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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:
10265
Service:
DCA
Call Sign:
KOHC-CD
Channel:
31 (UHF)
File Number:
0000028570
FRN:
0026907345
Date Submitted:
10/07/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

HC2 STATION GROUP, INC.

RENEE ILHARDT

450 Park Avenue

30th Floor

New York, NY 10022

United States

 +1 (954) 606-5486 RILHARDT@HC2BROADCASTING.COM Corporation

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 

Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan Order antenna and transmitter designed to operate on Channel 31 (repack channel), install on tower.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? No
Existing Transmitter Manufacturer and Type Manufacturer
Model 2000 watt
Year 2009
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 2000 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model TRN-5X-U-18-C
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 3 kW
Justification for New Transmitter Old Transmitter is no longer supported and cannot be re tuned to new channel .

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) Yes
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 2 inches
Length 20.0 feet
Other Electrical Service Yes
Description Electrical installation.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 5 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Additional Engineering Time

Additional Engineering Time

Converter Fiber and Fiber Jumper

Converter Fiber and Fiber Jumper

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
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: 15.0 kW
Manufacturer
Model PSILP200I/45
Year 2009

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? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types 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/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 PSILP12OI-31
Year 2018
Justification for New Antenna Old antenna cannot be tuned to work on CH 31.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? 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? 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

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Air
Diameter 1 5/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 300 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Foam
Diameter 7/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 100 feet per run
Justification for New Transmission Line In order to continue operation on CH 45, we will need install new transmission line to the new CH 31 antenna.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change 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? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 35° 21' 46.0" N-
Longitude (NAD83) 097° 26' 57.0" W-
Overall Structure Height 198.00 feet
Support Structure Height 198.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 1443.00 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Ronnie Tutor
Date Constructed 01/01/2000


Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for undocumented/poorly documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: Minor 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

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 150
Explanation Help with preparing the documents.
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 Yes
For Main Facility No
Prepare request for Special Temporary Authority No
Quantity N/A
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Repacking Related Tax Services

Repacking Related Tax Services

Internal Employee Time Costs

Internal Employee Time Costs

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 Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? 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

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Other Expenses Not Listed

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate 		Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $275,719.25 $236,551.75 N/A $61,084.30 N/A
Total for all systems $694,588.37 $628,861.50 N/A $141,140.20 N/A
Primary Transmitter TRN-5X-U-18-C $275,719.25 $236,551.75 $61,084.30
Converter Fiber and Fiber Jumper $409.25 $409.25 N/A $409.25 N/A
Additional Engineering Time $2,990.00 $2,990.00 N/A $2,990.00 N/A
5 Ton system $20,250.00 $19,250.00 N/A $0.00 N/A
Other Electrical Service: Electrical installation. $21,000.00 $21,000.00 N/A $20,382.55 N/A
2" Rigid Conduit and Wiring (Cost per foot) $520.00 $110.00 N/A $110.00 N/A
UHF - Air Cooled Solid State Transmitter 3 kW $36,750.00 $36,750.00 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $36,750.00 N/A
Switchgear - industrial 800 amp $38,200.00 $442.50 N/A $442.50 N/A
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW $155,600.00 $155,600.00 N/A $0.00 N/A

Components

Actual Information Description File Name
Converter Fiber and Fiber Jumper

Component Description:
Converter fiber and fiber jumper. #0807
Amount:
$409.25
Additional Engineering Time

Component Description:
Additional engineering time. #0807
Amount:
$2,990.00
5 Ton system

Component Description:
Please reject this invoice for this category. Invoice added to wrong reimbursement category
Amount:
N/A
Other Electrical Service: Electrical installation.

Component Description:
Transmitter related cost. #1008
Amount:
$4,988.55

Component Description:
Re-quoted Tutor Consulting Invoice on 08/05/2018 for $5,065.00 Accepted by Sunshine on 08/24/2018
Amount:
N/A

Component Description:
Station Air Conditioning upgrades for channel change equipment to be added to facilities.
Amount:
$15,394.00

Component Description:
Electrical upgrades including wiring, meter drop, installation and local permits for work
Amount:
$5,065.00

Component Description:
Supporting Documentation - Quote for Electrical Upgrades
Amount:
N/A

Component Description:
Supporting Documentation Revised Invoice further detailing costs and labor from Tutor Consulting
Amount:
N/A

Component Description:
Supporting Documentation of Vendor Description for Tutor Consulting
Amount:
N/A

Component Description:
Re-statement of Quote originally given by Tutor Consulting for Station Air Conditioning upgrade for Repack resubmitted on 11/01/2018 for Invoice 29170111-01 for $15,394.00.
Amount:
N/A

Component Description:
Transmitter related cost. #1006
Amount:
$15,394.00

Component Description:
Cover Letter clarifying issue date of Aug 01 2018, acceptance on Aug 24 2018, and agreed and revised due date of Aug 28 2018.
Amount:
N/A
2" Rigid Conduit and Wiring (Cost per foot)

Component Description:
Rigid Conduit and wiring. #0807
Amount:
$110.00
UHF - Air Cooled Solid State Transmitter 3 kW

