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:
67910
Service:
DTV
Call Sign:
KDTX-TV
Channel:
21 (UHF)
File Number:
0000027716
FRN:
0004346060
Date Submitted:
08/20/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

TRINITY BROADCASTING OF TEXAS, INC.

Doing Business As: Trinity Broadcasting Network

13600 Heritage Parkway

Fort Worth, TX 76177

United States

+1 (855) 826-2255 cmmay@maylawoffices.com Not-for-Profit

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 Remain on the air at full power. Install new SS xmitter at the ATC "Milton Tower" location. test.

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 DCX 2
Year 2004
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 50 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 HPTV PRLX U18
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 30 kW
Justification for New Transmitter See Attached

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring Yes
Size 2 inches
Length 500.0 feet
Other Electrical Service Yes
Description disconnects, labor, panels
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 10 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 1500.0 square feet
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

Ice Shield

Ice shield for HVAC

install

xmitter install

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 Leased
Owner Americanm Tower
Site N/A
Is the existing antenna shared with another station or stations? Yes
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 Broadband Panel
Number of Stations Supported 4
Number of Panels 16
Design power capacity in use 80.0 %
Lower Limit 470.00 MHz
Upper Limit 800.00 MHz
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model PHP-36C
Year 2000

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
22201 KDAF
42359 KTXD-TV
49326 KDTN

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 Leased
Owner American Tower
Is antenna shared? Yes
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 Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 4
Number of Panels/Bays 14
Lower Limit 490.00 MHz
Upper Limit 593.00 MHz
Design power capacity in use 80.0 %
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model TUM-AP-C4-14/48H-2-R-B
Year 2017
Justification for New Antenna RELOCATING TO NEW SITE.

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? Yes
Type New
Number of channels supported 4
Frequencies of channels supported Upper and lower frequency
Frequency 483.0 MHz - 597.0 MHz
Do you need a combiner output splitter/switcher for dual feed lines? No
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Broadband
Feed Line Size 8 3/16 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna?
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Installation

Combiner Installation

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 Leased
Owner American Tower
Site N/A
Is the existing transmission line shared with another station or stations? Yes
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 8 3/16 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 1800 feet per run

Facility ID's and Call Signs of all stations with whom the transmission line is shared.

Facility ID Call Sign
42359 KTXD-TV
22201 KDAF
49326 KDTN

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 7 3/16 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 2
Length 1700 feet per run
Justification for New Transmission Line Relocating to new site

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Transmission line Bridge

transmission line bridge

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? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1059733
Coordinates (NAD83) Latitude (NAD83) 32° 32' 36.0" N-
Longitude (NAD83) 096° 57' 33.0" W-
Overall Structure Height 1635.15 feet
Support Structure Height 1523.60 feet
Ground Elevation Above Mean Sea Level (AMSL) 813.97 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers, LLC
Date Constructed 06/18/2000

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
49326 KDTN DTV
51517 KTXA DTV
49324 KERA-TV DTV
23422 KTVT DTV
42359 KTXD-TV DTV
22201 KDAF DTV
68834 KPXD-TV DTV
17037 KDFI 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 undocumented/poorly documented tower
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

Name Description

Ground

Permit package

Construction project

Construction project management

structural

load study

Permit

Drawing package

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 95
Explanation American Tower
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 Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application No
For Auxiliary Facility N/A
For Main Facility N/A
Prepare request for Special Temporary Authority Yes
Quantity 2
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application No
For Auxiliary Facility N/A
For Main Facility N/A
Prepare request for Special Temporary Authority Yes
Quantity 2
NEPA Section 106 environmental review Yes
Environmental Assessment Yes
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

RF System test

RF System Test

migratory bird assessment

Migratory Bird assessment

site coordination meeting

site coordination meetings

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 Yes
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? No
Does this relocation require MVPD Notification of a Channel Change? No

