TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
WSPF-CA STATION, LLC Doing Business As: WSPF-CA STATION, LLC	Maria Martinez 147 Alhambra Circle Suite 131 Coral Gables, FL 33134 United States	+1 (305) 903-6507	maria.martinez@primetimepartners.net	Limited Liability Company

Applicant

Address

Phone

Applicant Type

WSPF-CA STATION, LLC

Doing Business As: WSPF-CA STATION, LLC

Maria Martinez

147 Alhambra Circle

Suite 131

Coral Gables, FL 33134

United States

+1 (305) 903-6507

maria.martinez@primetimepartners.net

Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant	Address	Phone	Email
[Confidential]

Preparer Contact Information

Preparer Contact Name and Information

Applicant	Address	Phone	Email
Daniel Kirkpatrick Attorney Fletcher Heald & Hildreth	1300 North 17th St. 11th Floor Arlington , VA 22209 United States	+1 (703) 812-0400	kirkpatrick@fhhlaw.com

Applicant

Address

Phone

Daniel Kirkpatrick

Attorney

Fletcher Heald & Hildreth

1300 North 17th St.

11th Floor

Arlington , VA 22209

United States

+1 (703) 812-0400

kirkpatrick@fhhlaw.com

Broadcaster Information and Transition Plan

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	WSPF has had to modify its transition plan to move to a new tower, replace its antenna, transmitter, and filter, and modify its authorization to specify the new facilities. A letter from American Tower explaining the need to relocate is attached.

Transmitters

Section	Question	Response
Transmitter Related Expenses	Do you have transmitter related expenses?	Yes

Primary Transmitter

Add 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	A5KST8U
	Year	2013
	Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power Capacity	5 kW

Primary Transmitter

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	TRN-U-2000-FA
	Transmitter Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power capacity	2 kW
	Justification for New Transmitter	Existing transmitter cannot be installed at new tower facility required based on American Tower determination that existing tower cannot support modified facility.

Primary Transmitter

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?	No
	Type	N/A
	Size	N/A
	Other Size	N/A
Transmitter Building Addition/Modification or Leasehold Improvement	Does the Transmitter Building require an addition, modification, other leashold improvement?	No
	Size	N/A
Channel 14 Costs	Is an RF Consulting Engineer needed?	N/A
	Is a channel 14 Mask Filer needed?	N/A
	Is additional field engineering time needed?	N/A
	Number of Days	N/A

Primary Transmitter

Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Purchase New
	Antenna Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing antenna shared with another station or stations?	No
	Is the existing antenna directional?	Yes
	Is antenna in operating condition?	Yes
	Is antenna located on or in close proximity to an antenna farm?	Yes
Existing Antenna Manufacturer and Type	Class	Class A
	Mounting	Side Mount
	Antenna position in stack	Middle
	Polarization	Circular
	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	16 Bay Circular Polarized
	ERP:	15.0 kW
	Manufacturer
	Model	TLP-M
	Year	2013

Primary Antenna

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?	No
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	Yes
	Will antenna be located on or in close proximity to an antenna farm?	Yes
New Antenna Manufacturer and Types	Class	Class A
	Mounting	Side Mount
	Antenna position in stack	Middle
	Polarization	Circular
	Type	Other
	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	16 Bay Circular Polarized Antenna
	ERP:	15.0 kW
	Manufacturer
	Model	TLP-16M
	Year	2017
	Justification for New Antenna	Current antenna will not tune to the new channel.

Primary Antenna

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

Other Antenna Cost Not Listed

Name	Description
Mask Filter	Mask filter required for new station location

Transmission Line

Section	Question	Response
Transmission Line Related Expenses	Do you have transmission line related expenses?	No

Tower Equipment And Rigging Costs

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

Primary Tower

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)	Yes
	Others Types of Users	No
	Is tower documented for structural analysis?	Yes
	Is tower compliant with Rev G?	Yes
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1030952
Coordinates (NAD83)	Latitude (NAD83)	27° 49' 47.1" N-
	Longitude (NAD83)	082° 15' 58.3" W-
	Overall Structure Height	1574.13 feet
	Support Structure Height	1451.75 feet
	Ground Elevation Above Mean Sea Level (AMSL)	74.80 feet
	Structure Type	GTOWER - Guyed Structure Used for Communication Purposes
	Tower Owner	American Towers LLC
	Date Constructed	02/01/2018

FM, AM or TV radio broadcasters. Facility ID's, Call Signs and Services of other broadcast stations with whom the tower is shared

Facility ID	Call Sign	Service
74112	WTOG	DTV

Primary Tower

Tower Rigging Costs

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

Primary Tower

Other Tower Expenses Not Listed

Information not provided.

