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:
21156
Service:
DTV
Call Sign:
KPXR-TV
Channel:
22 (UHF)
File Number:
0000028311
FRN:
0003720042
Date Submitted:
12/09/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

ION MEDIA LICENSE COMPANY, LLC

Doing Business As: ION MEDIA LICENSE COMPANY, LLC

Bianca Frye

601 Clearwater Park Road

West Palm Beach, FL 33401

United States

+1 (561) 682-4110 BiancaFrye@ionmedia.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 Relocate from ASR# 1052725 to ASR# 1012926. Construct post-repack facilities at alternate location. No interim facilities required. Install new transmitter, RF system, transmission line, and antenna on post-repack channel. Pursuant to the CP Authorization

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
Year 2002
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 40 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model HPTV-PRLX-U10
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 16.2 kW
Justification for New Transmitter See attached Transmitter Exhibits. See attached Transmitter Upgrade Disclaimer.

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 Yes
Description Electrical Installation of Primary Transmitter
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? Yes
Size 800.0 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

Removal of Existing Equipment

Removal of existing transmitters and equipment / Site Prep

RF Interconnect

Interconnect between RF System and transmission line

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 500.0 kW
Manufacturer
Model TFU-18DSC-R03
Year 2002

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 215.0 kW
Manufacturer
Model TFU30GTH/VP-R 04
Year 2018
Justification for New Antenna See attached Antenna Exhibit

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? No
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? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 6 1/8 inches inches
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

Name Description

ANTENNA BURY ADAPTER.

EXTENDS 20' INTO TOWER AND 43.9' ABOVE TOWER TOP. USED TO MAINTAIN EXISTING FAA STRUCTURE HEIGHT. INCLUDES NEW POLE SOCKET AND GUIDE FLANGE.

FEED THROUGH COMPONENTS

CONSISTS OF REQUIRED COMPONENTS AND HANGERS TO ROUTE LINE FROM ANTENNA INPUT THROUGH SUPPORT POLE INTO TOWER TO COMPLEX OUTPUT

3 FT ANTENNA MOUNTING WEDDING CAKE ADAPTER

3 FT ANTENNA MOUNTING WEDDING CAKE ADAPTER

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 Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1002 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 Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1360 feet per run
Justification for New Transmission Line See attached Antenna Exhibit

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Sweep existing transmission line

Sweep existing 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 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? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1052725
Coordinates (NAD83) Latitude (NAD83) 42° 17' 17.3" N-
Longitude (NAD83) 091° 52' 54.5" W-
Overall Structure Height 979.97 feet
Support Structure Height 937.32 feet
Ground Elevation Above Mean Sea Level (AMSL) 1001.96 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner SpectraSite Communications, LLC. through American Towers, LLC.
Date Constructed 12/11/1995


Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Structural analysis

Structural analysis

Primary Tower

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Add Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1012926
Coordinates (NAD83) Latitude (NAD83) 42° 17' 43.0" N-
Longitude (NAD83) 091° 53' 11.0" W-
Overall Structure Height 1355.63 feet
Support Structure Height 1270.33 feet
Ground Elevation Above Mean Sea Level (AMSL) 1049.86 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner KGAN Licensee, LLC
Date Constructed 01/29/1983


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: Major 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

Name Description

Tower Structural Study

Tower Structural Study

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 180
Explanation Required by tower Landlord.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review Yes
Environmental Assessment Yes
ASR Modification Yes
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 Yes
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

Information not provided.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
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
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

Sales Tax

Sales tax for repack equipment paid directly to the Iowa Department of Revenue

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 $1,222,156.94 $969,777.06 N/A $925,527.06 N/A
Total for all systems $3,129,088.51 $2,878,082.33 N/A $2,569,149.73 N/A
Primary Transmitter HPTV-PRLX-U10 $1,222,156.94 $969,777.06 $925,527.06
RF Interconnect $25,000.00 $25,000.00 N/A N/A N/A
Other -- Building Addition Size: 800.0 $378,202.94 $378,202.94 Building Modifications required for post-repack build out. See attached Worldwide Communications Quote #S-17-858, Worldwide Communications Quote #S-18-860, ThermoBond Buildings Quote #1709-429, and Worldwide Communications Quote #S-18-872. $378,202.94 N/A
5 Ton system $20,250.00 $19,250.00 See attached HVAC Exhibit. N/A N/A
Removal of Existing Equipment $32,500.00 $32,500.00 See attached Junk King #05072018, Paulson Electric Quote #9287; Item 1. and Skyline Communications Quote #98921196 $32,500.00 N/A
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW $684,000.00 $432,620.12 See attached Hitachi-Comark Quote #P3489PRLXU10. Estimate includes $20,969.52 of taxes on order. $432,620.12 N/A
Other Electrical Service: Electrical Installation of Primary Transmitter $82,204.00 $82,204.00 See attached Paulson Electric Quote #9287 - Item #2 and Broadcasters General Store Quote #536527 $82,204.00 N/A

