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:
14302
Service:
DCA
Call Sign:
K36NE-D
Channel:
36 (UHF)
File Number:
0000025777
FRN:
0026907345
Date Submitted:
05/20/2020

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 Station will co-locate on ATC's Black Mountain tower (ASR 1203429)

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 AT71-500
Year 2011
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity .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? No
Manufacturer
Model EKA DynaMaia
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1 kW
Justification for New Transmitter Existing transmitter is no longer supported by manufacturer.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 3 inches
Length 75.0 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

Other Costs

Other Costs

Additional engineering time

Additional engineering time

Combiner

Combiner

UHF inside RF system including switching

UHF inside RF system including switching

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? 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: 14.49 kW
Manufacturer
Model JA/LS-SB-16
Year 2003

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? Yes
New Antenna Manufacturer and Types Class Class A
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: 2.5 kW
Manufacturer
Model ETU-4U0-ESP CX-36
Year 2018
Justification for New Antenna 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.

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? Yes
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? No

Tower Equipment And Rigging Costs

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

Primary Tower

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Add Tower

Section Question Response
Existing Tower Description Type of change Move Equipment
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1009985
Coordinates (NAD83) Latitude (NAD83) 36° 00' 36.4" N-
Longitude (NAD83) 115° 00' 22.7" W-
Overall Structure Height 251.97 feet
Support Structure Height 247.04 feet
Ground Elevation Above Mean Sea Level (AMSL) 3227.98 feet
Structure Type LTOWER - Lattice Tower
Tower Owner American Tower, LLC
Date Constructed 08/24/2001

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
10498 KEEN-CD DTV
66807 KHDF-CD DTV
63768 KBLR DTV

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

Name Description

Structural Analysis

Tower structural analysis

Mapping

Tower mapping

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 500
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 No
Quantity N/A
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 No
Quantity N/A
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements 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 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

International Towers

Antenna Replacement, transport new antenna, remove and dispose existing antenna and install new antenna.

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 $135,362.57 $129,137.57 N/A $34,885.14 N/A
Total for all systems $411,494.11 $358,514.00 N/A $138,275.40 N/A
Primary Transmitter EKA DynaMaia $135,362.57 $129,137.57 $34,885.14
Other Costs $1,550.00 $1,550.00 N/A $1,550.00 N/A
Combiner $2,887.32 $2,887.32 N/A $2,887.32 N/A
UHF inside RF system including switching $425.25 $425.25 See quote from SWR. $425.25 N/A
3" Rigid Conduit and Wiring (Cost per foot) $3,900.00 $3,675.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $120,000.00 N/A $29,422.57 N/A
Additional engineering time $600.00 $600.00 N/A $600.00 N/A

Components

Actual Information Description File Name
Other Costs

Component Description:
Transmitter relate cost. #2019-01-31-K36NE-D.
Amount:
$1,550.00
Combiner

Component Description:
Combiner cost. #7094-01
Amount:
$2,887.32
UHF inside RF system including switching

Component Description:
Transmitter related cost. #18330
Amount:
$425.25
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
Transmitter related cost. #3667
Amount:
$22,519.07

Component Description:
EKA DynaMain NT Digital TV Transmitter
Amount:
$22,519.07

Component Description:
Transmitter related cost. #2037
Amount:
$3,903.75

Component Description:
Transmitter related cost. #3667
Amount:
$22,519.07

Component Description:
Combiner cost. #7094-01
Amount:
N/A

Component Description:
Installing transmitter and traveling expense
Amount:
$5,740.00

Component Description:
Transmitter related cost. #2093
Amount:
$433.75

Component Description:
Transmitter related cost. #20170034
Amount:
$2,566.00
Additional engineering time

Component Description:
Additional engineering time. #20200226002
Amount:
$600.00

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 $41,391.96 N/A $41,391.96 N/A
Total for all systems $411,494.11 $358,514.00 N/A $138,275.40 N/A
Primary Antenna ETU-4U0-ESP CX-36 $26,300.00 $41,391.96 $41,391.96
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $41,391.96 Updated cost of estimated amount. $41,391.96 N/A

Components

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

Component Description:
Antenna related costs, upgrade amount excluded. #K36NE-D-001
Amount:
$19,855.71

Component Description:
Antenna costs, non-reimbursable excluded. #K36NE-D-001
Amount:
$19,855.71

Component Description:
Partial payment for panel antenna. #35755
Amount:
$16,152.64

Component Description:
Mounts costs. #K36NE-D-002
Amount:
$1,573.25

Component Description:
Down payment for panel antenna. #102317-1
Amount:
$9,597.50

Component Description:
Antenna related cost. #59605
Amount:
$19,963.00

Component Description:
Antenna related costs for work completed. #59605
Amount:
$19,963.00

Component Description:
Remaining cost related to the panel antenna. #50993
Amount:
$1,754.83

Component Description:
The engineering portion for the new antenna related costs. #18-0112-8016
Amount:
$860.00

