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:
35090
Service:
DCA
Call Sign:
WSKC-CD
Channel:
14 (UHF)
File Number:
0000027898
FRN:
0005014766
Date Submitted:
12/14/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

KM LPTV OF ATLANTA, L.L.C.

3654 WEST JARVIS AVENUE

Skokie, IL 30047

United States

+1 (202) 293-0567 aaron@s-plaw.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

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. No
Briefly describe transition plan Move to Ch. 14, same height, current tower. Install new antenna and transmitter with related equipment, including filters.

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 DT830A
Year 2002
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 TMU9
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 2.4 kW
Justification for New Transmitter Current Ch. 22 transmitter originally Ch. 25, can't retune to Ch. 14, only outputs 0.5 kw power but 1.81 kw needed, vendor Axcera out of business not available to retune.

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 No
Size N/A
Length N/A
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 5 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? 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 Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Other
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 Broadband Slot
ERP: 15.0 kW
Manufacturer
Model PSILP8CUS-22
Year 2010

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Broadband Slot
Number of Stations Supported 1
Number of Panels/Bays 8
Lower Limit 470.00 MHz
Upper Limit 476.00 MHz
Design power capacity in use 36.2 %
Other Antenna Type N/A
ERP: 12.3 kW
Manufacturer
Model PSILP8CUS-14-CP
Year 2017
Justification for New Antenna Current Ch. 22 directional antenna custom built specifically for Ch. 22, not suitable for use on the new Ch. 14 per manufacturer (too many channels changed). See attached exhibit re: upgrade to elliptical polarization.

Primary Antenna

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Other Antenna Costs

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

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Foam
Diameter 1 5/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 290 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Foam
Diameter 1 5/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 290 feet per run
Justification for New Transmission Line Existing line is inoperable on Channel 14 because it reflects power back to the transmitter and will render the transmitter inoperable. A new line is required in order to operate on the repack channel.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change 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) No
Others Types of Users Yes
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 1020086
Coordinates (NAD83) Latitude (NAD83) 33° 58' 38.3" N-
Longitude (NAD83) 084° 09' 23.3" W-
Overall Structure Height 291.01 feet
Support Structure Height 283.13 feet
Ground Elevation Above Mean Sea Level (AMSL) 1063.96 feet
Structure Type LTOWER - Lattice Tower
Tower Owner Crown Castle South LLC
Date Constructed 11/23/1988


Other Types of Users

Users
WQIB747 Svc NN
WQVH580 Svc MG

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 595
Explanation reimbursement filing, expense tracking, vendor coordination, progress reporting, budget creation, budget review, budget tracking, daisy-chain monitoring and all other activities necessary
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 Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) Yes
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 No
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
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? No
Does this relocation require Equipment Storage? No
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? No

Other Expenses

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Other Expenses Not Listed

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $335,750.00 $302,875.00 N/A $28,089.24 N/A
Total for all systems $601,120.00 $563,633.69 N/A $160,910.07 N/A
Primary Transmitter TMU9 $335,750.00 $302,875.00 $28,089.24
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $120,000.00 N/A $26,542.74 N/A
5 Ton system $20,250.00 $2,875.00 Replacement of Compressor per AmeriCool HVAC Quote $0.00 N/A
Channel 14 Mask Filter $189,500.00 $180,000.00 N/A $1,546.50 N/A

Components

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

Component Description:
DP TAX
Amount:
$4,253.50

Component Description:
25% Downpayment Transmitter system, accessories, parts and related services
Amount:
$22,289.24
5 Ton system

Component Description:
4 Ton 240 volt Compressor Replacement
Amount:
$2,875.00
Channel 14 Mask Filter

Component Description:
10/10 - SW - Troubleshooting mask filter.
Amount:
$1,546.50

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 $33,030.00 $20,843.35 N/A $16,800.35 N/A
Total for all systems $601,120.00 $563,633.69 N/A $160,910.07 N/A
Primary Antenna PSILP8CUS-14-CP $33,030.00 $20,843.35 $16,800.35
Sweep test of existing antenna $6,730.00 $2,750.00 Please see WSKC-CD SJ Ramer Associates Quote 2020004R $2,750.00 N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $18,093.35 Estimated Cost Justification WSKC-CD-210-Primary Antenna - UHF Lower Power Side Mount, Class A v0 $14,050.35 N/A

Components

Actual Information Description File Name
Sweep test of existing antenna

Component Description:
Engineering Services
Amount:
$2,750.00
UHF - Lower Power Side Mount, Class A One Station antenna -- basic

