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:
34424
Service:
FM
Call Sign:
KOST
File Number:
0000086330
FRN:
0014042816
Eligibility Status:
Eligible
Date Submitted:
03/10/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

IHM LICENSES, LLC

Doing Business As: IHM LICENSES, LLC

7136 S. YALE AVENUE

SUITE 501

TULSA, OK 74136

United States

+1 (918) 664-4581 FCCCONTACT@IHEARTMEDIA.COM

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 New aux to be shared while work is ongoing at main and "big" aux tower. Each station had 2 aux, 1 on tower with main and 1 that does not provide for full coverage. This is for a 3rd site that is removed from where work area is and provides needed coverage

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)
Ownership Owned
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model GV10
Year 2016
Type Solid State
Solid State Cooling Air Cooled
Model Type Hybrid
Solid State Power Capacity 7 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? No
Manufacturer
Model GV5D
Transmitter Type Solid State
Solid State Cooling Air Cooled
Model Type Hybrid
Solid State Power capacity 5 kW
Justification for New Transmitter To build new aux location
Does the transmitter require the purchase of a new HD Importer? No
Does the transmitter require the purchase of a new HD Exporter? No

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Other Transmitter Costs Does the transmitter installation require an Additional Exciter? No
Does the transmitter installation require any additional transmitter installation costs? Yes
Does the transmitter installation require a Transmitter Building Site Survey/Installation? No
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Rigid Conduit and Wiring No
Other Electrical Service Yes
Description UPSs Electrical installation labor miscellaneous parts and wire for electrical installations
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 5 tons
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Other Transmitter-Related Expenses Does the replacement transmitter require a Remote Control? Yes
Does the replacement transmitter require an RDS Encoder? No
Does the replacement transmitter require Audio Processing? Yes
Audio Processing Analog/HD Upgraded

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Other Xmt Costs

Equipment Racks

Equipment Delivery and Handling Charges

Equipment Delivery and Handling Charges

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)
Ownership Owned
Is the existing antenna shared with another station or stations? Yes
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Circular
Type Cross Dipole
ERP: 65.0 kW
Manufacturer
Model MPX-4E
Year 2016

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
35022 KRRL
19218 KIIS-FM
6360 KBIG

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Change Type Purchase New
Ownership Owned
Is antenna shared? Yes
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Circular
Type Cross Dipole
ERP: 10.0 kW
Manufacturer
Model SHPXA-8BC-HW-SP
Year 2018
Justification for New Antenna To construct a new shared aux at different location to provide service for all 4 stations.

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? Yes
Type New
Number of channels supported 4
Frequencies of channels supported Upper and lower frequency
Frequency 90.1 MHz - 107.9 MHz
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
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? No
FM Band Pass Filters Do you require an FM band pass filter? No
Notch Filter Do you require a Notch filter? No
De-Icers Do you require De-Icers? No
Radomes Do you require Radomes? No

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Equipment Delivery and Handling Charges

Equipment Delivery and Handling Charges

Other Ant Costs

Antenna Mount

Other Ant Costs

Antenna Controller

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)
Ownership Owned
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 3 1/8 inches
Segment Length 20 inches
Number of parallel runs 1
Length 200 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Air
Diameter Other
Other Diameter 3 1/8 inches
Number of parallel runs 1
Length 300 feet per run
Justification for New Transmission Line To construct a new shared aux at different location to provide service for all 4 stations.
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? Yes
Does the Installation of the Transmission Line require additional or replacement Inside RF system elbows, fitting, hangers, etc.? Yes

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Equipment Delivery and Handling Charges

Equipment Delivery and Handling Charges

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)
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1062721
Coordinates (NAD83) Latitude (NAD83) 34° 13' 36.0" N-
Longitude (NAD83) 118° 04' 02.0" W-
Overall Structure Height 286.74 feet
Support Structure Height 286.74 feet
Ground Elevation Above Mean Sea Level (AMSL) 5700.06 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner InSite Towers Development
Date Constructed 11/22/2005

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
19218 KIIS-FM FM
34424 KOST FM
35022 KRRL FM

