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:
70097
Service:
DCA
Call Sign:
WGTB-CD
Channel:
27 (UHF)
File Number:
0000028547
FRN:
0009330457
Date Submitted:
02/22/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

VICTORY CHRISTIAN CENTER, INC.

Company

Doing Business As: VICTORY CHRISTIAN CENTER, INC.

Lynne Jackson

P.O. BOX 16408

CHARLOTTE, NC 28297

United States

+1 (704) 602-6028 ljackson@vccenter.net Other

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan Purchase main ANTENNA and MASK FILTER. Purchase an interim TRANSMITTER, ANTENNA and TRANSMISSION LINE. Install interim transmission system. Move to interim transmission system while replacement of main antenna is underway.

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 Retune Existing
Use Primary (Main)
Ownership Owned
Owner 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 HARRIS
Model UAX-500AT
Year 2012
Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1 kW

Primary Transmitter

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Retuning Transmitter Costs

Section Question Response
New IOT Tubes Number of Tubes (including accessories) needed N/A
New Mask Filter
Power 3 kW
Other Power N/A
New Exciter Is a new exciter needed? No

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? 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

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type 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: 1.3 kW
Manufacturer
Model AL8W-28
Year 2012

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type 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: 15.0 kW
Manufacturer
Model ALP16L4-ESW-27
Year 2020
Justification for New Antenna REPACK CHANNEL CHANGE

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 1 5/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Custom Mounts

Custom Mounts

Pattern Scatter Analysis

Pattern Scatter Analysis

Fine Matcher

Fine Matcher

UHF Filter System

UHF Filter System

SPX Model A600C Air Dryer

SPX Model A600C Air Dryer

Universal Brackets

Universal Brackets

Original Part ID and Price Obsolete For Liquid Tite Conduit Kit

Original Part ID and Price Obsolete For Liquid Tite Conduit Kit

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Air
Diameter Other
Other Diameter 2 1/4 inches
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 0
Length 1400 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Air
Diameter 3 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 1350 feet per run
Justification for New Transmission Line A sweep of the existing line determined it to be unusable.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Splice kit

Splice kit

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? 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 Yes
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
ASR Number 1006705
Coordinates (NAD83) Latitude (NAD83) 35° 21' 44.5" N-
Longitude (NAD83) 081° 09' 18.3" W-
Overall Structure Height 1943.55 feet
Support Structure Height 1887.44 feet
Ground Elevation Above Mean Sea Level (AMSL) 805.76 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Fox Television Stations, LLC
Date Constructed 01/01/1986

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
20624 WMYT-TV DTV
73152 WJZY DTV
74194 WHQC FM
53975 WNKS FM
6586 WPEG FM

Other Types of Users

Users
WQPA823
KPJ464
WLJ547
WMW670
WPNC378
WPNF947

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 documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: No reinforcements needed

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Addl Materials for Messenger Conduit

Addl Materials for Messenger Conduit

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 300
Explanation Do not have enough in-house staff to execute and manage this project. Antenna is 25 miles way from studio.
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 No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) Yes
Negotiation of Lease and other Matter for Shared Locations 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 Yes
RF exposure measurements Yes
Additional Field Engineering Service Yes
Number of Days 21
Justification Verify system compliance

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Other Engineering Services

Other Engineering Services

Other Expenses

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

Other Expenses

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Other Expenses Not Listed

Name Description

Port boot cushion

Port boot cushion

Additional parts for entry port to finish the install

Additional parts for entry port to finish the install

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 $109,355.00 $109,355.00 N/A $0.00 N/A
Total for all systems $709,815.42 $644,352.80 N/A $416,876.46 N/A
Primary Transmitter UAX-500AT $109,355.00 $109,355.00 $0.00
UHF and VHF - minor banding issues $105,200.00 $105,200.00 N/A N/A N/A
3 kW mask filter $4,155.00 $4,155.00 N/A N/A N/A

Components

Information not provided.