Component Description:
CHANGE ORDER - DULUTH, GA
Amount:
$2,000.00

Component Description:
8 Bay Low Power UHF Slot Antenna for Channel 14
Amount:
$8,093.35

Component Description:
PSILP8CUS-14-CP 8 Bay Low power UHF Slot Antenna for Channel 14
Amount:
$3,957.00

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 $6,960.00 $8,082.09 N/A $8,082.08 N/A
Total for all systems $601,120.00 $563,633.69 N/A $160,910.07 N/A
Primary Transmission Line $6,960.00 $8,082.09 $8,082.08
Flexible Foam Transmission Line - dielectric, 1 5/8" $6,960.00 $8,082.09 Please see Estimated Cost Justification WSKC-CD-310-Primary Transmission Line - Flexible Foam, 1 5_8 v1 $8,082.08 N/A

Components

Actual Information Description File Name
Flexible Foam Transmission Line - dielectric, 1 5/8"

Component Description:
GA Sales Tax - Invoice 682014
Amount:
$212.62

Component Description:
GA Sales Tax - Invoice 670018
Amount:
$6.89

Component Description:
Other Freight and Shopping
Amount:
$114.84

Component Description:
GA Sales Tax - Invoice 664015
Amount:
$237.96

Component Description:
Other Freight and Shipping
Amount:
$3,543.75

Component Description:
Flexible transmission line
Amount:
$3,966.02

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 $84,200.00 $80,000.00 N/A $11,506.00 N/A
Total for all systems $601,120.00 $563,633.69 N/A $160,910.07 N/A
Primary Tower LTOWER $84,200.00 $80,000.00 $11,506.00
Short Tower (less than 500') $84,200.00 $80,000.00 N/A $11,506.00 N/A

Components

Actual Information Description File Name
Short Tower (less than 500')

Component Description:
JOB COMPLETION - DULUTH, GA
Amount:
$4,382.50

Component Description:
WSKC-CD-410-Existing Primary Tower - Tower Rigging, Short Tower
Amount:
$1,803.50

Component Description:
2/17 - SW - Onsite with Ramer & Associates
Amount:
$937.50

Component Description:
50% DEPOSIT - DULUTH, GA; REMOVE (1) CHANNEL 22 ANTENNA AND MOUNT FROM TOWER
Amount:
$4,382.50

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 $128,985.00 $137,406.25 N/A $82,580.40 N/A
Total for all systems $601,120.00 $563,633.69 N/A $160,910.07 N/A
Outside Professional Services $128,985.00 $137,406.25 $82,580.40
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $210.00 See attached FAA determination exhibit. $210.00 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $600.00 Please see the attached invoice from Jeffrey L. Timmons, Esq. #2641 $600.00 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $7,860.00 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $7,860.00 Invoices received
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $420.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $1,800.00 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 $3,025.00 Khanna and Guill, Inc. invoices $3,025.00 x
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,636.25 Please see Estimated Cost Justification WSKC-CD-530-RF Eng - Engineering Study for New Channel Assignment v0 $7,636.25 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A $30.00 N/A
Project management of the transition $94,010.00 $99,675.00 per Widelity Strategic Hour Quote $54,089.15 N/A
Prepare and or review reimbursement form $2,630.00 $7,150.00 Per Estimated Cost Justification WSKC-CD-590-Prepare and/or Review Reimbursement Form v3 $6,910.00 Requesting reimbursement of only $2500, duplicate entries for Invoice 02400 because cover letter added to explain $470 credit on invoice.

Components

Actual Information Description File Name
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase

Component Description:
Legal invoice for Ch. 14 permit FAA determination filing.
Amount:
$210.00
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Work on alternate viewer/consumer notification
Amount:
$600.00
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
WSKC-CD-550-Attorney - Negotiate Lease and Other Matters
Amount:
$510.00

Component Description:
Charges for Legal Services Rendered
Amount:
$390.00

Component Description:
Email and fax Widelity and client
Amount:
$1,050.00

Component Description:
Legal services
Amount:
$690.00

Component Description:
Upload invoice to Widelity to submit for reimbursement
Amount:
$540.00

Component Description:
WSKC-CD-550-Attorney - Negotiate Lease and Other Matters
Amount:
$240.00