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: No study needed
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

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? No
Outside RF consulting Engineering Services Prepare engineering section of Form FCC Construction Permit Application No
Prepare engineering section of Form FCC License to Cover Application No
Prepare request for Special Temporary Authority No
Prepare Form 601 No
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application No
Prepare and file Form FCC License to Cover Application No
Prepare request for Special Temporary Authority No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement No
Form 399 assistance or other program management costs No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service No

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Prepare and or review reimbursement form

Prepare and or review reimbursement form

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Permit and Filing Costs FCC Construction Permit Major Change No
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application No
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? No
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? No
Does this relocation require Equipment Storage? No
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System No
New Point to Point Microwave System Yes
Type 6/11 GHz Licensed Part 101
1 pair IP-only Codecs for fiber, internet or IP microwave systems Yes

Other Expenses

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Other Expenses Not Listed

Name Description

STL

Starlink for backup

Equipment Delivery and Handling Charges

Equipment Delivery and Handling Charges

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 $148,153.12 $85,136.14 N/A $55,136.14 N/A
Total for all systems $307,432.09 $183,884.01 N/A $145,759.01 N/A
Primary Transmitter GV5D $148,153.12 $85,136.14 $55,136.14
Transmitter Installation $70,500.00 $30,000.00 N/A N/A N/A
Other Electrical Service: UPSs Electrical installation labor miscellaneous parts and wire for electrical installations $975.00 $975.00 N/A $975.00 N/A
5 Ton system $20,250.00 $3,387.50 N/A $3,387.50 N/A
Air Cooled Solid State FM Transmitter 3.5 - 6 kW Hybrid $40,350.00 $38,886.00 Config with importer and exporter built in $38,886.00 N/A
Other Xmt Costs $1,593.64 $1,593.64 miscellaneous connectors, audio and computer equipment racks Rackmount computer and accessory shipping $1,593.64 N/A
Equipment Delivery and Handling Charges $1,084.48 $1,084.48 N/A $1,084.48 N/A
Audio Processing - Analog /HD upgraded $11,000.00 $7,042.02 Processor and Justin HD align $7,042.02 N/A
Other Transmitter-Related Expenses Remote Control $2,400.00 $2,167.50 ESE GPS and 4-way output Arc Plus Touch remote control system $2,167.50 N/A

Components

Actual Information Description File Name
Transmitter Installation Information not provided.
Other Electrical Service: UPSs Electrical installation labor miscellaneous parts and wire for electrical installations

Component Description:
T Wainscott 02-2018 v201106pmv2
Amount:
$308.75

Component Description:
T Wainscott 05-2018 v201106pmv2
Amount:
$308.75

Component Description:
T Wainscott 03-2018 v201106pmv2
Amount:
$162.50

Component Description:
T Wainscott 06-2018 v201106pmv2
Amount:
$195.00
5 Ton system

Component Description:
Aryco 294128 v201103pmv2
Amount:
$650.00

Component Description:
Aryco 2834 v201103pmv2
Amount:
$2,737.50
Air Cooled Solid State FM Transmitter 3.5 - 6 kW Hybrid

Component Description:
Nautel SL030000837 v201111pmv2
Amount:
$38,886.00
Other Xmt Costs

Component Description:
Pacific Radio IN000063725 v201106pmv2
Amount:
$589.95

Component Description:
SHI B08122408 v201106pmv2
Amount:
$219.82

Component Description:
SCMS 122510 v201111pmv2
Amount:
$114.32

Component Description:
SCMS 122058 v201111pmv2
Amount:
$438.00

Component Description:
Pacific Radio IN000063758 v201229pmv3
Amount:
$231.55
Equipment Delivery and Handling Charges

