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:
25737
Service:
LPX
Call Sign:
K28OY-D
Channel:
28 (UHF)
File Number:
0000089008
FRN:
0028244937
Eligibility Status:
Eligible
Date Submitted:
09/09/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

KVOA LICENSE, LLC

Doing Business As: KVOA LICENSE, LLC

P.O. BOX 909

QUINCY, IL 62306

United States

+1 (217) 223-5100 BDREASLER@QUINCYMEDIA.COM Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Tony zumMallen

President

QCommunications, LLC

Tony zumMallen

705B SE Melody LN #314

Lee's Summit, MO 64063

United States

+1 (816) 729-1177 tony@qcomm.tv

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan Replace the transmitter, line and antenna per the channel reassignment with reasonable and customary engineering and business practices.

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)
Ownership Owned
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model 832A
Year 2000
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1 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 UAXTE-2R37
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1 kW
Justification for New Transmitter New transmitter required for new channel.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Other Transmitter Costs
Does the transmitter installation require a Transmitter Building Site Survey/Installation? Yes
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Rigid Conduit and Wiring No
Other Electrical Service No
HVAC Service Does the replacement transmitter require HVAC Service? No
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Site Prep

Preparation of site for new transmitter

Switch

Cisco 350 Series SG350-20 Switch

Decoder

Sencore SD 4:2:0 SDI/Discrete Video Decode Module

Decommissioning

Harvesting and removal of original transmitter

Transmitter Taxes

Sales tax for new transmitter

Power Supply

Power Supply

Spares, adapters, cable assemblies, etc.

Misc parts required to connect new transmitter to existing system

Transmitter Shipping fee

Shipping costs for transmitter

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)
Ownership Owned
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
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
ERP: 42.0 kW
Manufacturer
Model ATC-BCH710CNS-20
Year 2013

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Change Type Purchase New
Ownership Owned
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
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model ATC-BCE414C2-V4-28
Year 2019
Justification for New Antenna New antenna required for new channel.

Primary Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
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? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Antenna Shipping fee

Shipping fees for antenna

Antenna Sales Tax

Sales tax for antenna

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)
Ownership Owned
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Foam
Diameter 7/8 inches
Number of parallel runs 1
Length 38 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Foam
Diameter 7/8 inches
Number of parallel runs 1
Length 100 feet per run
Justification for New Transmission Line New line needed to mate new antenna and new transmitter.
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? No

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Transmission line shipping

Shipping fees for new line

Transmission line taxes

Sales tax for transmission line

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)
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? 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? No
Coordinates (NAD83) Latitude (NAD83) 31° 28' 54.2" N-
Longitude (NAD83) 109° 57' 35.0" W-
Overall Structure Height 63.00 feet
Support Structure Height 60.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 7120.00 feet
Structure Type LTOWER - Lattice Tower
Tower Owner KVOA-TV
Date Constructed 01/01/1998


Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Tower mapping and report for structural engineer
Tower Reinforcements Please select whether tower reinforcements are needed: No reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower N/A
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 150
Explanation Required to assist in the turnkey management of the channel relocation project in order that the existing internal personal can maintain and operate the stations daily operational requirements and plans.
Outside RF consulting Engineering Services Perform engineering study for displacement application 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
Prepare Form 601 Yes
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
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Form 399 assistance or other program management costs Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
Additional Field Engineering Service No

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Attorney Fees for displacement

Displacement Legal Services.

General Legal

General Legal expenses associated with Repack

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Permit and Filing Costs FCC Construction Permit Major Change Yes
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)? 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
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System No
New Point to Point Microwave System Yes
Type 7/13 GHz Licensed Part 74

