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:
168014
Service:
DCA
Call Sign:
W15EA-D
Channel:
15 (UHF)
File Number:
0000025765
FRN:
0026907345
Date Submitted:
11/03/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

HC2 STATION GROUP, INC.

RENEE ILHARDT

450 PARK AVENUE

3OTH FLOOR

NEW YORK, NY 10022

United States

+1 (646) 431-8489 RILHARDT@HC2BROADCASTING.COM Corporation

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan Perform structural analysis and tower modifications if needed. Tower expenses will be shared with other tenant WBUY (FAC ID 60830) but exact arrangement are TBD. Replace antenna and transmitter.

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 DTU2KU-50
Year 2010
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 2 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 TXUD3000AAC
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 3 kW
Justification for New Transmitter Transmitter is in working condition. Please see details in attachment "W50EA-D transmitter justification".

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) No
Power N/A
Rigid Conduit and Wiring Yes
Size 2 inches
Length 50.0 feet
Other Electrical Service Yes
Description RF Consulting Engineer
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 15.0 kW
Manufacturer
Model JA/SS-Omni
Year 2010

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? No
New Antenna Manufacturer and Types Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Circular
Type Broadband Slot
Number of Stations Supported 1
Number of Panels/Bays 12
Lower Limit 470.00 MHz
Upper Limit 862.00 MHz
Design power capacity in use 75.0 %
Other Antenna Type N/A
ERP: 15.0 kW
Manufacturer
Model ATC-BCSE16M-U1-16
Year 2018
Justification for New Antenna Existing coaxial slot antenna will not function on repacked channel.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
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? No

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 Air
Diameter 3 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 120 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Air
Diameter 3 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 120 feet per run
Justification for New Transmission Line Added 120' to existing transmission line to move to a new location in the building.

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? Candelabra
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1057943
Coordinates (NAD83) Latitude (NAD83) 35° 16' 33.0" N-
Longitude (NAD83) 089° 46' 38.0" W-
Overall Structure Height 1198.80 feet
Support Structure Height 1195.85 feet
Ground Elevation Above Mean Sea Level (AMSL) 250.00 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Vertical Bridge Towers, LLC
Date Constructed 05/16/1999

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
68518 WLMT DTV
11907 WATN-TV DTV
58397 WEGR FM
60830 WBUY-TV DTV

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 tower with candelabra
Tower Reinforcements Please select whether tower reinforcements are needed: Minor Reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Candelabra
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 400
Explanation Outside consulting engineering, legal work, and accounting services, as well as project management for regional and comprehensive repack execution.
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

Information not provided.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits No
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)? No
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? No
Does this relocation require Equipment Storage? No
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? No

Other Expenses

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Other Expenses Not Listed

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $326,254.00 $213,314.27 N/A $130,182.70 N/A
Total for all systems $1,065,434.00 $939,682.87 N/A $262,942.70 N/A
Primary Transmitter TXUD3000AAC $326,254.00 $213,314.27 $130,182.70
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $83,291.70 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $6,564.13 N/A
2" Rigid Conduit and Wiring (Cost per foot) $1,300.00 $1,250.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW $155,600.00 $75,934.57 N/A $75,934.57 N/A
Switchgear - industrial 800 amp $38,200.00 $47,684.00 See attached quote from Ellendale. $47,684.00 N/A
Other Electrical Service: RF Consulting Engineer $5,154.00 $5,154.00 N/A $0.00 N/A

Components

Actual Information Description File Name
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
Transmitter related cost. #2018005
Amount:
$2,924.30

Component Description:
Installation of transmitter and traveling expenses
Amount:
$2,162.50

Component Description:
Shipping cost. #3684
Amount:
$793.00

Component Description:
Transmitter cost, upgrade excluded. #3658
Amount:
$75,934.57

Component Description:
Transmitter related cost. #20170034
Amount:
$1,201.25

Component Description:
Transmitter related cost. #19110
Amount:
$2,438.58

Component Description:
Installation and travel expense. #20170034
Amount:
$2,001.25