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 $58,698.00 $68,371.72 N/A $61,471.72 N/A
Total for all systems $709,815.42 $644,352.80 N/A $416,876.46 N/A
Primary Antenna ALP16L4-ESW-27 $58,698.00 $68,371.72 $61,471.72
Pattern Scatter Analysis $4,800.00 $4,800.00 See attached / uploaded PDF file titled "ERI WGTB-37828A-3 v200817jgv1.pdf" $4,800.00 N/A
Elbow complex, single channel, 1 5/8” input (if needed) $6,900.00 $6,900.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $25,686.72 See attached / uploaded PDF files titled "Cesium 2020-0215A v200311jgv1.pdf", "ERI WGTB-37828A v200602jgv1.pdf" and "ERI WGTB-37828I v201027jgv1.pdf" $25,686.72 N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $17,017.00 See attached / uploaded PDF files titled "ERI WGTB-37828A v200602jgv1.pdf" and "ERI WGTB-37828A-2 v200817jgv1.pdf" $17,017.00 N/A
Original Part ID and Price Obsolete For Liquid Tite Conduit Kit $0.00 $0.00 See attached / uploaded PDF file titled "ERI WGTB-56639b v210128jgv2.pdf" $0.00 N/A
Custom Mounts $0.00 $0.00 See attached / uploaded PDF file titled "ERI WGTB-56639b v210128jgv2.pdf" $0.00 N/A
Universal Brackets $1,905.00 $1,905.00 See attached / uploaded PDF file titled "ERI WGTB-56639b v210128jgv2.pdf" $1,905.00 N/A
SPX Model A600C Air Dryer $4,590.00 $4,590.00 See attached / uploaded PDF file titled "ERI WGTB-56639b v210128jgv2.pdf" $4,590.00 N/A
Fine Matcher $1,275.00 $1,275.00 See attached / uploaded PDF file titled "ERI WGTB-37828I v201027jgv1.pdf" $1,275.00 N/A
UHF Filter System $6,198.00 $6,198.00 See attached / uploaded PDF file titled "ERI WGTB-37828A v200602jgv1.pdf" $6,198.00 N/A

Components

Actual Information Description File Name
Pattern Scatter Analysis

Component Description:
ERI WGTB-37828A-3 v200817jgv1
Amount:
$4,800.00
Elbow complex, single channel, 1 5/8” input (if needed) Information not provided.
Sweep test of existing antenna

Component Description:
Cesium 2020-0215A v200311jgv1
Amount:
$12,686.72

Component Description:
ERI WGTB-56639b v210128jgv2
Amount:
$625.00

Component Description:
ERI WGTB-37828A v200602jgv1
Amount:
$3,125.00

Component Description:
ERI WGTB-37828A-2 v200909jgv2
Amount:
$2,500.00

Component Description:
ERI WGTB-56607 v201201jgv1
Amount:
$3,375.00

Component Description:
ERI WGTB-37828I v201027jgv1
Amount:
$3,375.00
UHF - Lower Power Side Mount, Class A One Station antenna -- basic

Component Description:
ERI WGTB-37828A v200602jgv1
Amount:
$8,508.50

Component Description:
ERI WGTB-37828A-2 v200909jgv2
Amount:
$8,508.50
Original Part ID and Price Obsolete For Liquid Tite Conduit Kit

Component Description:
ERI WGTB-56639b v210128jgv2
Amount:
N/A
Custom Mounts

Component Description:
ERI WGTB-56639b v210128jgv2
Amount:
N/A

Component Description:
ERI WGTB-37828A v200602jgv1
Amount:
N/A
Universal Brackets

Component Description:
ERI WGTB-56639b v210128jgv2
Amount:
$1,905.00
SPX Model A600C Air Dryer

Component Description:
ERI WGTB-56639b v210128jgv2
Amount:
($117.30)

Component Description:
ERI WGTB-37828A v200602jgv1
Amount:
$2,353.65

Component Description:
ERI WGTB-37828A-2 v200909jgv2
Amount:
$2,353.65
Fine Matcher

Component Description:
ERI WGTB-37828I v201027jgv1
Amount:
$637.50

Component Description:
ERI WGTB-56607 v201201jgv1
Amount:
$637.50
UHF Filter System