Primary Tower

Add Tower

Section	Question	Response
Existing Tower Description	Type of change	Modify Existing
	Tower Use	Primary (Main)
	Description of Use	N/A
	Ownership	Leased
	Is this tower consider Complex?	No
	Is this tower currently shared with any other stations?	Yes
	One or more FM, AM or TV radio broadcaster(s)	Yes
	Others Types of Users	No
	Is tower documented for structural analysis?	No
	Is tower compliant with Rev G?	Yes
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1057473
Coordinates (NAD83)	Latitude (NAD83)	27° 49' 10.8" N-
	Longitude (NAD83)	082° 15' 38.0" W-
	Overall Structure Height	1592.83 feet
	Support Structure Height	1443.88 feet
	Ground Elevation Above Mean Sea Level (AMSL)	75.13 feet
	Structure Type	GTOWER - Guyed Structure Used for Communication Purposes
	Tower Owner	American Towers LLC
	Date Constructed	09/07/2011

FM, AM or TV radio broadcasters. Facility ID's, Call Signs and Services of other broadcast stations with whom the tower is shared

Facility ID	Call Sign	Service
23078	WMTX	FM
168481	WTBT-LD	LPD
47459	WMNF	FM
29732	WFLZ-FM	FM
74200	WWRM	FM
66013	WPOI	FM

Primary Tower

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:	No reinforcements needed

Primary Tower

Tower Rigging Costs

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

Primary Tower

Other Tower Expenses Not Listed

Name	Description
Tower permit drawing package	Tower permit drawing package

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	100
	Explanation	Project management fee for pre-construction services; management of timelines and schedules occurring during repack
Outside RF consulting Engineering Services	Perform engineering study for new channel assignment and antenna development	Yes
	Prepare engineering section of Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare engineering section of Form FCC License to Cover Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	No
	Quantity	N/A
	Do you have Distributed Transmission System engineering services?	N/A
	Critical Facility	N/A
	Terrain-Shielded Facility	N/A
Attorney and Other Outside Consulting Services	Prepare and file Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare and file Form FCC License to Cover Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	No
	Quantity	N/A
	NEPA Section 106 environmental review	No
	Environmental Assessment	No
	ASR Modification	No
	FAA Consultation (including preparation of FAA Form 7460)	No
	Negotiation of Lease and other Matter for Shared Locations	No
	Prepare or Review FCC Form 399 for Reimbursement	Yes
	Address transition timing and coordination issues w/ other stations and wireless providers	Yes
RF Field Engineering Services	Comprehensive coverage verification via field study	No
	RF exposure measurements	No
	Additional Field Engineering Service	Yes
	Number of Days	4
	Justification	On-site engineering for project management, to include scheduling and coordinating installation at shared transmitter facility.

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Name	Description
Attorney - Other Services	Outside Professional Services - Attorney - Other Services
Site Coordination - Other Service	Site coordination meeting management
Tower Move Project Management	Project Management for Tower Analysis and Relocation

Other Expenses

Section	Question	Response
AM Pattern Disturbance	Is an Impact Study needed?	No
AM Pattern Disturbance	Is Remediation needed?	No
Facility Expenses	Name	N/A
	Other Distributed Transmission System Expenses Not listed	N/A
	Name	N/A
	Is Notification of a Medical Facility required as a result of DTV broadcasting?	Yes
Permit and Filing Costs	Local Zoning	Yes
	Non-zoning permits	No
	BLM or NFS Coordination	No
	FCC Construction Permit Minor Change	Yes
	FCC License to Cover Application	Yes
	FCC Special Temporary Authority Application	No
Other Miscellaneous Expenses	Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)?	Yes
	Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs?	Yes
	Does this relocation require Equipment Storage?	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?	Yes

Other Expenses

Other Expenses Not Listed

Information not provided.

Cost Information

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	$126,000.00	$106,420.00	N/A	$106,420.00	N/A
Total for all systems	$722,373.00	$553,070.53	N/A	$336,000.78	N/A
Primary Transmitter TRN-U-2000-FA	$126,000.00	$106,420.00		$106,420.00
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW	$126,000.00	$106,420.00	N/A	$106,420.00	N/A

Components

Actual Information Description	File Name
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW	Component Description: New transmitter including installation Amount: $106,420.00