Component Description:
BGS 0411948 v201103pmv2
Amount:
$3.66

Component Description:
SHI B08124284 v201106pmv2
Amount:
$4.44

Component Description:
SCMS 122058 v201111pmv2
Amount:
$2.98

Component Description:
Nautel SL030000837 v201111pmv2
Amount:
$841.25

Component Description:
BGS 0412670 v201103pmv2
Amount:
$7.73

Component Description:
SHI B08122408 v201106pmv2
Amount:
$2.01

Component Description:
SCMS 122510 v201111pmv2
Amount:
$5.93

Component Description:
Burk 00068361 v201111pmv2
Amount:
$50.45

Component Description:
SCMS 121350 v201111pmv2
Amount:
$45.99

Component Description:
Pacific Radio IN000063725 v201106pmv2
Amount:
$105.45

Component Description:
BSW IN.STD00896670 v201103pmv2
Amount:
$14.59
Audio Processing - Analog /HD upgraded

Component Description:
BGS 0411948 v201103pmv2
Amount:
$184.00

Component Description:
BGS 0412670 v201103pmv2
Amount:
$236.00

Component Description:
SCMS 121350 v201111pmv2
Amount:
$3,260.64

Component Description:
BSW IN.STD00896670 v201103pmv2
Amount:
$462.37

Component Description:
SCMS 122634 v201116pmv2
Amount:
$2,899.01
Other Transmitter-Related Expenses Remote Control

Component Description:
Burk 00068361 v201111pmv2
Amount:
$2,167.50

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 $31,479.84 $45,398.29 N/A $45,398.29 N/A
Total for all systems $307,432.09 $183,884.01 N/A $145,759.01 N/A
Primary Antenna SHPXA-8BC-HW-SP $31,479.84 $45,398.29 $45,398.29
Equipment Delivery and Handling Charges $2,612.34 $2,612.34 N/A $2,612.34 N/A
High Power 6 kW - 10 kW Circularly-polarized $5,885.00 $23,053.95 ERI Axiom $23,053.95 N/A
New FM combiner, cost per channel (depends on power input and min. frequency separation) $21,782.50 $18,532.00 High power combiner. $18,532.00 N/A
Other Ant Costs $1,200.00 $1,200.00 supplies for antenna switch controller Custom antenna mount and installation $1,200.00 N/A

Components

Actual Information Description File Name
Equipment Delivery and Handling Charges

Component Description:
Shively 35357-2 v201106pmv2
Amount:
$775.00

Component Description:
ERI 51311 v201106pmv2
Amount:
$1,837.34
High Power 6 kW - 10 kW Circularly-polarized

Component Description:
ERI 36042 v201106pmv2
Amount:
N/A

Component Description:
ERI 21618 v201106pmv2
Amount:
N/A

Component Description:
ERI 51311 v201106pmv2
Amount:
$23,053.95
New FM combiner, cost per channel (depends on power input and min. frequency separation)

Component Description:
Shively 35357-2 v201106pmv2
Amount:
$5,559.60

Component Description:
Shively 35357 v201109pmv2
Amount:
$12,972.40
Other Ant Costs

Component Description:
Sea W 3284 v201106pmv2
Amount:
$1,080.00

Component Description:
Sea W 3285 v201106pmv2
Amount:
$120.00

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 $4,029.62 $4,029.62 N/A $4,029.62 N/A
Total for all systems $307,432.09 $183,884.01 N/A $145,759.01 N/A
Primary Transmission Line $4,029.62 $4,029.62 $4,029.62
Flexible Air Transmission Line - 3 1/8" 1 parallel runs 300 feet $2,736.24 $2,736.24 N/A $2,736.24 N/A
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators $196.01 $196.01 Andrew Dehydrator $196.01 N/A
Interior RF Systems: Elbows, fitting, hangers, etc. $628.53 $628.53 Connectors and Hangers $628.53 N/A
Equipment Delivery and Handling Charges $468.84 $468.84 N/A $468.84 N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - 3 1/8" 1 parallel runs 300 feet

Component Description:
SCMS 121516 v201111pmv2
Amount:
$2,736.24
Interior RF Systems: Inside RF system including switching, patch panels and dehydrators

Component Description:
SCMS 122134 v201111pmv2
Amount:
$118.54

Component Description:
SCMS 122083 v201116pmv2
Amount:
$77.47
Interior RF Systems: Elbows, fitting, hangers, etc.