Component Description:
ERI WGTB-37828A v200602jgv1
Amount:
$3,099.00

Component Description:
ERI WGTB-37828A-2 v200909jgv2
Amount:
$3,099.00

Component Description:
ERI WGTB-37828A-2 v200909jgv2
Amount:
$3,099.00

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $81,540.09 $57,531.76 N/A $57,531.76 N/A
Total for all systems $709,815.42 $644,352.80 N/A $416,876.46 N/A
Primary Transmission Line $81,540.09 $57,531.76 $57,531.76
Flexible Air Transmission Line - dielectric, 3" $79,650.00 $55,641.67 See attached / uploaded PDF files titled "ERI WGTB-37828A v200602jgv1.pdf", "ERI 56193 v200828jgv1.pdf" and "ERI WGTB-56639b v210128jgv2.pdf" $55,641.67 N/A
Splice kit $1,890.09 $1,890.09 See attached / uploaded PDF file titled "ERI 56225 v200911jgv1.pdf" $1,890.09 N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 3"

Component Description:
ERI WGTB-56639b v210128jgv2
Amount:
$117.30

Component Description:
ERI WGTB-37828A v200602jgv1
Amount:
$27,498.14

Component Description:
ERI 56193 v200828jgv1
Amount:
$528.08

Component Description:
ERI WGTB-37828A-2 v200909jgv2
Amount:
$27,498.15
Splice kit

Component Description:
ERI 56225 v200911jgv1
Amount:
$1,890.09

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 $224,136.15 $211,893.14 N/A $211,893.14 N/A
Total for all systems $709,815.42 $644,352.80 N/A $416,876.46 N/A
Primary Tower TOWER $224,136.15 $211,893.14 $211,893.14
Addl Materials for Messenger Conduit $1,036.15 $1,036.15 See attached / uploaded PDF file titled "ERI 57064 v210222jgv1.pdf" $1,036.15 N/A
Tall Tower (greater than 500') $210,500.00 $201,356.99 See attached / uploaded PDF files titled "ERI WGTB-37828A v200602jgv1.pdf", "ERI 56357 v201014jgv1.pdf", "ERI 56635 v201106jgv1.pdf" and "ERI WGTB-56639b v210128jgv2.pdf" $201,356.99 N/A
Structural engineering tower load study for well documented tower $12,600.00 $9,500.00 See attached / uploaded PDF files titled "ERI 37828 v200312jgv1.pdf" and "ERI 55754 v200814jgv1.pdf" $9,500.00 N/A

Components

Actual Information Description File Name
Addl Materials for Messenger Conduit

Component Description:
ERI 57064 v210222jgv1
Amount:
$1,036.15
Tall Tower (greater than 500')

Component Description:
ERI WGTB-37828A-2 v200909jgv2
Amount:
$67,932.80

Component Description:
ERI WGTB-56639b v210128jgv2
Amount:
$16,983.19

Component Description:
ERI WGTB-37828A v200602jgv1
Amount:
$84,916.00

Component Description:
ERI 56357 v201014jgv1
Amount:
$3,100.00

Component Description:
ERI 56635 v201106jgv1
Amount:
$28,425.00
Structural engineering tower load study for well documented tower

Component Description:
ERI 55754 v200814jgv1
Amount:
$4,000.00

Component Description:
ERI 37828 v200312jgv1
Amount:
$5,500.00

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $209,855.00 $170,970.00 N/A $82,298.66 N/A
Total for all systems $709,815.42 $644,352.80 N/A $416,876.46 N/A
Outside Professional Services $209,855.00 $170,970.00 $82,298.66
Other Engineering Services $14,390.00 $14,390.00 Cost estimate for other engineering services such as RF calculations, evolving transition plan calculations, bid spec prep / distribution / award recommendation / etc and discussion, etc. $14,390.00 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $36,300.00 See attached / uploaded PDF file titled "Accepted WGTB RF Testing Proposal 20200618 v200702jgv1.pdf" $24,880.00 N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,105.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,680.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,365.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,260.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $2,050.00 $2,050.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,250.00 N/A $1,250.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,155.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,360.00 N/A N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,630.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $11,975.00 The Estimated Cost includes Form 399 submissions including ongoing Actual Cost invoice prep and submission, and amendments as needed. $11,975.00 N/A
Project management of the transition $47,400.00 $47,400.00 N/A $28,113.66 N/A
Additional Field Engineering Service, 21 Days $10,000.00 $10,000.00 N/A $1,690.00 N/A
RF Exposure Measurements $21,050.00 $21,050.00 N/A N/A N/A