Components

Actual Information Description File Name
RF Interconnect Information not provided.
Other -- Building Addition Size: 800.0

Component Description:
25% "remaining balance" payment to supply/install ice bridge to protect transmitter building. Supporting documentation attached. This invoice has been paid.
Amount:
$11,527.50

Component Description:
75% "deposit" payment to supply/install ice bridge to protect transmitter building. Supporting documentation attached. This invoice has been paid.
Amount:
$34,582.50

Component Description:
75% "remaining balance" for pre-cast concrete equipment shelter, associated freight & taxes. Supporting documentation attached.
Amount:
$176,451.69

Component Description:
25% "remaining balance" on transmitter building demolition. Inclusive of taxes. Supporting documentation attached. This invoice has been paid.
Amount:
$7,420.00

Component Description:
25% deposit payment for pre-cast concrete equipment shelter and associated freight. Supporting documentation attached.
Amount:
$54,729.25

Component Description:
65% deposit payment on transmitter building demolition. Inclusive of taxes. Supporting documentation attached. This invoice has been paid.
Amount:
$19,292.00

Component Description:
10% deposit payment for transmitter building foundation. Supporting documentation attached. This invoice has been paid.
Amount:
$7,123.20

Component Description:
25% "remaining balance" for transmitter building foundation. Inclusive of taxes. Supporting documentation attached. This invoice has been paid.
Amount:
$17,808.00

Component Description:
65% deposit payment for transmitter building foundation. Supporting documentation attached. This invoice has been paid.
Amount:
$46,300.80

Component Description:
10% deposit payment on transmitter building demolition. Inclusive of taxes. Supporting documentation attached. This invoice has been paid.
Amount:
$2,968.00
5 Ton system Information not provided.
Removal of Existing Equipment

Component Description:
Cost to remove old transmitter and related equipment. Supporting documentation is attached. This invoice has been paid.
Amount:
$13,500.00

Component Description:
Cost to cleanup and vacate transmitter building for transmitter installation. Supporting documentation attached.
Amount:
$10,000.00

Component Description:
Cost to electrically disconnect transmitter from transmitter building. Supporting documentation attached.
Amount:
$9,000.00
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW

Component Description:
This invoice is for 20% remaining balance payment for Comark Transmitter. Supporting documentation attached.
Amount:
$85,027.30

Component Description:
Cost of additional equipment for main transmitter package. Supporting documentation is attached. This invoice has been paid.
Amount:
$7,483.60

Component Description:
30% "Deposit Due with Order" Payment for Hitachi-Comark transmitter. Supporting documentation attached. This invoice has been paid.
Amount:
$127,540.96

Component Description:
Per reviewers request, estimated amount has been updated to reflect total transmitter cost. This invoice is for 30% "Deposit" Payment for Hitachi-Comark transmitter. Revised supporting documentation attached. This invoice has been paid.
Amount:
$127,540.96

Component Description:
Per reviewers request, estimated cost has been updated to reflect total transmitter cost. This invoice is for 50% Progress payment for Comark Transmitter. Supporting documentation attached. This invoice has been paid.
Amount:
$212,568.26
Other Electrical Service: Electrical Installation of Primary Transmitter

Component Description:
Partial Billing Payment #1 for electrical installation of primary transmitter. Per FCC reviewers request, invoice is being resubmitted with cover letter. Supporting documentation attached. This invoice has been paid.
Amount:
$71,000.00

Component Description:
Cost of electrical grounding equipment for transmitter. Supporting documentation is attached. This invoice has been paid.
Amount:
$1,304.00

Component Description:
Remaining balance due on electrical installation of primary transmitter. Supporting documentation attached.
Amount:
$9,900.00