Other Expenses

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Other Expenses Not Listed

Name Description

cost of construction

cost of construction electrical permits

cost of construction

Electrical permits

site security

Site security theft and vandalism

tree clearing

tag alley

Nitrogen Generator

Nitrogen Generator

Lease Application fee

Lease Application fee

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 $1,349,900.00 $1,230,850.00 N/A $932,882.99 N/A
Total for all systems $3,584,935.00 $2,185,785.00 N/A $1,493,026.15 N/A
Primary Transmitter HPTV PRLX U18 $1,349,900.00 $1,230,850.00 $932,882.99
Ice Shield $40,000.00 $40,000.00 Quoted by American Tower $40,000.00 N/A
install $40,000.00 $40,000.00 xmitter install quoted $40,000.00 N/A
Other -- Building Addition Size: 1500.0 $130,000.00 $130,000.00 quoted by American Tower $62,699.99 N/A
10 Ton system $60,500.00 $50,600.00 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $34,800.00 quoted
Other Electrical Service: disconnects, labor, panels $30,000.00 $30,000.00 N/A $0.00 N/A
2" Rigid Conduit and Wiring (Cost per foot) $13,000.00 $6,250.00 N/A N/A N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $17,500.00 N/A $0.00 N/A
Switchgear - industrial 800 amp $38,200.00 $12,000.00 N/A N/A N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $4,500.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $900,000.00 N/A $755,383.00 N/A

Components

Actual Information Description File Name
Ice Shield

Component Description:
invoiced
Amount:
$30,000.00

Component Description:
25% deposit, see attached cap Con for details
Amount:
$10,000.00
install

Component Description:
xmitter install
Amount:
$40,000.00
Other -- Building Addition Size: 1500.0

Component Description:
invoiced
Amount:
$41,799.99

Component Description:
25% deposit see attached Cap Con KDTX.
Amount:
$20,900.00
10 Ton system

Component Description:
invoiced
Amount:
$23,200.00

Component Description:
25% deposit HVAC for new addition. see attached Cap Con for details
Amount:
$11,600.00
Other Electrical Service: disconnects, labor, panels Information not provided.
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 300 KVA Information not provided.
Switchgear - industrial 800 amp Information not provided.
Service entrance 3 phase/800 amp/208 volt Information not provided.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
final balance
Amount:
$37,769.15

Component Description:
Deposit for U18 xmitter
Amount:
$264,384.05

Component Description:
30% due prior to shipment
Amount:
$226,614.90

Component Description:
30% within 60 days
Amount:
$226,614.90

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 $275,980.00 $239,050.00 N/A $158,374.98 N/A
Total for all systems $3,584,935.00 $2,185,785.00 N/A $1,493,026.15 N/A
Primary Antenna TUM-AP-C4-14/48H-2-R-B $275,980.00 $239,050.00 $158,374.98
Installation $8,100.00 $8,100.00 Combiner installation quoted by ATC $4,687.50 N/A
Elbow complex, broadband, at antenna input, per 8 3/16. feedline (if needed) $18,950.00 $9,200.00 N/A $4,875.00 N/A
New combiner, cost per channel (without antenna) $84,200.00 $60,000.00 N/A $45,000.00 N/A
Sweep test of existing antenna $6,730.00 $3,750.00 N/A $2,812.50 N/A
UHF - Lower Power, Top Mount, Class A, broadband panel, 14 bay,, 1000 kW input, directional,, elliptically or circularly polarized $158,000.00 $158,000.00 quoted by ATC $100,999.98 N/A

Components

Actual Information Description File Name
Installation

Component Description:
invoiced
Amount:
$3,125.00

Component Description:
25% deposit see attached Cap Con KDTX.
Amount:
$1,562.50
Elbow complex, broadband, at antenna input, per 8 3/16. feedline (if needed)

Component Description:
invoiced
Amount:
$3,250.00

Component Description:
25% deposit elbow complex. see attached Cap Con
Amount:
$1,625.00
New combiner, cost per channel (without antenna)

Component Description:
50% cap 2
Amount:
$30,000.00

Component Description:
25% deposit. See attached cap Con new combiner
Amount:
$15,000.00
Sweep test of existing antenna

Component Description:
invoiced
Amount:
$1,875.00

Component Description:
25% deposit sweep. see attached Cap Con
Amount:
$937.50
UHF - Lower Power, Top Mount, Class A, broadband panel, 14 bay,, 1000 kW input, directional,, elliptically or circularly polarized

Component Description:
invoiced
Amount:
$67,333.32

Component Description:
25% deposit for antenna. see attached Cap Con
Amount:
$33,666.66