Cost Information

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Transmission Line

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 $113,300.00 $109,100.00 N/A $29,100.00 N/A
Total for all systems $411,494.11 $358,514.00 N/A $138,275.40 N/A
Primary Tower LTOWER $113,300.00 $109,100.00 $29,100.00
Short Tower (less than 500') $84,200.00 $80,000.00 N/A N/A N/A
Structural Analysis $13,100.00 $13,100.00 Updated cost of estimated amount. $13,100.00 N/A
Mapping $16,000.00 $16,000.00 N/A $16,000.00 N/A

Components

Actual Information Description File Name
Short Tower (less than 500') Information not provided.
Structural Analysis

Component Description:
Tower structure related cost, quote attached. #760021968
Amount:
$10,600.00

Component Description:
Tower related cost. #460199684
Amount:
$2,500.00

Component Description:
Tower structure related cost. #760021968
Amount:
$10,600.00

Component Description:
Tower analysis costs
Amount:
$10,600.00
Mapping

Component Description:
Tower mapping, quote attached. #460197092
Amount:
$16,000.00

Component Description:
Broadcast tower mapping expenses
Amount:
$16,000.00

Component Description:
Tower mapping cost. #460197092
Amount:
$16,000.00

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 $108,190.00 $56,142.93 N/A $30,773.99 N/A
Total for all systems $411,494.11 $358,514.00 N/A $138,275.40 N/A
Outside Professional Services $108,190.00 $56,142.93 $30,773.99
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $1,179.60 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $580.00 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $0.00 N/A
Project management of the transition $79,000.00 $28,392.93 N/A $28,392.93 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 $621.46 N/A

Components

Actual Information Description File Name
Perform engineering study for new channel assignment and antenna development

Component Description:
Engineering consulting cost. #18-0112-8016
Amount:
$859.60

Component Description:
Engineering consulting services. #18-0112-8016
Amount:
$860.00

Component Description:
Engineering Study
Amount:
$320.00

Component Description:
Perform engineering study. #20170034
Amount:
$320.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
Form 399 review and preparation. #201757
Amount:
$180.00

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

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

Component Description:
FCC 399 update
Amount:
$400.00

Component Description:
Form 399 update and preparation. #201757
Amount:
$180.00
Attorney Fees - Negotiation of lease and other matters for shared locations 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.
Project management of the transition

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

Component Description:
$1,399.33 credit to be split across 7 HC2 stations (see attached allocation) reimbursed for invoice 472568 (correct amount is $821.47).
Amount:
($164.29)

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 27 stations. #119
Amount:
$271.70

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 23 stations. #473451
Amount:
$1,054.24

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. #1129
Amount:
$1,758.65

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 23 stations. #1146
Amount:
$888.15

Component Description:
Legal services cost. #474785
Amount:
$205.00

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. #475439
Amount:
$268.86

Component Description:
Legal services cost. #2020-K36NE
Amount:
$400.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 20 stations. #1144
Amount:
$796.10

Component Description:
Legal services cost. #475457
Amount:
$110.00

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

Component Description:
Legal services cost. #475031
Amount:
$66.00

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 10 stations. #1140
Amount:
$1,503.60

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 23 stations. #474784
Amount:
$374.23

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 10 stations. #473121
Amount:
$2,044.14

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 23 stations. #475948
Amount:
$419.80

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #471657
Amount:
$1,206.00

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. #1165
Amount:
$497.50

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 15 stations. #1118
Amount:
$1,609.03

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 23 stations. #1158
Amount:
$723.06

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1096
Amount:
$714.93
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:
Engineering review
Amount:
$233.33

Component Description:
Preparation of CP. #201757
Amount:
$60.00

Component Description:
Form 399 filing.
Amount:
$65.63

Component Description:
Preparation of CP. #201757
Amount:
$60.00

Component Description:
CP preparation
Amount:
$262.50

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $28,341.54 $22,741.54 N/A $2,124.31 N/A
Total for all systems $411,494.11 $358,514.00 N/A $138,275.40 N/A
Other Expenses $28,341.54 $22,741.54 $2,124.31
International Towers $0.00 $0.00 N/A N/A N/A
MVPD Notification of Channel Change $500.00 $500.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $2,500.00 $2,500.00 Prepare notices for changing channel. N/A N/A
Equipment Storage $1,000.00 $1,000.00 Hold equipment until we can move up the mountain. N/A N/A
Equipment Delivery and Handling Charges $346.54 $346.54 N/A $346.54 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $10,000.00 $10,000.00 N/A N/A N/A
Local Zoning $1,000.00 $1,000.00 N/A $0.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A $0.00 N/A
DTV Medical Facility Notification $11,550.00 $6,000.00 N/A $1,777.77 N/A

Components

Actual Information Description File Name
International Towers Information not provided.
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges

Component Description:
Antenna related shipping cost. #3838759864
Amount:
$346.54
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Local Zoning

Component Description:
Building permit. #129650
Amount:
$618.03
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application

Component Description:
Building permit to replace antenna. #129650
Amount:
$618.03
DTV Medical Facility Notification

Component Description:
Medical notification service. #INV-001871
Amount:
$1,777.77

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $411,494.11 $358,514.00 $138,275.40

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


05/20/2020

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


05/20/2020

Attachments

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