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $441,475.00 $349,106.00 N/A $349,106.00 N/A
Total for all systems $3,129,088.51 $2,878,082.33 N/A $2,569,149.73 N/A
Primary Antenna TFU30GTH/VP-R 04 $441,475.00 $349,106.00 $349,106.00
ANTENNA BURY ADAPTER. $100,630.00 $100,630.00 See attached Dielectric #199018. Pages 4 (Change Order) Page 5 (Detailed Cost Breakout) and Pages 6-9 for Quote & Purchase Order. $100,630.00 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $10,298.00 See attached Dielectric Quote #700032CMZ-7. $10,298.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 See attached Dielectric Quote #700032CMZ-7. $6,400.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $199,463.00 V-Pol cost not included in reimbursement request. See attached Dielectric Quote #700032CMZ-7. $199,463.00 N/A
3 FT ANTENNA MOUNTING WEDDING CAKE ADAPTER $18,330.00 $18,330.00 See attached Dielectric Quote #700032CMZ-7. $18,330.00 N/A
FEED THROUGH COMPONENTS $13,985.00 $13,985.00 See attached Dielectric Quote #700032CMZ-7 and Change Order on Page 3 on attached Dielectric Invoice #235005. $13,985.00 N/A

Components

Actual Information Description File Name
ANTENNA BURY ADAPTER.

Component Description:
45% "down payment" for primary antenna bury adapter. Explanation of variance and supporting documentation attached. This invoice has been paid.
Amount:
$50,436.00

Component Description:
45% "prior to ship" payment for primary antenna bury adapter. Supporting documentation and explanation of variance attached.
Amount:
$45,283.50

Component Description:
Remaining balance due on antenna bury adapter. Explanation of variance, supporting documentation and detailed cost breakout attached.
Amount:
$4,910.50
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
45% "down payment" for primary antenna elbow complex. Explanation of variance and supporting documentation attached. This invoice has been paid.
Amount:
$4,634.10

Component Description:
45% "prior to ship" payment for primary antenna elbow complex. Supporting documentation and explanation of variance attached.
Amount:
$4,634.10

Component Description:
Remaining balance due on primary antenna elbow complex. Supporting documentation and detailed cost breakout attached.
Amount:
$1,029.80
Sweep test of existing antenna

Component Description:
45% "prior to ship" payment for repack sweep of primary operations. Supporting documentation and explanation of variance attached.
Amount:
$2,880.00

Component Description:
Remaining balance due on repack sweep of primary antenna operations. Supporting documentation and detailed cost breakout attached.
Amount:
$640.00

Component Description:
45% "down payment" for repack sweep of primary operations. Explanation of variance and supporting documentation attached. This invoice has been paid.
Amount:
$2,880.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
45% "prior to ship" payment for primary antenna. Supporting documentation and explanation of variance attached.
Amount:
$89,758.35

Component Description:
45% "down payment" for primary antenna. Explanation of variance and supporting documentation attached. This invoice has been paid.
Amount:
$89,758.35

Component Description:
Remaining balance due on primary antenna. Explanation of variance, supporting documentation and detailed cost breakout attached.
Amount:
$19,946.30
3 FT ANTENNA MOUNTING WEDDING CAKE ADAPTER

Component Description:
45% "prior to ship" payment for primary antenna wedding cake adapter. Supporting documentation and explanation of variance attached.
Amount:
$8,248.50

Component Description:
45% "down payment" for primary antenna wedding cake adapter. Explanation of variance and supporting documentation attached. This invoice has been paid.
Amount:
$8,248.50

Component Description:
Remaining balance due on antenna wedding cake adapter. Explanation of variance, supporting documentation and detailed cost breakout attached.
Amount:
$1,833.00
FEED THROUGH COMPONENTS

Component Description:
45% "down payment" for primary antenna feed through components. Explanation of variance and supporting documentation attached. This invoice has been paid.
Amount:
$7,526.25

Component Description:
45% "prior to ship" payment for primary antenna feed through components. Supporting documentation and explanation of variance attached.
Amount:
$6,293.25

Component Description:
Remaining balance on reduced priced for Feed Through Components. Supporting documentation attached. This invoice has been paid.
Amount:
$165.50