Cost Information

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	$36,318.00	$57,840.53	N/A	$54,552.53	N/A
Total for all systems	$722,373.00	$553,070.53	N/A	$336,000.78	N/A
Primary Antenna TLP-16M	$36,318.00	$57,840.53		$54,552.53
Mask Filter	$3,288.00	$3,288.00	Invoiced amount from Dielectric for installation of mask filter	$0.00	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$6,400.00	N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic	$26,300.00	$48,152.53	Invoiced costs from Dielectric and RF Specialties for antenna and mounting hardware	$48,152.53	Invoiced cost from Dielectric and RF Specialties South

Components

Actual Information Description	File Name
Mask Filter	Component Description: New mask filters Amount: $3,288.00
Sweep test of existing antenna	Component Description: Repack Sweep Amount: $6,400.00 Component Description: Repack Sweep Amount: $6,400.00
UHF - Lower Power Side Mount, Class A One Station antenna -- basic	Component Description: Antenna mounting hardware Amount: $3,159.48 Component Description: Antenna Amount: $28,189.60 Component Description: Custom Mounts for Antenna Amount: $14,049.69 Component Description: Florida sales tax on custom mounts Amount: $937.38 Component Description: Florida Sales Tax on Antenna Amount: $1,816.38 Component Description: Custom mounts for WSPF-CD antenna Amount: $9,544.00 Component Description: UHF High Power Side Mount antenna Amount: $28,189.60

Cost Information

Transmission Line

Information not provided.

Cost Information

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	$478,300.00	$300,185.00	N/A	$147,585.00	N/A
Total for all systems	$722,373.00	$553,070.53	N/A	$336,000.78	N/A
Primary Tower GTOWER	$241,500.00	$173,885.00		$147,585.00
Tower permit drawing package	$4,700.00	$4,700.00	Estimate provided by American Tower	$4,700.00	N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	$26,300.00	$26,300.00	N/A	$0.00	N/A
Tall Tower (greater than 500')	$210,500.00	$142,885.00	N/A	$142,885.00	Invoiced amounts from Tower owner and tower serving company
Primary Tower GTOWER	$236,800.00	$126,300.00		$0.00
Tall Tower (greater than 500')	$210,500.00	$100,000.00	N/A	N/A	N/A
Tower permit drawing package	$0.00	$0.00	N/A	N/A	N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	$26,300.00	$26,300.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Tower permit drawing package	Component Description: Tower Permit Drawing Package Amount: $4,700.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	Information not provided.
Tall Tower (greater than 500')	Component Description: Structural engineering for tower modifications Amount: $5,200.00 Component Description: Balance upon completion Amount: $73,683.00 Component Description: Capital contribution to tower owner for required upgrades Amount: $5,400.00 Component Description: Project management fees to tower owner Amount: $9,480.00 Component Description: Deposit Amount: $49,122.00
Tall Tower (greater than 500')	Information not provided.
Tower permit drawing package	Information not provided.
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	Information not provided.

Cost Information

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	$59,260.00	$66,730.00	N/A	$17,881.25	N/A
Total for all systems	$722,373.00	$553,070.53	N/A	$336,000.78	N/A
Outside Professional Services	$59,260.00	$66,730.00		$17,881.25
Attorney - Other Services	$4,500.00	$4,500.00	Consultation on reimbursable expenses and compliance with legal requirements; filing of required reports; addressing unexpected condemnation of existing tower	$3,913.75	Actual invoiced costs arising from tower condemnation
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	N/A	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$2,000.00	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	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
Prepare and or review reimbursement form	$2,630.00	$15,000.00	See actual invoiced costs to date	$10,107.50	Actual invoiced costs for Form 399 preparation and filing
Project management of the transition	$15,800.00	$12,000.00	N/A	N/A	N/A
Tower Move Project Management	$9,480.00	$9,480.00	N/A	N/A	N/A
Site Coordination - Other Service	$2,500.00	$2,500.00	Site Coordination meeting estimate per American Tower	N/A	N/A
Additional Field Engineering Service, 4 Days	$2,000.00	$2,000.00	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	$813.75	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$5,000.00	N/A	$1,046.25	N/A