Other Expenses

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Other Expenses Not Listed

Name Description

MW Shipping fees

Shipping fees for new MW system

MW installation

Installation of new MW system

MW sales tax

Sales tax on MW system

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 $129,786.09 $139,786.09 N/A $75,025.63 N/A
Total for all systems $408,765.17 $446,501.77 N/A $99,803.05 N/A
Primary Transmitter UAXTE-2R37 $129,786.09 $139,786.09 $75,025.63
Transmitter Shipping fee $2,500.00 $2,500.00 Estimated shipping fees for new transmitter. Actual costs to be determined. $67.59 N/A
Spares, adapters, cable assemblies, etc. $12,000.00 $12,000.00 Estimate of misc parts, spares, cables, assemblies, etc to connect new equipment to existing system. Actual costs to be determined. $0.00 N/A
Power Supply $669.42 $669.42 Power adapter - Quote WISQ54012 $669.42 N/A
Transmitter Taxes $6,300.94 $6,300.94 Per attached GatesAir invoice. $6,300.94 N/A
Decommissioning $4,000.00 $4,000.00 Estimated costs of harvesting and removal of old transmitter from site. Revised upon Site Survey. $0.00 N/A
Decoder $3,609.72 $3,609.72 Sencore SD 4:2:0 SDI/Discrete Video Decode Module actual costs $3,609.72 N/A
Switch $706.01 $706.01 Actual costs for Cisco switch - Heartland 66239 - PO K28OY $706.01 N/A
Site Prep $6,000.00 $6,000.00 Site preparation including receiving and inventory of transmitter and components; prepare site for acceptance of transmitter; pre-assemble cabinets and subassemblies; ensure all installation materials are available for installation crew. N/A N/A
Transmitter Building Site Survey/Installation $10,000.00 $20,000.00 Estimated costs for site survey and transmitter installation. Revised upon Site Survey. N/A N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $84,000.00 $84,000.00 N/A $63,671.95 N/A

Components

Actual Information Description File Name
Transmitter Shipping fee

Component Description:
Freight charges for mask filter
Amount:
$67.59
Spares, adapters, cable assemblies, etc.

Component Description:
Parts - tx. Heartland - INV 67747 - PO K28OY-COM
Amount:
$824.92

Component Description:
Receipt: cable assemblies for K28OY
Amount:
$99.96

Component Description:
Receipt for 7/8" adapters for K28OY.
Amount:
$100.86

Component Description:
Tx parts - INV 66778 - Heartland Video - PO K28OY-LOAD
Amount:
$1,137.88
Power Supply

Component Description:
Power Adapter - Heartland - INV 66313 - Quote WISQ54012
Amount:
$669.42
Transmitter Taxes

Component Description:
Sales tax for Transmitter US0321591
Amount:
$6,300.94
Decommissioning Information not provided.
Decoder

Component Description:
Decoder - Heartland - INV 66703 - PO K28OY-DEC
Amount:
$3,609.72
Switch

Component Description:
Station had RC prior to Repack which was not compatible with new equipment. This equipment was necessary to replace old RC. Heartland - INV 66239
Amount:
$706.01

Component Description:
Cisco 350 Series SG350-20 Switch
Amount:
$706.01
Site Prep Information not provided.
Transmitter Building Site Survey/Installation Information not provided.
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
Balance on transmitter invoice. US0321591 PO K28OY-TX (less costs for spares).
Amount:
$21,165.63

Component Description:
2nd Transmitter Invoice Gates GO10005089-2 (less costs for spares)
Amount:
$21,253.16

Component Description:
1st Transmitter invoice GO10005089-1 - PO K28OY-TX (less charges for "spares".
Amount:
$21,253.16

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 $29,232.20 $29,232.20 N/A $15,988.60 N/A
Total for all systems $408,765.17 $446,501.77 N/A $99,803.05 N/A
Primary Antenna ATC-BCE414C2-V4-28 $29,232.20 $29,232.20 $15,988.60
Antenna Sales Tax $1,223.60 $1,223.60 Per attached Alive invoice. N/A N/A
Antenna Shipping fee $1,665.00 $1,665.00 Per attached Alive invoice. N/A N/A
Sweep test of transmission line and antenna $5,730.00 $5,730.00 N/A N/A N/A
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Elliptical $15,988.60 $15,988.60 Estimated amount does not include E-POL upgrade, but does include taxes and shipping per the (2) Alive Telecom Invoices/Quotes $15,988.60 Per actual invoices from Alive Telecom.
Side Mount antenna brackets $4,625.00 $4,625.00 N/A N/A N/A

Components

Actual Information Description File Name
Antenna Sales Tax Information not provided.
Antenna Shipping fee Information not provided.
Sweep test of transmission line and antenna Information not provided.
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Elliptical

Component Description:
Note: This invoice shows the payment already made on 10/9/18 by the station - thus resulting in a $0 amount due. Total invoice Less the E-POL upgrade. INV 2014.
Amount:
$6,550.00

Component Description:
1/2 antenna cost Including sales tax & shipping but does NOT include the E-POL upgrade. Alive - INV 2093 - PO K28OY-ANT
Amount:
$9,438.60
Side Mount antenna brackets Information not provided.