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 $274,720.00 $221,981.71 N/A $221,981.71 N/A
Total for all systems $3,129,088.51 $2,878,082.33 N/A $2,569,149.73 N/A
Primary Transmission Line $274,720.00 $221,981.71 $221,981.71
Rigid Transmission Line - copper, 6 1/8" $274,720.00 $221,981.71 See attached Dielectric Quote #700032CMZ-7 for cost of Tx line, Dielectric #269007 (Page 4), Dielectric #276011 (Page 3), Dielectric #301008 (Page 3) Change Orders for cost of additional Tx line components, and Worldwide Communications Quote #S-18-899. $221,981.71 N/A
Sweep existing transmission line $0.00 $0.00 N/A N/A N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 6 1/8"

Component Description:
Remaining balance due on 2 out of 3 transmission line cut pieces (flange). Supporting documentation and detailed cost breakout attached.
Amount:
$343.70

Component Description:
75% "deposit" payment to supply/install ice bridge running from tower to transmitter building to protect transmission line. Supporting documentation attached. This invoice has been pad.
Amount:
$22,875.00

Component Description:
10% remaining balance on primary transmission line. Supporting documentation attached. This invoice has been paid.
Amount:
$17,407.68

Component Description:
Remaining balance due on 1 out of 3 transmission line cut pieces (flange). Supporting documentation and detailed cost breakout attached.
Amount:
$171.85

Component Description:
45% "prior to ship" payment for primary transmission line. Supporting documentation and explanation of variance attached.
Amount:
$78,334.51

Component Description:
Full cost of additional transmission line components per Change Order 10.16.18. Supporting documentation and detailed cost breakout attached.
Amount:
$815.00

Component Description:
Full cost of additional transmission line components per Change Order 9.27.18. Supporting documentation and detailed cost breakout attached.
Amount:
$1,652.70

Component Description:
45% "down payment" for primary transmission line. Explanation of variance and supporting documentation attached. This invoice has been paid.
Amount:
$78,334.51

Component Description:
45% "prior to ship" payment for additional transmission line flanges. Supporting documentation and explanation of variance attached.
Amount:
$3,866.63

Component Description:
25% "remaining balance" payment to supply/install ice bridge running from tower to transmitter building to protect transmission line. Supporting documentation attached. This invoice has been pad.
Amount:
$7,625.00

Component Description:
45% "down payment" for additional transmission line flanges. Explanation of variance and supporting documentation attached. This invoice has been paid.
Amount:
$3,866.63

Component Description:
Full cost of additional transmission line components per Change Order 9.24.18. Supporting documentation and detailed cost breakout attached.
Amount:
$6,688.50
Sweep existing transmission line Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $879,800.00 $1,054,068.00 N/A $1,011,618.00 N/A
Total for all systems $3,129,088.51 $2,878,082.33 N/A $2,569,149.73 N/A
Primary Tower TOWER $662,800.00 $789,588.00 $747,138.00
Tower Structural Study $5,000.00 $5,000.00 See attached Elevated Structural Consultants Quote #01. $5,000.00 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $9,500.00 See attached Elevated Structural Consultants Quote #02. $9,500.00 N/A
Tall Tower (greater than 500') $210,500.00 $299,128.00 See attached Worldwide Communications Quote #S-17-847 + Worldwide Communications Quote #S-18-914 + Additional work on tower = $11,550 $287,578.00 N/A
Major tower reinforcement/modifications $421,000.00 $475,960.00 See attached Worldwide Communications Purchase Order & Quote #S-17-847. Tower Reinforcement portion of quote is for $84,800 w/ Taxes. Tower Modification portion of quote is $218,360 w/ Taxes. Weather downtime payable of $172,800 also included. $445,060.00 N/A
Primary Tower TOWER $217,000.00 $264,480.00 $264,480.00
Tall Tower (greater than 500') $210,500.00 $257,980.00 See attached Worldwide Communications Quote #S-17-846 and associated Purchase Order. Taxes of $11,880.00 included. Estimate also includes weather delay charges of $48,100. Please see attached Worldwide Communications Invoice #2181, 2220, 2216, 2229, 2224. $257,980.00 N/A
Structural analysis $6,500.00 $6,500.00 Cost of structural analysis to remove antenna and line from old site. Please see attached Elevated Structural Consultants Quote dated 1-13-2019. and structural study charged by American Tower $6,500.00 N/A