Components

Actual Information Description File Name
Other Engineering Services

Component Description:
Osborn 38989 v200811jgv1
Amount:
$13,465.00

Component Description:
Osborn 39305 v200811jgv1
Amount:
$925.00
Comprehensive coverage verification via field study, if needed

Component Description:
Osborn 41105 v210105jgv1
Amount:
$24,880.00
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization 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 Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Osborn 40012 v200923jgv1
Amount:
$1,250.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
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:
Osborn 41472 v210222jgv1
Amount:
$775.00

Component Description:
Osborn 39659 v200826jgv1
Amount:
$1,850.00

Component Description:
Osborn 40012 v200923jgv1
Amount:
$825.00

Component Description:
Osborn 40430 v201027jgv1
Amount:
$2,925.00

Component Description:
Osborn 38281 v200604pmv1
Amount:
$200.00

Component Description:
Osborn 39305 v200811jgv1
Amount:
$2,350.00

Component Description:
Osborn 38989 v200811jgv1
Amount:
$50.00

Component Description:
Osborn 41101 v210104jgv1
Amount:
$675.00

Component Description:
Osborn 38739 v200611jgv1
Amount:
$1,200.00

Component Description:
Osborn 40759 v201204jgv1
Amount:
$1,125.00
Project management of the transition

Component Description:
Osborn 41472 v210222jgv1
Amount:
$316.00

Component Description:
Osborn 38739 v200611jgv1
Amount:
$3,082.00

Component Description:
Osborn 38989 v200811jgv1
Amount:
$4,345.00

Component Description:
Osborn 40759 v201204jgv1
Amount:
$790.00

Component Description:
Osborn 40012 v200923jgv1
Amount:
$6,632.66

Component Description:
Osborn 40430 v201027jgv1
Amount:
$1,343.00

Component Description:
Osborn 39305 v200811jgv1
Amount:
$4,029.00

Component Description:
Osborn 38281 v200604pmv1
Amount:
$4,108.00

Component Description:
Osborn 41101 v210104jgv1
Amount:
$237.00

Component Description:
Osborn 39659 v200826jgv1
Amount:
$3,231.00
Additional Field Engineering Service, 21 Days

Component Description:
Modern BSI 2165 v200225jgv2
Amount:
$1,690.00
RF Exposure Measurements 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 $26,231.18 $26,231.18 N/A $3,681.18 N/A
Total for all systems $709,815.42 $644,352.80 N/A $416,876.46 N/A
Other Expenses $26,231.18 $26,231.18 $3,681.18
Port boot cushion $60.00 $60.00 See attached / uploaded PDF file titled "Full Wave 90 v201027jgv1.pdf" $60.00 N/A
MVPD Notification of Channel Change $5,000.00 $5,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $3,000.00 $3,000.00 N/A N/A N/A
Equipment Storage $500.00 $500.00 N/A N/A N/A
Additional parts for entry port to finish the install $253.98 $253.98 See attached / uploaded PDF file titled "ERI 56554 v210114jgv1.pdf" $253.98 N/A
Equipment Delivery and Handling Charges $3,367.20 $3,367.20 See attached / uploaded PDF files titled "ERI 56193 v200828jgv1.pdf", "ERI WGTB-56607 v201201jgv1.pdf" and "ERI WGTB-56639b v210128jgv2.pdf" $3,367.20 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,500.00 $2,500.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,550.00 N/A N/A N/A

Components

Actual Information Description File Name
Port boot cushion

Component Description:
Full Wave 90 v201027jgv1
Amount:
$60.00
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
Additional parts for entry port to finish the install

Component Description:
ERI 56554 v210114jgv1
Amount:
$253.98
Equipment Delivery and Handling Charges

Component Description:
ERI WGTB-56607 v201201jgv1
Amount:
$16.94

Component Description:
ERI 56193 v200828jgv1
Amount:
$82.08

Component Description:
ERI WGTB-56639b v210128jgv2
Amount:
$3,268.18
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
DTV Medical Facility Notification Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $709,815.42 $644,352.80 $416,876.46

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.

Jeffrey C Gehman

Engineering Associate


02/22/2021

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.

Jeffrey C Gehman

Engineering Associate


02/22/2021

Attachments

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