Component Description:
Transmitter related costs. #3658
Amount:
$80,118.80

Component Description:
FCC Channel Repack
Amount:
$80,118.80
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW

Component Description:
Transmitter cost, upgrade excluded. #3658
Amount:
$75,934.57
Switchgear - industrial 800 amp

Component Description:
Transmitter related cost, 20% down. #SVI-106944
Amount:
$10,172.00

Component Description:
Transmitter related cost, 80% balance. #SPI-008386
Amount:
$37,512.00
Other Electrical Service: RF Consulting Engineer

Component Description:
Electrical emergency visit. #2922
Amount:
$5,154.00

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 $26,300.00 $78,690.18 N/A $78,690.18 N/A
Total for all systems $1,065,434.00 $939,682.87 N/A $262,942.70 N/A
Primary Antenna ATC-BCSE16M-U1-16 $26,300.00 $78,690.18 $78,690.18
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $78,690.18 See attached quote from Kathrein. The reimbursed ERI invoices should be interim antenna. $78,690.18 N/A

Components

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

Component Description:
50% downpayment, upgrade excluded. #W50EA-D-001
Amount:
$5,437.50

Component Description:
50% balance, upgrade excluded. #50753
Amount:
$6,028.68

Component Description:
Antenna replacement related cost. Downpayment upon acceptance of the agreement. #1924
Amount:
$3,000.00

Component Description:
Transmitter 50% balance. #184485
Amount:
$30,064.00

Component Description:
Transmitter 50% down, upgrade excluded. #184485-01
Amount:
$28,240.00

Component Description:
Balance of the agreement. Antenna replacement related cost. #1961
Amount:
$5,500.00

Component Description:
Existing antenna is not designed to operate on the post repack channel. Licensee has included pricing information for equivalent horizontally polarized antenna in addition to elliptically polarized antenna actually purchased.
Amount:
$9,750.00

Component Description:
Balance due for antenna related cost. #50753
Amount:
$6,706.30

Component Description:
Redelivery cost. #184501
Amount:
$420.00

Component Description:
Antenna replacement related cost. #1961
Amount:
$5,500.00

Component Description:
Antenna replacement related cost. #1924
Amount:
$3,000.00

Component Description:
50% down payment for antenna equipment. #W50EA-D-001
Amount:
$6,115.13

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 $7,080.00 $7,613.42 N/A $7,613.42 N/A
Total for all systems $1,065,434.00 $939,682.87 N/A $262,942.70 N/A
Primary Transmission Line $7,080.00 $7,613.42 $7,613.42
Flexible Air Transmission Line - dielectric, 3" $7,080.00 $7,613.42 See attached quote from Kathrein, freight cost was not included in the quote. $7,613.42 N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 3"

Component Description:
Transmission line cost. #19157
Amount:
$388.82

Component Description:
TL cost, 50% down. #16635-01
Amount:
$3,251.55

Component Description:
TL cost, 50% balance plus shipping cost. #183611
Amount:
$3,973.05

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 $599,000.00 $569,000.00 N/A $11,544.00 N/A
Total for all systems $1,065,434.00 $939,682.87 N/A $262,942.70 N/A
Primary Tower TOWER $599,000.00 $569,000.00 $11,544.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $400,000.00 N/A $8,294.00 N/A
Minor tower reinforcement/modifications $158,000.00 $150,000.00 N/A $0.00 N/A
Structural engineering tower load study for a documented tower with candelabra $20,000.00 $19,000.00 N/A $3,250.00 The third item should be removed.