Components

Actual Information Description File Name
Tower Structural Study

Component Description:
Cost of Tower Structural Study. Supporting documentation attached. This invoice has been paid.
Amount:
$5,000.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Cost for Site Visit to Map Tower and provide Structural Modification Drawings. Supporting documentation attached. This invoice has been paid.
Amount:
$9,500.00
Tall Tower (greater than 500')

Component Description:
25% "remaining balance" payment for cost of laying down level rock pads for crane safety and semi-truck mobility during tower rigging process. Supporting documentation attached. This invoice has been paid.
Amount:
$10,070.00

Component Description:
65% "due upon arrival" payment for cost of laying down level rock pads for crane safety and semi-truck mobility during tower rigging process. Supporting documentation attached. This invoice has been paid.
Amount:
$26,182.00

Component Description:
Per FCC reviewers request, this invoice is being re-submitted with cover letter. 25% "remaining balance" payment for "tower service" portion of purchase order at new site. Supporting documentation attached.
Amount:
$61,824.50

Component Description:
10% "deposit" payment on tower service at new site. Supporting documentation attached. This invoice has been paid.
Amount:
$24,729.80

Component Description:
10% "deposit" payment for cost of laying down level rock pads for crane safety and semi-truck mobility during tower rigging process. Supporting documentation attached. This invoice has been paid.
Amount:
$4,028.00

Component Description:
65% "mobilization payment" for tower service at new site. Supporting documentation attached. This invoice has been paid.
Amount:
$160,743.70

Component Description:
Cost of additional work for tower crew to remove grating and punch rental to relocate 6-inch line hangers. Supporting documentation attached.
Amount:
$11,550.00
Major tower reinforcement/modifications

Component Description:
65% "deposit" payment for tower modifications. Supporting documentation attached. This invoice has been paid.
Amount:
$141,934.00

Component Description:
Cost of 1 day of downtime due to Rain/Wind on 5/21/2018. Cover letter, explanation of variance, and supporting documentation attached. This invoice has been paid.
Amount:
$3,250.00

Component Description:
25% "remaining balance" payment for tower reinforcements. Supporting documentation attached. This invoice has been paid.
Amount:
$21,200.00

Component Description:
Per FCC reviewers request, this invoice is being re-submitted wih cover letter. 25% "remaining balance" payment for tower modifications portion of purchase order. Supporting documentation attached.
Amount:
$54,590.00

Component Description:
Cost of 4 day downtime (due to rain/wind) 7/19/2018, 7/20/2018, 7/21/2018, 7/222018. Cover letter, explanation of variance, and supporting documentation attached. This invoice has been paid.
Amount:
$13,000.00

Component Description:
Cost of 4 day downtime (due to rain) 6/25/2018, 6/26/2018, 6/30/2018, 7/1/2018. Cover letter, explanation of variance, and supporting documentation attached. This invoice has been paid.
Amount:
$13,000.00

Component Description:
Cost of 1 day downtime - Storms & High Winds (8/14/2018). Cover letter, explanation of variance, and supporting documentation attached. This invoice has been paid.
Amount:
$3,250.00

Component Description:
Cost of downtime 3 days of rain & wind on 7/8/2018, 7/9/2018, 7/10/2018. Cover letter, explanation of variance, and supporting documentation attached. This invoice has been paid.
Amount:
$9,750.00

Component Description:
Cost of 6 day downtime (due to rain) 6/18/2018, 6/19/2018, 6/20/2018, 6/21/2018, 6/22/2018, 6/23/2018. Cover letter, explanation of variance, and supporting documentation attached. This invoice has been paid.
Amount:
$19,500.00

Component Description:
Cost of 2 day downtime (due to rain/wind) 10/1/2018, (rain/fog) 10/3/2018. Cover letter, explanation of variance, and supporting documentation attached. This invoice has been paid.
Amount:
$7,800.00

Component Description:
Cost of 2 day downtime - Rain/High Wind (8/4/2018, 8/5/2018). Cover letter, explanation of variance, and supporting documentation attached. This invoice has been paid.
Amount:
$6,500.00

Component Description:
Cost of 2 day downtime (due to rain) 8/20/2018 (due to fog) 8/22/2018. Cover letter, explanation of variance, and supporting documentation attached. This invoice has been paid.
Amount:
$6,500.00

Component Description:
Cost of downtime 2 days of rain, wind and fog on 6/12/2018, 6/14/2018. Cover letter, explanation of variance, and supporting documentation attached. This invoice has been paid.
Amount:
$6,500.00

