8.5 . 12.5 kW $447,500.00 $110,545.00 See attached / uploaded file "Comark S10459-1 v190912jgv1" $110,545.00 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A

Components

Actual Information Description File Name
Standby Exciter and Switch Information not provided.
Additional Interior RF System Information not provided.
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 150 KVA Information not provided.
High VHF - Liquid Cooled Solid State Transmitter 8.5 . 12.5 kW

Component Description:
Comark S10459-1 v190912jgv1
Amount:
$110,545.00
Switchgear - industrial 800 amp 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 $546,870.00 $544,800.00 N/A $0.00 N/A
Total for all systems $2,101,520.00 $1,721,465.00 N/A $178,221.00 N/A
Interim Antenna TBD $215,140.00 $213,400.00 $0.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 N/A N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
High VHF - High Power Side Mount One Station horizontally polarized $180,000.00 $180,000.00 N/A N/A N/A
Primary Antenna TBD $331,730.00 $331,400.00 $0.00
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
High VHF - High Power Top Mount One Station horizontally polarized $325,000.00 $325,000.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $65,990.00 $62,960.00 N/A $0.00 N/A
Total for all systems $2,101,520.00 $1,721,465.00 N/A $178,221.00 N/A
Interim Transmission Line $59,590.00 $56,560.00 $0.00
Flexible Air Transmission Line - dielectric, 3" $59,590.00 $56,560.00 N/A N/A N/A
Primary Transmission Line $6,400.00 $6,400.00 $0.00
Sweep Line $6,400.00 $6,400.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $657,800.00 $625,000.00 N/A $22,500.00 N/A
Total for all systems $2,101,520.00 $1,721,465.00 N/A $178,221.00 N/A
Primary Tower GTOWER $657,800.00 $625,000.00 $22,500.00
Major tower reinforcement/modifications $421,000.00 $400,000.00 N/A N/A N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $25,000.00 N/A $22,500.00 N/A
Tall Tower (greater than 500') $210,500.00 $200,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Major tower reinforcement/modifications Information not provided.
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
TEP 369151 v200305jgv1
Amount:
$9,500.00

Component Description:
TEP 373507 v200305jgv1
Amount:
$3,500.00

Component Description:
TEP 388003 v200303jgv1
Amount:
$9,500.00
Tall Tower (greater 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 $116,400.00 $115,200.00 N/A $25,716.00 N/A
Total for all systems $2,101,520.00 $1,721,465.00 N/A $178,221.00 N/A
Outside Professional Services $116,400.00 $115,200.00 $25,716.00
Other Legal Services $10,000.00 $10,000.00 N/A $1,001.00 N/A
Additional Field Engineering Service, 22 Days $42,000.00 $42,000.00 N/A N/A N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 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 $2,500.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $3,500.00 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 $3,950.00 See attached invoices and quotes where applicable. $3,950.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $1,540.00 N/A
Project management of the transition $9,480.00 $9,000.00 N/A $1,650.00 N/A
Other Engineering Services $20,000.00 $20,000.00 N/A $11,575.00 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 request for Special Temporary Authorization $3,680.00 $3,500.00 N/A N/A N/A

Components

Actual Information Description File Name
Other Legal Services

Component Description:
Repack Prep of Legal Invoices
Amount:
$77.00

Component Description:
WACS amount. Refer to GMP master summary invoice WACS with attached invoice.
Amount:
$38.50

Component Description:
GMP 30377 v190702pmv1
Amount:
$231.00

Component Description:
GMP 31273 v200213jgv1
Amount:
$77.00

Component Description:
WACS amount. Refer to Jan-Apr matter summary for all 5 sites.Refer to letter and attachments uploaded by GPB 8.2.18
Amount:
$38.50

Component Description:
WACS amount. Refer to May matter summary for all 5 sites.Refer to letter and attachments uploaded by GPB 8.2.18
Amount:
$154.00

Component Description:
WACS amount. Refer to GMP master summary invoice WACS with attached invoice.
Amount:
$38.50

Component Description:
WACS amount. Refer to GMP master summary invoice WACS with attached invoice.
Amount:
$115.50