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 $1,169,200.00 $337,000.00 N/A $168,716.25 N/A
Total for all systems $3,584,935.00 $2,185,785.00 N/A $1,493,026.15 N/A
Primary Transmission Line $1,169,200.00 $337,000.00 $168,716.25
Transmission line Bridge $37,000.00 $37,000.00 Transmission line bridge. quoted by American tower. $16,875.00 N/A
Rigid Transmission Line - copper, 7 3/16" broadband $1,132,200.00 $300,000.00 N/A $151,841.25 N/A

Components

Actual Information Description File Name
Transmission line Bridge

Component Description:
invoiced
Amount:
$11,250.00

Component Description:
25% deposit see attached Cap Con KDTX.
Amount:
$5,625.00
Rigid Transmission Line - copper, 7 3/16" broadband

Component Description:
invoiced
Amount:
$101,227.50

Component Description:
25% deposit coax. see attached Cap Con
Amount:
$50,613.75

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 $633,610.00 $267,115.00 N/A $179,711.53 N/A
Total for all systems $3,584,935.00 $2,185,785.00 N/A $1,493,026.15 N/A
Primary Tower GTOWER $633,610.00 $267,115.00 $179,711.53
Construction project $15,000.00 $15,000.00 Construction project management, quoted ATC $5,625.00 N/A
Permit $4,700.00 $4,700.00 N/A $3,525.00 N/A
Ground $4,700.00 $4,700.00 N/A $3,525.00 N/A
structural $3,910.00 $3,910.00 N/A $2,932.50 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $63,845.00 N/A $47,884.03 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $4,960.00 N/A $3,720.00 N/A
Minor tower reinforcement/modifications $158,000.00 $170,000.00 Quoted by ATC $112,500.00 N/A

Components

Actual Information Description File Name
Construction project

Component Description:
invoiced
Amount:
$3,750.00

Component Description:
25% deposit, see attached Cap con for details.
Amount:
$1,875.00
Permit

Component Description:
invoiced
Amount:
$2,350.00

Component Description:
25% deposit, see attached Cap Con
Amount:
$1,175.00
Ground

Component Description:
invoiced
Amount:
$2,350.00

Component Description:
25% deposit, see attached Cap Con
Amount:
$1,175.00
structural

Component Description:
invoiced
Amount:
$1,955.00

Component Description:
25% deposit, see attached Cap Con
Amount:
$977.50
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
invoiced
Amount:
$31,922.69

Component Description:
25% deposit, see attached Cap Con
Amount:
$15,961.34
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
invoiced
Amount:
$2,480.00

Component Description:
25% deposit, see attached Cap Con
Amount:
$1,240.00
Minor tower reinforcement/modifications

Component Description:
invoiced
Amount:
$75,000.00

Component Description:
25% deposit, tower mods. see attached Cap Con
Amount:
$37,500.00

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 $97,445.00 $56,490.00 N/A $23,982.50 N/A
Total for all systems $3,584,935.00 $2,185,785.00 N/A $1,493,026.15 N/A
Outside Professional Services $97,445.00 $56,490.00 $23,982.50
site coordination meeting $2,500.00 $2,500.00 Site coordination meeting. 25% deposit see attached cap Con for details. $1,875.00 N/A
migratory bird assessment $350.00 $350.00 Migratory Bird assessment. Quoted by American Tower. $262.50 N/A
RF System test $5,000.00 $5,000.00 Quoted by American tower $3,000.00 N/A
RF Exposure Measurements $21,050.00 $3,000.00 N/A $2,250.00 N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $1,080.00 N/A $810.00 N/A
NEPA Section 106 environmental review, if needed $6,310.00 $1,080.00 N/A $0.00 N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $2,105.00 $2,000.00 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 $4,100.00 $3,000.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $2,000.00 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 $1,750.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $5,050.00 Q
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A $1,875.00 N/A
Project management of the transition $15,010.00 $9,480.00 N/A $7,110.00 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A

Components

Actual Information Description File Name
site coordination meeting

Component Description:
invoiced
Amount:
$1,250.00

Component Description:
25% deposit see attached cap Con for details.
Amount:
$625.00
migratory bird assessment

Component Description:
invoiced
Amount:
$175.00

Component Description:
25% deposit see attached cap Con for details.
Amount:
$87.50
RF System test