Component Description:
Cost of 4 day downtime (due to rain) 7/11/2018, 7/12/2018, 7/14/2018, 7/15/2018. Cover letter, explanation of variance, and supporting documentation attached. This invoice has been paid.
Amount:
$13,000.00

Component Description:
Per FCC reviewers request, this invoice is being re-submitted with cover letter. Cost of 1 day downtime - Storms & High Winds (8/14/2018). Supporting documentation attached.
Amount:
$4,000.00

Component Description:
10% "deposit" payment for tower modifications. Supporting documentation attached. This invoice has been paid.
Amount:
$21,836.00

Component Description:
Per FCC reviewers request, this invoice is being re-submitted with cover letter. Cost of 2 day downtime - Rain/High Wind (8/4/2018, 8/5/2018). Supporting documentation attached.
Amount:
$8,000.00

Component Description:
Cost of 2 day downtime (due to rain) 7/4/2018, 7/5/2018. Cover letter, explanation of variance, and supporting documentation attached. This invoice has been paid.
Amount:
$6,500.00

Component Description:
Per FCC reviewers request, this invoice is being re-submitted with cover letter. Cost of downtime 3 days of rain & wind on 7/8/2018, 7/9/2018, 7/10/2018. Supporting documentation attached.
Amount:
$12,000.00

Component Description:
Per FCC reviewers request, this invoice is being re-submitted with cover letter. Cost of 2 day downtime (due to rain/wind) 10/1/2018, (rain/fog) 10/3/2018. Supporting documentation attached.
Amount:
$9,600.00

Component Description:
Per FCC reviewers request, this invoice is being re-submitted with cover letter. Cost of 2 day downtime (due to rain) 8/20/2018 (due to fog) 8/22/2018. Supporting documentation attached.
Amount:
$8,000.00

Component Description:
Per FCC reviewers request, this invoice is being re-submitted with cover letter. Cost of 4 day downtime (due to rain) 7/11/2018, 7/12/2018, 7/14/2018, 7/15/2018; Supporting documentation attached.
Amount:
$16,000.00

Component Description:
65% "deposit" payment for tower reinforcements. Supporting documentation attached. This invoice has been paid.
Amount:
$55,120.00

Component Description:
Cost of 1 day of downtime due to Rain/Wind on 5/21/2018. Cover letter, explanation of variance, and supporting documentation attached. This invoice has been paid.
Amount:
$3,250.00

Component Description:
10% "deposit" payment for tower reinforcements. Supporting documentation attached. This invoice has been paid.
Amount:
$8,480.00

Component Description:
Per FCC reviewers request, this invoice is being re-submitted with cover letter. Cost of 3 day downtime - Rain/Wind (8/6/2018), (8/7/2018), (8/9/2018). Supporting documentation attached.
Amount:
$12,000.00

Component Description:
Per FCC reviewers request, this invoice is being re-submitted with cover letter. Cost of 6 day downtime (due to rain) 6/18/2018, 6/19/2018, 6/20/2018, 6/21/2018, 6/22/2018, 6/23/2018. Supporting documentation attached.
Amount:
$24,000.00

Component Description:
Per FCC reviewers request, this invoice is being re-submitted with cover letter. Cost of 4 day downtime (due to rain) 6/25/2018, 6/26/2018, 6/30/2018, 7/1/2018. Supporting documentation attached.
Amount:
$16,000.00

Component Description:
Per FCC reviewers request, this invoice is being re-submitted with cover letter. Cost of 4 day downtime (due to rain/wind) 7/19/2018, 7/20/2018, 7/21/2018, 7/222018. Supporting documentation attached.
Amount:
$16,000.00

Component Description:
Per FCC reviewers request, this invoice is being re-submitted with cover letter. Cost of 2 day downtime (due to rain) 7/4/2018, 7/5/2018. Supporting documentation attached.
Amount:
$8,000.00

Component Description:
Per FCC reviewers request, this invoice is being re-submitted with cover letter. Cost of 4 day downtime (rain/fog) 9/20/2018, 9/25/2018, 9/29/2018, 9/30/2018. Supporting documentation attached.
Amount:
$19,200.00

Component Description:
Cost of 3 day downtime - Rain/Wind (8/6/2018), (8/7/2018), (8/9/2018). Cover letter, explanation of variance, and supporting documentation attached. This invoice has been paid.
Amount:
$9,750.00