Component Description:
GMP 30910 v200213jgv1
Amount:
$231.00
Additional Field Engineering Service, 22 Days Information not provided.
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
ASR modification (prepare FCC Form 854) 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

Component Description:
Prepare engineering section of Form 2100 (main) construction permit application
Amount:
$2,500.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Perform engineering study for new channel assignment
Amount:
$3,500.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
Prepare and review reimbursement form
Amount:
$2,500.00

Component Description:
KGA 554-705 v200213jgv1
Amount:
$450.00

Component Description:
KGA 554-603 v190620pmv1
Amount:
$275.00

Component Description:
KGA 554-680 v200213jgv1
Amount:
$725.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
WACS amount. Refer to GMP master summary invoice WACS with attached invoice.Refer to letter and attachments from GPB 8.2.18
Amount:
$385.00

Component Description:
WACS amount. Refer to GMP master summary invoice WACS with attached invoice. Refer to letter and attachments uploaded by GPB 8.2.18
Amount:
$1,155.00
Project management of the transition

Component Description:
KGA 554-659 v200213jgv1
Amount:
$150.00

Component Description:
KGA 554-596 v190624pmv2
Amount:
$150.00

Component Description:
KGA 554-710 v200213jgv1
Amount:
$150.00

Component Description:
Project management Bob Gehman
Amount:
$225.00

Component Description:
Form 387 2Q18
Amount:
$150.00

Component Description:
Project management Bob Gehman
Amount:
$225.00

Component Description:
KGA 554-596 v190620pmv1
Amount:
$150.00

Component Description:
Form 387 4Q18
Amount:
$150.00

Component Description:
Project management Bob Gehman
Amount:
$300.00

Component Description:
Form 387 3Q18
Amount:
$150.00
Other Engineering Services

Component Description:
KGA 554-639 v190702pmv1
Amount:
$1,450.00

Component Description:
KGA 554-630 v190620pmv1
Amount:
$2,475.00

Component Description:
KGA 554-673 v200213jgv1
Amount:
$1,700.00

Component Description:
KGA 554-731 v200213jgv1
Amount:
$125.00

Component Description:
KGA 554-738 v200213jgv1
Amount:
$400.00

Component Description:
KGA 554-605 v190620pmv1
Amount:
$500.00

Component Description:
KGA 554-606 v190620pmv1
Amount:
$675.00

Component Description:
KGA 554-666 v200213jgv1
Amount:
$1,500.00

Component Description:
KGA 554-722 v200213jgv1
Amount:
$1,250.00

Component Description:
KGA 554-701 v200213jgv1
Amount:
$1,500.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization 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 $98,010.00 $97,460.00 N/A $19,460.00 N/A
Total for all systems $2,101,520.00 $1,721,465.00 N/A $178,221.00 N/A
Other Expenses $98,010.00 $97,460.00 $19,460.00
Electrical Design $4,160.00 $4,160.00 See attached / uploaded PDF file titled "NBP Eng 18188 v200303jgv1.pdf" $4,160.00 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $16,000.00 $16,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $33,000.00 $33,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A N/A N/A
Equipment Storage $16,000.00 $16,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $0.00 $0.00 N/A N/A N/A
System Design and Site Survey $15,300.00 $15,300.00 See attached / uploaded file "Comark 12831 v190912jgv1.pdf" $15,300.00 N/A
MVPD Notification of Channel Change $2,000.00 $2,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Electrical Design

Component Description:
NBP Eng 18188 v200303jgv1
Amount:
$4,160.00
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Equipment Delivery and Handling Charges Information not provided.
DTV Medical Facility Notification Information not provided.
Equipment Storage Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
System Design and Site Survey

Component Description:
Comark 12831 v190912jgv1
Amount:
$15,300.00
MVPD Notification of Channel Change Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,101,520.00 $1,721,465.00 $178,221.00

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.

Jeffrey C Gehman

Engineering Associate


03/05/2020

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.

Jeffrey C Gehman

Engineering Associate


03/05/2020

Attachments

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