Skip to main content Skip to footer and contact information
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:
68135
Service:
DCA
Call Sign:
WYLN-LP
Channel:
26 (UHF)
File Number:
0000028239
FRN:
0005012992
Date Submitted:
05/19/2021

Applicant Information

Back to Top ↑

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

TRIPLE J COMMUNITY BROADCASTING., L.L.C.

Doing Business As: TRIPLE J COMMUNITY BROADCASTING., L.L.C.

Pat Gans

1055 EAST 10TH STREET

HAZLETON, PA 18201

United States

 +1 (570) 459-1869 theresagmi@ptd.net Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 

Preparer Contact Information

Back to Top ↑

Preparer Contact Name and Information

Applicant Address Phone Email

Clarence M Beverage

Broadcast Engineering Consultant

Communications Technologies, Inc.

PO Box 1130

Marlton, NJ 08053

United States

 +1 (609) 451-5296 cbeverage@commtechrf.com

Broadcaster Information and Transition Plan

Back to Top ↑
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 Not Applicable

Transmitters

Back to Top ↑
Section Question Response
Transmitter Related Expenses Do you have transmitter related expenses? Yes

Primary Transmitter

Back to Top ↑

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 Rohde & Schwarz
Model SCx8302E
Year 2015
Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 0.9 kW

Primary Transmitter

Back to Top ↑

Retuning Transmitter Costs

Section Question Response
New IOT Tubes Number of Tubes (including accessories) needed N/A
New Mask Filter
Power 1.5 kW
Other Power N/A
New Exciter Is a new exciter needed? No

Primary Transmitter

Back to Top ↑

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

Back to Top ↑

Other Transmitter Cost Not Listed

Information not provided.

Antennas

Back to Top ↑
Section Question Response
Antenna Related Expenses Do you have antenna related expenses? Yes

Primary Antenna

Back to Top ↑

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 Broadband Panel
Number of Stations Supported 1
Number of Panels 8
Design power capacity in use 90.0 %
Lower Limit 560.00 MHz
Upper Limit 656.00 MHz
Other Antenna Type N/A
ERP: 15.0 kW
Manufacturer
Model 4DR
Year 1995

Primary Antenna

Back to Top ↑

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? No
New Antenna Manufacturer and Types Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels/Bays 8
Lower Limit 470.00 MHz
Upper Limit 560.00 MHz
Design power capacity in use 90.0 %
Other Antenna Type N/A
ERP: 4.55 kW
Manufacturer
Model 4DR
Year 2017
Justification for New Antenna Existing antenna can not be retuned and has outlived its expected life

Primary Antenna

Back to Top ↑

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? 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

Back to Top ↑

Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

Back to Top ↑

Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Foam
Diameter 7/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 150 feet per run

Primary Transmission Line

Back to Top ↑

New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Foam
Diameter 7/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 150 feet per run
Justification for New Transmission Line Old line in place since 1995 and has outlived its useful life

Primary Transmission Line

Back to Top ↑

Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

Back to Top ↑

Existing 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? Located on Building
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? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1060097
Coordinates (NAD83) Latitude (NAD83) 40° 58' 10.0" N-
Longitude (NAD83) 075° 57' 23.0" W-
Overall Structure Height 98.42 feet
Support Structure Height 98.42 feet
Ground Elevation Above Mean Sea Level (AMSL) 1879.90 feet
Structure Type BANT - Building with an Antenna
Tower Owner GANS MULTIMEDIA PARTNERSHIP
Date Constructed 07/01/1990


Primary Tower

Back to Top ↑

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

Back to Top ↑

Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Located on Building
Helicopter Services Required Are helicopter services required? No

Primary Tower

Back to Top ↑

Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

Back to Top ↑
Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 595
Explanation Coordination for testing, tower crew scheduling, order coordination, and 399 prep.
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 3
Justification SUPERVISE RIGGERS, INSTALL FILTER, RETUNE AND PROOF TRANSMITTER