Component Description:
legal services
Amount:
$1,920.00

Component Description:
Legal Services
Amount:
$450.00

Component Description:
Charges for Legal Services Rendered:
Amount:
$1,050.00

Component Description:
Legal Services
Amount:
$810.00

Component Description:
Emails with vendor and fax client
Amount:
$210.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Set up repack Channel 14 license to cover application in LMS
Amount:
$420.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Legal invoice for repack Ch. 14 construction permit application work.
Amount:
$1,800.00
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 invoice for Form 2100 construction permit application for repack Ch. 14.
Amount:
$1,850.00

Component Description:
Review of post auction TV Channel 14 for WSKC-CD
Amount:
$1,175.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Consulting Engineering Services
Amount:
$4,836.25

Component Description:
Resubmitting revised engineering invoice for engineering studies and antenna pattern for repack Ch. 14, with cover letter per Commission email, and payment check.
Amount:
$1,175.00

Component Description:
Cover letter with revised engineering invoice for engineering studies and antenna pattern for repack Ch. 14, and payment check.
Amount:
$1,175.00

Component Description:
Engineering Services, to place station on Post Auction channel.
Amount:
$2,800.00
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Legal Services
Amount:
$30.00
Project management of the transition

Component Description:
Project Management
Amount:
$75.00

Component Description:
Project Management
Amount:
$1,803.90

Component Description:
Project Management
Amount:
$3,194.60

Component Description:
Project Management
Amount:
$2,692.95

Component Description:
Project Management
Amount:
$660.00

Component Description:
Project Management
Amount:
$3,110.40

Component Description:
Project management
Amount:
$2,506.05

Component Description:
Project Management
Amount:
$4,111.65

Component Description:
Project management
Amount:
$2,628.05

Component Description:
Project Management
Amount:
$4,175.40

Component Description:
Project Management
Amount:
$720.00

Component Description:
Project Management
Amount:
$2,274.10

Component Description:
Project Management
Amount:
$4,031.70

Component Description:
Project Management
Amount:
$3,593.10

Component Description:
Project Management
Amount:
$1,176.25

Component Description:
Project Management
Amount:
$2,548.60

Component Description:
Cost Reconciliation
Amount:
$33.75

Component Description:
Project Management
Amount:
$780.00

Component Description:
Project Management
Amount:
$2,785.20

Component Description:
Project Management
Amount:
$2,336.25

Component Description:
Project Management
Amount:
$3,145.60

Component Description:
Project Management
Amount:
$2,767.45

Component Description:
Project Management
Amount:
$2,939.15
Prepare and or review reimbursement form

Component Description:
Legal Services
Amount:
$450.00

Component Description:
WSKC-CD-590-Prepare and/or Review Reimbursement Form
Amount:
$150.00

Component Description:
Legal Services Rendered
Amount:
$330.00

Component Description:
Requesting balance of $2500 paid after $470 credit given on $2970 invoice, to reflect an agreed fee cap.
Amount:
$2,500.00

Component Description:
Requesting balance of $2500 paid after $470 credit given on $2970 invoice, to reflect an agreed fee cap; added cover letter to explain same.
Amount:
$2,500.00

Component Description:
WSKC-CD-590-Prepare and/or Review Reimbursement Form
Amount:
$330.00

Component Description:
Legal Services
Amount:
$2,460.00

Component Description:
WSKC-CD-590-Prepare and/or Review Reimbursement Form
Amount:
$690.00

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 $12,195.00 $14,427.00 N/A $13,852.00 N/A
Total for all systems $601,120.00 $563,633.69 N/A $160,910.07 N/A
Other Expenses $12,195.00 $14,427.00 $13,852.00
Develop and air announcement of upcoming channel change $250.00 $250.00 Contract voice talent to tape announcement. N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $60.00 $60.00 Please see attached Disposal Costs justification document and EngineeringTVRF Invoice 10312019 $60.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $13,792.00 See DTVNotification Estimate # EST-001602 and RF Notifications Quote PS20190826 $13,792.00 N/A

Components

Actual Information Description File Name
Develop and air announcement of upcoming channel change Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
storage of old ch 22 transmitter
Amount:
$60.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.
DTV Medical Facility Notification

Component Description:
Notification of Medical Facilities
Amount:
$8,592.00

Component Description:
Land Mobile Services
Amount:
$5,200.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $601,120.00 $563,633.69 $160,910.07

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.

Myoung Hwa Bae

President


12/14/2020

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.

Myoung Hwa Bae

President


12/14/2020

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.

Myoung Hwa Bae

President


12/14/2020

Attachments

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