Components

Actual Information Description File Name
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
Removing and replacing antenna. #160987
Amount:
$4,147.00

Component Description:
Change order. #160996
Amount:
$4,147.00

Component Description:
Coast to Coast Tower Services
Amount:
$8,500.00
Minor tower reinforcement/modifications Information not provided.
Structural engineering tower load study for a documented tower with candelabra

Component Description:
Vertical Bridge Invoice INV-000135856 replaces Vertical Bridge PO for Structural Analysis
Amount:
$3,250.00

Component Description:
Structural engineering tower load study. #INV-000135856
Amount:
$3,250.00

Component Description:
Structural analysis. #INV-000135856
Amount:
$3,250.00

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 $91,280.00 $56,150.00 N/A $31,304.63 N/A
Total for all systems $1,065,434.00 $939,682.87 N/A $262,942.70 N/A
Outside Professional Services $91,280.00 $56,150.00 $31,304.63
Project management of the transition $63,200.00 $29,900.00 N/A $29,783.18 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 N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $621.45 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $320.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $580.00 N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 20 stations. #145
Amount:
$745.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #1129
Amount:
$1,758.65

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1116
Amount:
$1,254.03

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1118
Amount:
$1,609.03

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #472232
Amount:
$901.10

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #474243
Amount:
$1,304.02

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #473121
Amount:
$2,044.14

Component Description:
Legal services cost. #2020-W15EA
Amount:
$823.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #1150
Amount:
$630.93

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #474784
Amount:
$374.23

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #1158
Amount:
$723.06

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 27 stations. #115
Amount:
$467.12

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 20 stations. #473857
Amount:
$1,198.13

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations.
Amount:
$1,503.60

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #1163
Amount:
$607.03

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 18 stations. #472568
Amount:
$821.47

Component Description:
Legal services cost. #475971
Amount:
$50.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 20 stations.
Amount:
$796.10

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 27 stations. #130
Amount:
$450.81

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 27 stations. #119
Amount:
$271.70

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #475011
Amount:
$1,023.40

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #1146
Amount:
$888.15

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #1165
Amount:
$497.50

Component Description:
Legal services cost. #475034
Amount:
$44.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #475439
Amount:
$268.86

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #475948
Amount:
$419.80

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #471659
Amount:
$1,206.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #473121
Amount:
$2,044.14

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1112
Amount:
$521.40

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1104
Amount:
$644.80

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #473451
Amount:
$1,054.24

Component Description:
Legal services cost. #474788
Amount:
$508.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #1134
Amount:
$1,678.60

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #1122
Amount:
$1,979.10

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #472568
Amount:
$985.76

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1096
Amount:
$714.93
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.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
CP preparation. #201757
Amount:
$60.00

Component Description:
Engineering review
Amount:
$233.33

Component Description:
CP application. #201757
Amount:
$60.00

Component Description:
Form 399 filing
Amount:
$65.62

Component Description:
CP preparation
Amount:
$262.50
Perform engineering study for new channel assignment and antenna development

Component Description:
Engineering services. #20170034
Amount:
$320.00

Component Description:
Engineering services. #20170034
Amount:
$320.00

Component Description:
Engineering study
Amount:
$320.00
Prepare and or review reimbursement form

Component Description:
Form 399 preparation. #20170034
Amount:
$400.00

Component Description:
FCC 399 preparation. #201757
Amount:
$180.00

Component Description:
FCC 399 update
Amount:
$400.00

Component Description:
Prepare and review reimbursement form. #201757
Amount:
$180.00

Component Description:
FCC 399 Update Preparation of CP
Amount:
$240.00

Component Description:
Review reimbursement form. #20170034
Amount:
$400.00

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 $15,520.00 $14,915.00 N/A $3,607.77 N/A
Total for all systems $1,065,434.00 $939,682.87 N/A $262,942.70 N/A
Other Expenses $15,520.00 $14,915.00 $3,607.77
Develop and air announcement of upcoming channel change $1,830.00 $1,830.00 N/A $1,830.00 N/A
Local Zoning $500.00 $500.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $1,777.77 N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A

Components

Actual Information Description File Name
Develop and air announcement of upcoming channel change

Component Description:
Announcement cost. #2814007400
Amount:
$1,545.00

Component Description:
Announcement cost. #2814056206
Amount:
$285.00
Local Zoning Information not provided.
DTV Medical Facility Notification

Component Description:
Medical notification service. #INV-001869
Amount:
$1,777.77
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,065,434.00 $939,682.87 $262,942.70

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.

Henry Turner

COO


11/03/2020

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.

Henry Turner

COO


11/03/2020

Attachments

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