Outside Professional Services Costs

Back to Top ↑

Other Professional Services Expenses Not Listed

Name Description

Attorney Fees and Other Matters

Legal Services

Other Expenses

Back to Top ↑
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? 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

Back to Top ↑

Other Expenses Not Listed

Name Description

Internal Labor Costs

Repack work performed in-house

Cost Information

Back to Top ↑

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 $108,230.00 $17,800.00 N/A $11,750.00 N/A
Total for all systems $783,213.50 $272,576.61 N/A $202,935.52 N/A
Primary Transmitter SCx8302E $108,230.00 $17,800.00 $11,750.00
UHF and VHF - minor banding issues $105,200.00 $15,000.00 N/A $11,750.00 N/A
1.5 kW mask filter $3,030.00 $2,800.00 CHANNEL CHANE EXISTING FILTER CANNOT BE RETUNED N/A N/A

Components

Actual Information Description File Name
UHF and VHF - minor banding issues

Component Description:
Contract Engineering Services
Amount:
$11,750.00
1.5 kW mask filter Information not provided.

Cost Information

Back to Top ↑

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 $43,110.00 $28,165.24 N/A $25,165.23 N/A
Total for all systems $783,213.50 $272,576.61 N/A $202,935.52 N/A
Primary Antenna 4DR $43,110.00 $28,165.24 $25,165.23
Sweep test of existing antenna $6,730.00 $3,000.00 N/A N/A N/A
UHF - Lower Power Side Mount, Class A broadband panel (cost per panel) $10,080.00 $0.00 QUOTE FROM SJ RAMER FROM SCALA WITH SHIPPING N/A N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $25,165.24 QUOTE 1835R FROM SJ RAMER FROM SCALA WITH SHIPPING, Invoice 19026. $25,165.23 N/A

Components

Actual Information Description File Name
Sweep test of existing antenna Information not provided.
UHF - Lower Power Side Mount, Class A broadband panel (cost per panel) Information not provided.
UHF - Lower Power Side Mount, Class A One Station antenna -- basic

Component Description:
UHF H-Pol panel antenna, 470-862 MHz, 1.2 kW
Amount:
$25,165.23

Cost Information

Back to Top ↑

Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate 		Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,650.00 $1,500.00 N/A $0.00 N/A
Total for all systems $783,213.50 $272,576.61 N/A $202,935.52 N/A
Primary Transmission Line $1,650.00 $1,500.00 $0.00
Flexible Foam Transmission Line - dielectric, 7/8" $1,650.00 $1,500.00 N/A $0.00 N/A

Components

Information not provided.

Cost Information

Back to Top ↑

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 $447,300.00 $44,400.00 N/A $44,400.00 N/A
Total for all systems $783,213.50 $272,576.61 N/A $202,935.52 N/A
Primary Tower BANT $447,300.00 $44,400.00 $44,400.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $35,200.00 See Justifying Quote - WYLN Convergence Communications LLC Proposal #15050701, Lines 2, 3 and 4 $35,200.00 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $9,200.00 Please see the attached invoice from CONVERGENCE Communications, LLC # 083012 $9,200.00 N/A

Components

Actual Information Description File Name
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
"INSTALLATION OF NEW ANTENNA, MOUNTING SYSTEM, WAVEGUIDE, REQUIRED CABLING SUPPORTS."
Amount:
$35,200.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
TOWER STRUCTURAL MAPPING AND ANALYSIS
Amount:
$9,200.00