Component Description:
Cost of 2 days of tower modifications downtime due to Rain/Wind on 6/2/2018 and 6/3/2018. Supporting documentation attached.
Amount:
$8,000.00

Component Description:
Per FCC reviewers request, this invoice is being re-submitted cover letter. Cost of 1 day of downtime due to Rain/Wind on 5/21/2018. Supporting documentation attached.
Amount:
$4,000.00

Component Description:
Per FCC reviewers request, this invoice is being re-submitted with cover letter. Cost of downtime 2 days of rain, wind and fog on 6/12/2018, 6/14/2018. Supporting documentation attached.
Amount:
$8,000.00

Component Description:
Cost of 4 day downtime (rain/fog) 9/20/2018, 9/25/2018, 9/29/2018, 9/30/2018. Cover letter, explanation of variance, and supporting documentation attached. This invoice has been paid.
Amount:
$15,600.00
Tall Tower (greater than 500')

Component Description:
65% "deposit" payment for tower service. Supporting documentation attached. This invoice has been paid.
Amount:
$136,422.00

Component Description:
Weather delay payment for tower services for six workers for three days at approved rate of $650 per day. Supporting documentation is attached. This invoice has been paid.
Amount:
$11,700.00

Component Description:
Weather delay payment for tower services for six workers for two days at approved rate of $650 per day. Supporting documentation is attached. This invoice has been paid.
Amount:
$7,800.00

Component Description:
10% "deposit" payment for tower service. Supporting documentation attached. This invoice has been paid.
Amount:
$20,988.00

Component Description:
Weather delay payment for tower services for six workers for three days at approved rate of $650 per day. Supporting documentation is attached. This invoice has been paid.
Amount:
$11,700.00

Component Description:
Weather delay payment for tower services for four workers for five days at approved rate of $650 per day. Supporting documentation is attached. This invoice has been paid.
Amount:
$13,000.00

Component Description:
Weather delay payment for tower services for six workers for one day at approved rate of $650 per day. Supporting documentation is attached. This invoice has been paid.
Amount:
$3,900.00

Component Description:
"Balance due" payment for tower service. Supporting documentation attached. This invoice has been paid.
Amount:
$52,470.00
Structural analysis

Component Description:
Cost of tower structural study charged by landlord. Supporting documentation is attached. This invoice has been paid.
Amount:
$1,500.00

Component Description:
Cost of structural analysis to remove antenna and line from old site. Supporting documentation is attached. This invoice has been paid.
Amount:
$5,000.00

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $189,650.00 $171,427.99 N/A $6,710.49 N/A
Total for all systems $3,129,088.51 $2,878,082.33 N/A $2,569,149.73 N/A
Outside Professional Services $189,650.00 $171,427.99 $6,710.49
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A N/A N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $10,000.00 N/A N/A N/A
NEPA Section 106 environmental review, if needed $6,310.00 $6,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,147.99 Please see Cooley invoices with detailed billing backups $5,147.99 N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A
Project management of the transition $28,440.00 $18,530.00 See AT Exhibits for more information. N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $62.50 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $1,500.00 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
RF Exposure Measurements $21,050.00 $20,000.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A

Components

Actual Information Description File Name
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
ASR modification (prepare FCC Form 854) Information not provided.
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet Information not provided.
NEPA Section 106 environmental review, 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.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Cost of legal fees related to construction permit application. Supporting documentation is attached. This invoice has been paid.
Amount:
$405.00

Component Description:
Invoice for station's portion of general repack legal expenses incurred for 42 of the ION repack stations for period 2/1/2017 - 12/15/2017. Payee has corresponded with FCC staff and has provided corrected supporting documentation.
Amount:
$4,837.97