Component Description:
Transmitter cost. #7271-01
Amount:
$36,750.00
Switchgear - industrial 800 amp

Component Description:
Switchgear. #0807
Amount:
$442.50
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW

Component Description:
Converter fiber, Fiber jumper. #0807
Amount:
N/A

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate 		Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $33,030.00 $31,400.00 N/A $25,896.37 N/A
Total for all systems $694,588.37 $628,861.50 N/A $141,140.20 N/A
Primary Antenna PSILP12OI-31 $33,030.00 $31,400.00 $25,896.37
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,025.00 N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $25,000.00 N/A $19,871.37 N/A

Components

Actual Information Description File Name
Sweep test of existing antenna

Component Description:
Supporting Documentation -Quote for Sweeps, Removal and Installation of Antenna
Amount:
N/A

Component Description:
Quote for Sweeps, Removal and Installation of UHF Transmitter
Amount:
N/A

Component Description:
Invoice from Tutor Consulting for Sweeps, Removal and Installation of Transmitter in conjunction with Antenna
Amount:
$1,825.00

Component Description:
Invoice Number 1009 from Tutor Consulting for Sweep of Antenna, removal of old Antenna, and installation of new Antenna to be done in conjunction with transmitter installation
Amount:
$4,200.00

Component Description:
Supporting Documentation Vendor Description Tutor Consulting
Amount:
N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic

Component Description:
Antenna cost, 50% balance adjusted freight. #1996
Amount:
$6,932.50

Component Description:
Antenna cost, 50% down. #P010919-PK4.
Amount:
$7,287.21

Component Description:
Antenna related cost. #21374
Amount:
$2,151.66

Component Description:
Antenna installation cost. #083060
Amount:
$3,500.00

Component Description:
Antenna Manufacturing and Delivery: 50% of the Total Down, Balance due upon completion of manufacturing. Delivery 6-8 weeks.
Amount:
$7,287.22

Component Description:
Supporting Documentation of Final Invoice for 50% order from PSI for Basic UHF - Lower Power Side Mount, Class A One Station antenna to match August 2018 PO and contract
Amount:
N/A

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 $11,000.00 $13,382.28 N/A $13,382.28 N/A
Total for all systems $694,588.37 $628,861.50 N/A $141,140.20 N/A
Primary Transmission Line $11,000.00 $13,382.28 $13,382.28
Flexible Foam Transmission Line - dielectric, 7/8" $1,100.00 $238.00 N/A $238.00 N/A
Flexible Air Transmission Line - dielectric, 1 5/8" $9,900.00 $13,144.28 ***System Notice: Estimate adjusted and locked because line has been superseded.***Actual costs higher than first estimated due to physical layout of facilities of station. See attached letter from Sunshine State Television Network. $13,144.28 N/A

Components

Actual Information Description File Name
Flexible Foam Transmission Line - dielectric, 7/8"

Component Description:
Transmission line cost. #21374
Amount:
$238.00
Flexible Air Transmission Line - dielectric, 1 5/8"

Component Description:
TL related cost. #1005
Amount:
$13,144.28

Component Description:
Costs of transmission line 220ft. Auto Debydrator, hangers, grips, ground kits, adapters, elbows,tower crew installation and Engineering services plus shipping and handling of installation components.
Amount:
$13,144.28

Component Description:
Cover letter to clarify the dates of Tutor Consulting Invoice 1005 issued Aug 01. Sunshine acceptance, Aug 24, and the final due date of the Invoice with agreed payment due immediately, Aug 28.
Amount:
N/A

Component Description:
Supporting Documentation - Vendor Description for Tutor Consulting
Amount:
N/A

Component Description:
Transmission line cost. #21374
Amount:
N/A

Component Description:
Detailed Quote for Invoice 1005.
Amount:
N/A

Component Description:
Supporting Documentation - Quote from Tutor Consulting for labor and equipment for Transmission Line work.
Amount:
N/A

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 $268,500.00 $255,000.00 N/A $0.00 N/A
Total for all systems $694,588.37 $628,861.50 N/A $141,140.20 N/A
Primary Tower TOWER $268,500.00 $255,000.00 $0.00
Short Tower (less than 500') $84,200.00 $80,000.00 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 $25,000.00 N/A N/A N/A
Minor tower reinforcement/modifications $158,000.00 $150,000.00 N/A N/A N/A

Components

Information not provided.

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 $76,369.12 $67,300.70 N/A $28,150.70 N/A
Total for all systems $694,588.37 $628,861.50 N/A $141,140.20 N/A
Outside Professional Services $76,369.12 $67,300.70 $28,150.70
Internal Employee Time Costs $1,258.38 $1,258.38 N/A $1,258.38 N/A
Repacking Related Tax Services $120.74 $120.74 N/A $120.74 N/A
RF Exposure Measurements $21,050.00 $20,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A $2,100.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $0.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $7,068.75 See details in associated invoice $7,068.75 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, 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 N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $0.00 N/A
Prepare and or review reimbursement form $2,630.00 $4,068.75 See details in associated invoice $4,068.75 N/A
Project management of the transition $23,700.00 $13,534.08 N/A $13,534.08 N/A