Cost Information

Back to Top ↑

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 $126,474.50 $126,812.37 N/A $94,383.09 N/A
Total for all systems $783,213.50 $272,576.61 N/A $202,935.52 N/A
Outside Professional Services $126,474.50 $126,812.37 $94,383.09
Project management of the transition $94,010.00 $99,675.00 per quote $79,766.85 N/A
Attorney Fees and Other Matters $2,984.50 $2,984.50 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $2,984.50 N/A
Additional Field Engineering Service, 3 Days $4,500.00 $4,500.00 PER QUOTE N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $3,503.00 Please see Estimated Cost Justification WYLN-550-Attorney - License to Cover Application (Main) v0 $3,503.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $1,228.87 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,250.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $1,750.00 N/A $1,750.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $1,500.00 N/A $500.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,000.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $4,649.87 Womble Bond Dickinson invoices #2648035, #2656709 $4,649.87 N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Project Management
Amount:
$1,665.45

Component Description:
THIRD QUARTER 387 REPORT PREPARATION POST PROJECT REVIEW
Amount:
$185.00

Component Description:
Project Management
Amount:
$3,696.80

Component Description:
Project management
Amount:
$3,782.05

Component Description:
Project Management
Amount:
$3,295.50

Component Description:
Project management
Amount:
$3,936.05

Component Description:
Project Management
Amount:
$517.50

Component Description:
Project Management
Amount:
$1,165.15

Component Description:
Project Management
Amount:
$2,375.40

Component Description:
Project Management
Amount:
$1,031.80

Component Description:
Project Management
Amount:
$2,402.00

Component Description:
Project Management
Amount:
$93.75

Component Description:
Project management
Amount:
$3,207.70

Component Description:
Project Management
Amount:
$1,722.30

Component Description:
Project Management
Amount:
$2,466.00

Component Description:
Project Management
Amount:
$228.10

Component Description:
Professional Services
Amount:
$177.00

Component Description:
Project management
Amount:
$5,211.80

Component Description:
Project management
Amount:
$446.20

Component Description:
Project Management
Amount:
$609.85

Component Description:
Project Management
Amount:
$1,506.15

Component Description:
Project Management
Amount:
$2,753.10

Component Description:
Project Management
Amount:
$2,040.75

Component Description:
Project Management
Amount:
$3,021.10

Component Description:
Project Management
Amount:
$3,315.40

Component Description:
Project Management
Amount:
$1,191.15

Component Description:
THIRD QUARTER 387 REPORT PREPARATION POST PROJECT REVIEW
Amount:
$185.00

Component Description:
Non Reimbursable
Amount:
N/A

Component Description:
Project Management
Amount:
$489.00

Component Description:
Professional Services
Amount:
$265.50

Component Description:
Project Management
Amount:
$2,318.60

Component Description:
Project Management
Amount:
$2,996.75

Component Description:
Project Management
Amount:
$4,144.45

Component Description:
Project Management
Amount:
$2,865.75

Component Description:
Project management
Amount:
$2,436.70

Component Description:
Project Management
Amount:
$3,336.25

Component Description:
Project Management
Amount:
$1,386.20

Component Description:
Project Management
Amount:
$277.60

Component Description:
Project Management
Amount:
$2,515.35

Component Description:
Project Management
Amount:
$1,656.15

Component Description:
Project Management
Amount:
$2,850.50
Attorney Fees and Other Matters

Component Description:
Professional Service
Amount:
$1,922.00

Component Description:
Professional Services
Amount:
$434.00

Component Description:
Attorney Other Matters
Amount:
$442.50

Component Description:
E-mail exchange and telephone call with Clarence Beverage
Amount:
$186.00
Additional Field Engineering Service, 3 Days Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Professional Services
Amount:
$3,503.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
WYLN Attorney Construction Permit Application
Amount:
$70.62

Component Description:
WYLN-550-Attorney - Construction Permit Application (Main)
Amount:
$1,158.25
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:
FCC MINOR CHANGE APPLICATION FOR CP COORDINATION AND ENGINEERING
Amount:
$1,750.00
Perform engineering study for new channel assignment and antenna development

Component Description:
INVOICE 008403-A STUDY FEE TO CONFIRM THAT WYLN FORM 2100 APPLICATION CAN BE SUCCESSFULLY FILED FOR NEW FREQUENCY
Amount:
$500.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
FCC FORM 399 FORM PREPARATION AND REVIEW IN JUNE AND JULY 2017
Amount:
$555.00