Component Description:
Invoice for KPXR's portion of general repack legal expenses incurred for 42 of the ION repack stations for period 2/1/2017 - 12/15/2017. Payee has corresponded with FCC staff. Hourly supporting documentation and invoice attached.
Amount:
$4,742.99
Prepare request for Special Temporary Authorization Information not provided.
Prepare and or review reimbursement form Information not provided.
Project management of the transition Information not provided.
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
Cost of engineering consultant work for new channel assignment and antenna development. Hourly supporting documentation attached. This invoice has been paid.
Amount:
$62.50
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Cost of engineering consultant work for preparation of engineering section of FCC Form 2100. Hourly supporting documentation attached. This invoice has been paid.
Amount:
$1,500.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
RF Exposure Measurements Information not provided.
Comprehensive coverage verification via field study, if needed 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 $121,286.57 $111,721.57 N/A $54,206.47 N/A
Total for all systems $3,129,088.51 $2,878,082.33 N/A $2,569,149.73 N/A
Other Expenses $121,286.57 $111,721.57 $54,206.47
Sales Tax $34,845.42 $34,845.42 Please see Cedar Rapids - Repack Sales Tax spreadsheet $34,845.32 N/A
Local Zoning $25,000.00 $25,000.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $2,000.00 N/A N/A N/A
MVPD Notification of Channel Change $500.00 $500.00 N/A $500.00 N/A
Develop and air announcement of upcoming channel change $0.00 $0.00 The amount is yet to be determined (TBD) and ION will submit on-air announcement costs when finalized. N/A N/A
Equipment Storage $1,870.00 $1,870.00 See attached Dielectric #86300STORAGE. $1,870.00 N/A
Equipment Delivery and Handling Charges $16,991.15 $16,991.15 This is what ION has been billed by vendors to deliver equipment for repack $16,991.15 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $15,000.00 $15,000.00 N/A N/A N/A
Non-zoning permits $15,000.00 $15,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Sales Tax

Component Description:
Sales tax paid directly to the Iowa Department of Revenue for repack equipment. Supporting documentation and explanation of variance are attached. This one time payment has been made.
Amount:
$3,414.49

Component Description:
Sales tax paid directly to the Iowa Department of Revenue for repack equipment. Supporting documentation attached. This one time payment has been made.
Amount:
$1,680.00

Component Description:
Sales tax paid directly to the Iowa Department of Revenue for repack equipment. Supporting documentation and explanation of variance are attached. This one time payment has been made.
Amount:
$14,625.15

Component Description:
Sales tax paid directly to the Iowa Department of Revenue for repack equipment. Supporting documentation and explanation of variance are attached. This one time payment has been made.
Amount:
$14,315.68

Component Description:
Sales tax paid directly to the Iowa Department of Revenue for repack equipment. Supporting documentation and explanation of variance are attached. This one time payment has been made.
Amount:
$810.00
Local Zoning Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
DTV Medical Facility Notification Information not provided.
MVPD Notification of Channel Change

Component Description:
Cost of MVPD notification for channel change. Supporting documentation is attached. This invoice has been paid.
Amount:
$500.00
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage

Component Description:
Full cost of equipment storage related to antenna and transmission line during repack build out. Supporting documentation and detailed cost breakout attached.
Amount:
$1,870.00
Equipment Delivery and Handling Charges

Component Description:
Cost of freight for main transmitter package that exceeded original estimate amount. Supporting documentation is attached. This invoice has been paid.
Amount:
$4,032.86

Component Description:
Cost of freight, shipping, and handling associated with sending 1 van to site. Supporting documentation and detailed cost breakout attached.
Amount:
$4,733.10

Component Description:
Cost of freight, shipping, and handling related to Dielectric Invoice #269007. Supporting documentation and detailed cost breakout attached.
Amount:
$2,783.71

Component Description:
Cost of freight, shipping, and handling related to 1 of the 3 transmission line cut pieces on original order. Supporting documentation and detailed cost breakout attached.
Amount:
$498.11

Component Description:
Cost of freight for delivery of grounding equipment for transmitter. Supporting documentation is attached. This invoice has been paid.
Amount:
$134.20

Component Description:
Cost of freight, shipping, and handling related to Dielectric Invoice #276011. Supporting documentation and detailed cost breakout attached.
Amount:
$1,218.33

Component Description:
Cost of freight, shipping, and handling related to Dielectric Invoice #301008. Supporting documentation and detailed cost breakout attached.
Amount:
$3,590.84
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Non-zoning permits Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,129,088.51 $2,878,082.33 $2,569,149.73

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. No
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator. No

Certification

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Section Question Response
Submission of Estimated Expenses Statements

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.

  1. The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.

  2. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

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

  4. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).

  5. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.

  6. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.

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

  8. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Mario Vasquez

Vice President - Finance, Operations


12/09/2020

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.

Mario Vasquez

Vice President - Finance, Operations


12/09/2020

Attachments

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