Components

Actual Information Description	File Name
Attorney - Other Services	Component Description: Prepare and file quarterly transition status report Amount: $250.00 Component Description: Review status of repack Amount: $348.75 Component Description: Review and prepare transition progress reports Amount: $341.25 Component Description: Preparation and filing of quarterly transition status report Amount: $168.75 Component Description: Preparation and filing of quarterly transition status report Amount: $250.00 Component Description: Prepare and file transition progress reports; review and discuss other transition issues Amount: $857.50 Component Description: Correcting erroneous duplicate submission of invoiced amount Amount: ($250.00) Component Description: Preparation and filing of quarterly transition status report Amount: $250.00 Component Description: Research, analyze, and discuss issues re required tower relocation due to condemnation Amount: $1,215.00 Component Description: Prepare and file quarterly transition status report Amount: $250.00 Component Description: Review, research and discuss repack timing Amount: $232.50
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: Preparation of CP Mod application Amount: $1,000.00 Component Description: Preparation of CP modification application Amount: $1,000.00
Perform engineering study for new channel assignment and antenna development	Information not provided.
Address transition timing and coordination issues w/ other stations and wireless	Information not provided.
Prepare and or review reimbursement form	Component Description: Preparation and filing of Form 399 reimbursement request Amount: $2,250.00 Component Description: Preparation of Form 399 reimbursement request Amount: $3,000.00 Component Description: Preparation of Form 399 reimbursement request Amount: $1,232.50 Component Description: Preparation of Form 399 reimbursement request Amount: $875.00 Component Description: Preparation of form 399 reimbursement request Amount: $1,000.00 Component Description: Preparation of Form 399 reimbursement request Amount: $1,000.00 Component Description: Preparation of Form 399 reimbursement request Amount: $625.00 Component Description: Preparation of Form 399 reimbursement request Amount: $125.00
Project management of the transition	Information not provided.
Tower Move Project Management	Information not provided.
Site Coordination - Other Service	Information not provided.
Additional Field Engineering Service, 4 Days	Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Component Description: Preparation and filing of covering license application Amount: $813.75
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: Preparation and filing of minor modification CP application Amount: $1,046.25

Cost Information

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	$22,495.00	$21,895.00	N/A	$9,562.00	N/A
Total for all systems	$722,373.00	$553,070.53	N/A	$336,000.78	N/A
Other Expenses	$22,495.00	$21,895.00		$9,562.00
MVPD Notification of Channel Change	$1,000.00	$1,000.00	N/A	N/A	N/A
Develop and air announcement of upcoming channel change	$500.00	$500.00	N/A	N/A	N/A
Equipment Delivery and Handling Charges	$2,000.00	$2,000.00	N/A	N/A	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$5,000.00	$5,000.00	N/A	N/A	N/A
Local Zoning	$1,000.00	$1,000.00	Invoiced permitting cost per American Tower	$1,000.00	Invoices amount from American Tower
FCC Filing Fees - Form 2100 license to cover application	$335.00	$325.00	N/A	N/A	N/A
FCC Filing Fees - Form 2100 minor change CP application	$1,110.00	$1,070.00	N/A	N/A	N/A
DTV Medical Facility Notification	$11,550.00	$11,000.00	N/A	$8,562.00	N/A

Components

Actual Information Description	File Name
MVPD Notification of Channel Change	Information not provided.
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Delivery and Handling Charges	Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value)	Information not provided.
Local Zoning	Component Description: Building permits for tower work Amount: $1,000.00
FCC Filing Fees - Form 2100 license to cover application	Information not provided.
FCC Filing Fees - Form 2100 minor change CP application	Information not provided.
DTV Medical Facility Notification	Component Description: Medical facility notification Amount: $8,562.00

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$722,373.00	$553,070.53	$336,000.78

Reimbursement Status

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

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.
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. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. 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). 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. 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. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. 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.	Jose Rodriguez Manager 01/28/2021

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.

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.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
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).
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.
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.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
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.

Jose Rodriguez

Manager

01/28/2021

Certification

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.
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. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. 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. 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. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. 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.	Jose Rodriguez Manager 01/28/2021

Section

Question

Response

Submission of Final Allocation or Accounting Information Statements

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.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
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.
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.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
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.

Jose Rodriguez

Manager

01/28/2021

(REFERENCE COPY - Not for submission) FCC Form 399: Reimbursement Request

Applicant Information

Applicant Name, Type, and Contact Information

Reimbursement Contact Information

Reimbursement Contact Name and Information

Preparer Contact Information

Preparer Contact Name and Information

Broadcaster Information and Transition Plan

Transmitters

Primary Transmitter

Add Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Antennas

Primary Antenna

Existing Antenna Information

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Transmission Line

Tower Equipment And Rigging Costs

Primary Tower

Existing Tower

FM, AM or TV radio broadcasters. Facility ID's, Call Signs and Services of other broadcast stations with whom the tower is shared

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

Primary Tower

Add Tower

FM, AM or TV radio broadcasters. Facility ID's, Call Signs and Services of other broadcast stations with whom the tower is shared

Primary Tower

Tower Modification Costs

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Cost Information

Tower Equipment and Rigging Costs

Components

Cost Information

Outside Professional Services

Components

Cost Information

Other Expenses

Components

Cost Information

Grand Total

Reimbursement Status

Certification

Certification

Attachments