Component Description:
Email exchange and phone call'; review progress reports
Amount:
$177.00

Component Description:
Review 2nd Priority Window Modification Applications and send to client for approval; file and send filed copies
Amount:
$118.00

Component Description:
Legal services
Amount:
$1,412.50

Component Description:
For professional services Rendered through 10/31/2018
Amount:
$372.00

Component Description:
Attention to problem with these stations Forms 1876 relating to the CORES User Name listed; telephone with Theresa
Amount:
$560.50

Component Description:
Legal services
Amount:
$1,454.87

Cost Information

Back to Top ↑

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 $56,449.00 $53,899.00 N/A $27,237.20 N/A
Total for all systems $783,213.50 $272,576.61 N/A $202,935.52 N/A
Other Expenses $56,449.00 $53,899.00 $27,237.20
Internal Labor Costs $24,899.00 $24,899.00 Please see WYLN-CD Internal Labor Budget Justification Letter $23,337.20 N/A
MVPD Notification of Channel Change $7,500.00 $7,500.00 N/A $1,000.00 N/A
Develop and air announcement of upcoming channel change $7,500.00 $7,500.00 N/A $0.00 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 $9,000.00 N/A $2,900.00 N/A
Equipment Delivery and Handling Charges $2,500.00 $2,500.00 N/A N/A N/A

Components

Actual Information Description File Name
Internal Labor Costs

Component Description:
Develop Ads
Amount:
$296.00

Component Description:
Internal Labor for Theresa Velosky
Amount:
$2,116.00

Component Description:
Prepare and Review Reimbursement
Amount:
$625.00

Component Description:
Internal labor for Patricia Gans
Amount:
$5,575.00

Component Description:
Field auxiliary Service report
Amount:
$11,685.00

Component Description:
Internal labor for Joe Kutchi
Amount:
$279.00

Component Description:
will be resubmitted under new invoice name
Amount:
N/A

Component Description:
will be resubmitted under new invoice name
Amount:
N/A

Component Description:
Internal labor for Barry Jais
Amount:
$550.00

Component Description:
will be resubmitted under new invoice name
Amount:
N/A

Component Description:
Internal labor for Michele Jais
Amount:
$1,700.00

Component Description:
will be resubmitted under new invoice name
Amount:
N/A

Component Description:
Pick Up and Storage of Tower
Amount:
$48.00

Component Description:
will be resubmitted under new invoice name
Amount:
N/A

Component Description:
will be resubmitted under new invoice name
Amount:
N/A

Component Description:
will be resubmitted under new invoice name
Amount:
N/A

Component Description:
will be resubmitted under new invoice name
Amount:
N/A

Component Description:
will be resubmitted under new invoice name
Amount:
N/A

Component Description:
Internal Labor for Celeste Samec
Amount:
$463.20

Component Description:
will be resubmitted under new invoice name
Amount:
N/A
MVPD Notification of Channel Change

Component Description:
Prepare letters to MVPDs. Research and contact all relevant MVPD entities
Amount:
$1,000.00
Develop and air announcement of upcoming channel change Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
DTV Medical Facility Notification

Component Description:
Mailing: Print and mail a two page, black and white generically addressed letter with a specifically addressed USPS barcoded route
Amount:
$2,900.00
Equipment Delivery and Handling Charges Information not provided.

Cost Information

Back to Top ↑

Grand Total

Predetermined
Cost Estimate 		Estimated Cost Actual Cost
Total for all systems $783,213.50 $272,576.61 $202,935.52

Reimbursement Status

Back to Top ↑
Question Response
The facility has ceased operating on its pre-auction channel. No
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

Back to Top ↑
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.

Joseph S Gans

owner


05/19/2021

Certification

Back to Top ↑
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.

Joseph S Gans

owner


05/19/2021

Attachments

Back to Top ↑