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,198.68 $1,198.68 N/A $0.00 N/A
Total for all systems $408,765.17 $446,501.77 N/A $99,803.05 N/A
Primary Transmission Line $1,198.68 $1,198.68 $0.00
Transmission line taxes $63.18 $63.18 Per attached Heartland invoice. N/A N/A
Transmission line shipping $35.50 $35.50 Per attached Heartland invoice. N/A N/A
Flexible Foam Transmission Line - dielectric, 7/8" $1,100.00 $1,100.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $77,190.00 $77,190.00 N/A $0.00 N/A
Total for all systems $408,765.17 $446,501.77 N/A $99,803.05 N/A
Primary Tower LTOWER $77,190.00 $77,190.00 $0.00
Tower mapping and report for structural engineer $21,000.00 $21,000.00 N/A N/A N/A
Tower Rigging Short Tower (less than 500') $56,190.00 $56,190.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $98,479.00 $97,676.00 N/A $8,788.82 N/A
Total for all systems $408,765.17 $446,501.77 N/A $99,803.05 N/A
Outside Professional Services $98,479.00 $97,676.00 $8,788.82
General Legal $5,000.00 $5,000.00 Estimated costs for general legal expenses associated with Repack $2,334.50 N/A
Attorney Fees for displacement $364.00 $364.00 Displacement legal fees actual costs $364.00 N/A
Comprehensive coverage verification via field study, if needed $52,600.00 $43,732.00 QForce quote 720-R N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $2,235.00 $2,235.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $3,262.50 $3,262.50 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 N/A $0.00 N/A
Prepare Form 601 $755.00 $755.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,025.00 N/A $0.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,052.50 N/A $510.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,102.50 N/A $1,040.00 N/A
Prepare request for Special Temporary Authorization $1,280.00 $1,280.00 N/A N/A N/A
Project management of the transition $15,825.00 $23,100.00 Estimated 150 hours at $154/hr. Actual costs to be determined. $0.00 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $2,500.00 Per attached QCommunications quote. $2,500.00 N/A
Perform engineering study for displacement application $1,800.00 $1,800.00 N/A $450.00 N/A
Form 399 assistance or other Program Management costs $5,890.00 $5,890.00 Per attached QCommunications quote. $1,590.32 N/A

Components

Actual Information Description File Name
General Legal

Component Description:
Gen Legal Sept 2019 - Brooks - INV 3972821
Amount:
$871.50

Component Description:
Gen Legal October 2019 - Brooks - INV 3974485
Amount:
$312.00

Component Description:
Gen Legal Aug 2019 - Brooks - INV 3971027
Amount:
$995.00

Component Description:
Gen Legal Nov 2019 - Brooks - INV 3975580
Amount:
$156.00
Attorney Fees for displacement

Component Description:
Displacement Legal Services - Brooks - INV 3977760
Amount:
$364.00
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
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.
Prepare Form 601 Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Prepare license application - eng section - Lohnes INV 201909-0275-16-2. NOTE: vendor's name is Lohnes & Culver: "and" was substituted for special character "&".
Amount:
$510.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepare form 2100 - engineering services - Lohnes INV 201909-0275-16-2. NOTE: vendor name is Lohnes & Culver - "and" was substituted for special character "&".
Amount:
$1,040.00
Prepare request for Special Temporary Authorization Information not provided.
Project management of the transition Information not provided.
Prepare/ Review 399 reimbursement form

Component Description:
Prepare initial Form 399 reimbursement form to meet 11/16/19 deadline. Comm - INV QC20-249
Amount:
$2,500.00
Perform engineering study for displacement application