Components

Actual Information Description File Name
Internal Employee Time Costs

Component Description:
Internal time costs. #IL-HC2-08312020-IM
Amount:
$50.20

Component Description:
Internal time costs. #IL-HC2-09302020-RH
Amount:
$72.10

Component Description:
Internal time costs. #IL-HC2-08312020-AG
Amount:
$76.27

Component Description:
Internal time costs. #IL-HC2-08312020-DD
Amount:
$111.90

Component Description:
Internal time costs. #IL-HC2-09302021-PD
Amount:
$135.20

Component Description:
Internal time costs. #IL-HC2-10012021-RI
Amount:
$812.71
Repacking Related Tax Services

Component Description:
Services rendered in relation to discussion and analysis of the tax treatment of invoice related to FCC repacking. #1034466828-9
Amount:
$120.74
RF Exposure Measurements Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
Legal services cost. #925
Amount:
$2,100.00

Component Description:
Legal Services attributable to Negotiations with vendors for discounts, lease for facilities, and other commercial matters.
Amount:
$2,100.00

Component Description:
Line item for $4,068.75 USD on Invoice #925 can be disregarded at this time. STA not sought at this time. Invoice 925 line item for preparation and review of FCC Form 399 negotiated down from $5,006.25 USD to $5,000.00. SUPPORTING DOCUMENTATION
Amount:
N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Legal services cost. #925
Amount:
$7,068.75

Component Description:
Legal services attributable to Form 2100 Construction Permit application, included liaison work with FCC.
Amount:
$5,000.00

Component Description:
Line item for $4,068.75 USD on Invoice #925 can be disregarded at this time. STA not sought at this time. Invoice 925 line item for preparation and review of FCC Form 399 negotiated down from $5,006.25 USD to $5,000.00. SUPPORTING DOCUMENTATION
Amount:
N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
Please disregard this invoice at this time.
Amount:
N/A
Prepare and or review reimbursement form

Component Description:
Legal services cost. #925
Amount:
$4,068.75

Component Description:
Negotiated portion of services for final line item of attorney fees is allocated to preparation, and submission of form 399.
Amount:
$2,400.00

Component Description:
Line item for $4,068.75 USD on Invoice #925 can be disregarded at this time. STA not sought at this time. Invoice 925 line item for preparation and review of FCC Form 399 negotiated down from $5,006.25 USD to $5,000.00. SUPPORTING DOCUMENTATION
Amount:
N/A
Project management of the transition

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #474784
Amount:
$374.23

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 27 stations. #119
Amount:
$271.70

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 27 stations. #130
Amount:
$450.81

Component Description:
Legal services cost. #475039
Amount:
$395.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #1150
Amount:
$630.93

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #1146
Amount:
$888.15

Component Description:
Legal services cost. #474793
Amount:
$233.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #1158
Amount:
$723.06

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #475439
Amount:
$268.86

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 27 stations. #115
Amount:
$467.12

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #473451
Amount:
$1,054.24

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #173
Amount:
$691.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 20 stations. #145
Amount:
$745.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #1165
Amount:
$497.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #1163
Amount:
$607.03

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 20 stations. #1144
Amount:
$796.10

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #475011
Amount:
$1,023.40

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #474243
Amount:
$1,304.02

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 23 stations. #475948
Amount:
$419.80

Component Description:
Legal services cost. #481061
Amount:
$50.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 20 stations. #473857
Amount:
$1,198.13

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 14 stations. #159
Amount:
$443.75

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 $29,970.00 $25,226.77 N/A $12,626.55 N/A
Total for all systems $694,588.37 $628,861.50 N/A $141,140.20 N/A
Other Expenses $29,970.00 $25,226.77 $12,626.55
MVPD Notification of Channel Change $1,865.00 $1,865.00 See attached quote from DTV $1,865.00 N/A
Develop and air announcement of upcoming channel change $2,915.00 $2,915.00 See attached report from Tutor Consulting $2,915.00 N/A
Equipment Delivery and Handling Charges $10,000.00 $10,000.00 N/A $984.78 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,000.00 $2,000.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
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 $6,861.77 See attached quote from DTV $6,861.77 N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change

Component Description:
MVPD notification services. #INV-001982
Amount:
$1,865.00
Develop and air announcement of upcoming channel change

Component Description:
Air announcement. #0805
Amount:
$1,535.00

Component Description:
Air announcement. #0806
Amount:
$1,380.00
Equipment Delivery and Handling Charges

Component Description:
Shipping cost. #05609164362
Amount:
$781.78

Component Description:
Shipping cost. #21374
Amount:
$203.00
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
DTV Medical Facility Notification

Component Description:
Medical notification service. #INV-001861
Amount:
$1,777.77

Component Description:
Medical notification services. #INV-001983
Amount:
$5,084.00

Cost Information

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Grand Total

Predetermined
Cost Estimate 		Estimated Cost Actual Cost
Total for all systems $694,588.37 $628,861.50 $141,140.20

Reimbursement Status

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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

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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.

Michael Voge

Director of Engineering Operations


10/07/2021

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.

Michael Voge

Director of Engineering Operations


10/07/2021

Attachments

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