Component Description:
invoiced
Amount:
$2,000.00

Component Description:
RF system test. 25% deposit see attached cap Con for details.
Amount:
$1,000.00
RF Exposure Measurements

Component Description:
invoiced
Amount:
$1,500.00

Component Description:
25% deposit, see attached Cap Con
Amount:
$750.00
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet

Component Description:
invoiced
Amount:
$540.00

Component Description:
Environmental review if needed. 25% of CAP CON. See attached
Amount:
$270.00
NEPA Section 106 environmental review, if needed

Component Description:
25% deposit, see attached Cap Con
Amount:
$270.00
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License 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.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Engineering for 2100 CP
Amount:
$1,750.00
Perform engineering study for new channel assignment and antenna development

Component Description:
invoiced
Amount:
$2,500.00

Component Description:
Interference study for CP
Amount:
$650.00

Component Description:
Further interference study for CP
Amount:
$650.00

Component Description:
25% deposit, engineering study
Amount:
$1,250.00
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
invoiced
Amount:
$1,250.00

Component Description:
25% deposit, see attached Cap Con
Amount:
$625.00
Project management of the transition

Component Description:
invoiced
Amount:
$4,740.00

Component Description:
25% deposit, see attached Cap Con
Amount:
$2,370.00
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Prepare and or review reimbursement form 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 $58,800.00 $55,280.00 N/A $29,357.90 N/A
Total for all systems $3,584,935.00 $2,185,785.00 N/A $1,493,026.15 N/A
Other Expenses $58,800.00 $55,280.00 $29,357.90
Lease Application fee $2,500.00 $2,500.00 Quoted ATC N/A N/A
Nitrogen Generator $3,800.00 $3,800.00 Quoted ATC N/A N/A
tree clearing $1,600.00 $1,600.00 Quoted by ATC $1,200.00 N/A
site security $8,550.00 $8,550.00 quoted by ATC $6,412.50 N/A
cost of construction $10,000.00 $10,000.00 Cost of construction electrical permits. quoted by ATC $7,500.00 N/A
Equipment Storage $6,000.00 $6,000.00 Quoted ATC N/A N/A
Equipment Delivery and Handling Charges $5,000.00 $5,000.00 American Tower $3,750.00 N/A
Non-zoning permits $0.00 $0.00 N/A $0.00 N/A
Local Zoning $4,700.00 $4,700.00 Quoted by ATC $3,525.00 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $5,100.00 $5,100.00 Quoted ATC N/A N/A
DTV Medical Facility Notification $11,550.00 $8,030.00 N/A $6,970.40 N/A

Components

Actual Information Description File Name
Lease Application fee Information not provided.
Nitrogen Generator Information not provided.
tree clearing

Component Description:
invoiced
Amount:
$800.00

Component Description:
tree clearing for tag alley 25% deposit, see attached Cap Con
Amount:
$400.00
site security

Component Description:
invoiced
Amount:
$4,275.00

Component Description:
site security during construction 25% deposit, see attached Cap Con
Amount:
$2,137.50
cost of construction

Component Description:
invoiced
Amount:
$5,000.00

Component Description:
Cost of construction electrical permits. 25% deposit see attached cap Con for details.
Amount:
$2,500.00
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges

Component Description:
invoiced
Amount:
$2,500.00

Component Description:
equipment delivery & handling charges 25% deposit, see attached Cap Con
Amount:
$1,250.00
Non-zoning permits Information not provided.
Local Zoning

Component Description:
invoiced
Amount:
$2,350.00

Component Description:
obtain building permits from local zoning 25% deposit, see attached Cap Con
Amount:
$1,175.00
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
DTV Medical Facility Notification

Component Description:
medical notifications
Amount:
$6,970.40

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,584,935.00 $2,185,785.00 $1,493,026.15

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. Yes
Construction of final facilities or all necessary modifications are complete. Yes
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.

Steve Hastings

Network RF Manager


08/20/2020

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.

Steve Hastings

Network RF Manager


08/20/2020

Certification

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Section Question Response
Submission of Final Allocation or Accounting Information 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 and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

  2. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  3. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.

  4. 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.

  5. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  6. 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.

Steve Hastings

Network RF Manager


08/20/2020

Attachments

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