Component Description:
Preliminary licensing check - engineering services - Lohnes INV 201909-0275-16-2 . NOTE: vendor name is Lohnes & Culver - "and" was substituted for special character "&".
Amount:
$450.00
Form 399 assistance or other Program Management costs

Component Description:
July 399 form PM Hours - QComm - QC20-441
Amount:
$736.12

Component Description:
June paper work PM hours - QC20-357
Amount:
$677.60

Component Description:
Repack PM hours - QComm - May hours - INV QC20-314
Amount:
$354.20

Component Description:
Qcomm- INV QC20-249 - Prepare initial 399 eligibility form to meet 11/16/19 deadline
Amount:
$500.00

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 $72,879.20 $101,418.80 N/A $0.00 N/A
Total for all systems $408,765.17 $446,501.77 N/A $99,803.05 N/A
Other Expenses $72,879.20 $101,418.80 $0.00
MW installation $1,925.00 $1,925.00 Per attached Heartland invoice 67221. $0.00 Cost to install MW is $6450 per attached invoices DP36518 and 67221
MW Shipping fees $602.30 $602.30 Per attached Heartland invoice 67221. $0.00 N/A
New Point to Point Microwave System: 7/13 GHz Licensed Part 74 $51,300.00 $79,839.60 Per attached Heartland Quote CRDQ1366-03. Estimated cost has been adjusted to actual costs including taxes and shipping not included on original quote. $0.00 N/A
Equipment Storage $2,000.00 $2,000.00 Expecting multiple staggered equipment deliveries from different vendors and need to store and stage new equipment prior to installation date. N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,000.00 $2,000.00 Estimated 4-6 yard disposal bin on site to capture all waste from on site system integration and tower vendors. Actual costs to be determined. N/A N/A
FCC Filing Fees - Form 2100 Major change CP application $4,960.00 $4,960.00 N/A N/A N/A
MW sales tax $6,341.90 $6,341.90 Per attached Heartland invoice 67221. $0.00 N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,110.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $305.00 N/A N/A N/A
Equipment Delivery and Handling Charges $2,000.00 $2,000.00 Estimated transport, forklift rental and handling fees from staging area to transmitter site. Actuals to be determined. N/A N/A

Components

Actual Information Description File Name
MW installation

Component Description:
Revised Heartland MW INV DP36518
Amount:
$4,525.00

Component Description:
See revised cover letter for justification. Heartland INV 67221
Amount:
$1,925.00

Component Description:
MW Install - Heartland - INV 67221- Quote CRDQ1366-03
Amount:
$6,450.00
MW Shipping fees

Component Description:
Equipment shipping costs - Heartland - INV 67221 - Quote: CRDQ1366-03
Amount:
$602.30

Component Description:
See revised cover letter for justification. Heartland INV 67221
Amount:
$602.30
New Point to Point Microwave System: 7/13 GHz Licensed Part 74

Component Description:
See attached cover letter for justification. Heartland INV DP36518
Amount:
$33,223.00

Component Description:
Final invoice Microwave system - Heartland INV 67221
Amount:
$42,091.60

Component Description:
Downpayment invoice for Microwave system - Heartland - INV DP36518
Amount:
$37,748.00

Component Description:
See revised cover letter for justification. Heartland INV 67221
Amount:
$33,222.40
Equipment Storage Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
FCC Filing Fees - Form 2100 Major change CP application Information not provided.
MW sales tax

Component Description:
AZ Sales tax on Microwave system - INV 67221 - Quote: CRDQ1366-03
Amount:
$6,341.90

Component Description:
See revised cover letter for justification. Heartland INV 67221
Amount:
$6,341.90
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.
Equipment Delivery and Handling Charges Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $408,765.17 $446,501.77 $99,803.05

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.

BRADY DREASLER

CORPORATE DIRECTOR OF ENGINEERING


09/09/2020

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.

BRADY DREASLER

CORPORATE DIRECTOR OF ENGINEERING


09/09/2020

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.

BRADY DREASLER

CORPORATE DIRECTOR OF ENGINEERING


09/09/2020

Attachments

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