Component Description:
SCMS 122157 v201111pmv2
Amount:
$628.53
Equipment Delivery and Handling Charges

Component Description:
SCMS 122134 v201111pmv2
Amount:
$14.67

Component Description:
SCMS 121516 v201111pmv2
Amount:
$429.51

Component Description:
SCMS 122083 v201116pmv2
Amount:
$8.73

Component Description:
SCMS 122157 v201111pmv2
Amount:
$15.93

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 $73,650.00 $6,041.48 N/A $6,041.48 N/A
Total for all systems $307,432.09 $183,884.01 N/A $145,759.01 N/A
Primary Tower TOWER $73,650.00 $6,041.48 $6,041.48
Tower Rigging Short Tower (less than 500') $73,650.00 $6,041.48 N/A $6,041.48 N/A

Components

Actual Information Description File Name
Tower Rigging Short Tower (less than 500')

Component Description:
Com Plus 7971 v201104pmv2
Amount:
$435.63

Component Description:
Com Plus 7959 v201104pmv2
Amount:
$1,681.25

Component Description:
Com Plus 7953 v201104pmv2
Amount:
$1,681.25

Component Description:
Com Plus 7958 v201104pmv2
Amount:
$2,243.35

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 $7,355.00 $7,355.00 N/A $7,355.00 N/A
Total for all systems $307,432.09 $183,884.01 N/A $145,759.01 N/A
Outside Professional Services $7,355.00 $7,355.00 $7,355.00
Prepare and or review reimbursement form $7,355.00 $7,355.00 See attached invoices. $7,355.00 N/A

Components

Actual Information Description File Name
Prepare and or review reimbursement form

Component Description:
KGA 991-22 v201013pmv1
Amount:
$650.00

Component Description:
KGA 991-75 v220223pmv1
Amount:
$100.00

Component Description:
KGA 991-68 v220223pmv1
Amount:
$830.00

Component Description:
KGA 991-220 v220310pmv1
Amount:
$80.00

Component Description:
KGA 991-55 v201210pmv1
Amount:
$4,645.00

Component Description:
KGA 991-40 v201202pmv1
Amount:
$975.00

Component Description:
KGA 991-04 v201013pmv1
Amount:
$75.00

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 $42,764.51 $35,923.48 N/A $27,798.48 N/A
Total for all systems $307,432.09 $183,884.01 N/A $145,759.01 N/A
Other Expenses $42,764.51 $35,923.48 $27,798.48
FCC Filing Fees - Form 2100 license to cover application $335.00 $225.00 FCC 302 N/A N/A
Point to Point Microwave (STL/ICR): 1 pair IP-only Codecs for fiber, internet or IP microwave systems $5,850.00 $9,463.38 See attached invoices. Cisco catalyst GatesAir IP100 GatesAir IP MPXp $9,463.38 Prior cost estimates did not include necessary redundant equipment
STL $6,800.00 $6,800.00 6' dish for 950 MHz pair of 950 MHz Moseley Starlinks N/A N/A
Equipment Delivery and Handling Charges $1,079.51 $1,079.51 N/A $1,079.51 N/A
FCC Filing Fees - Form 2100 minor change CP application $200.00 $1,100.00 FCC 301 N/A N/A
New Point to Point Microwave System: 6/11 GHz Licensed Part 101 $28,500.00 $17,255.59 11 GHz radio system with antennas power supplies for 11 GHz IDUs 11 GHz antenna installations 18 GHz radio system with antennas 1.625" coax $17,255.59 N/A

Components

Actual Information Description File Name
FCC Filing Fees - Form 2100 license to cover application Information not provided.
Point to Point Microwave (STL/ICR): 1 pair IP-only Codecs for fiber, internet or IP microwave systems

Component Description:
BGS 0412776 v201103pmv2
Amount:
$6,526.43

Component Description:
SHI B08124284 v201106pmv2
Amount:
$632.36

Component Description:
BGS 0413814 v201103pmv2
Amount:
$2,304.59
STL Information not provided.
Equipment Delivery and Handling Charges

Component Description:
SCMS 126388 v201111pmv2
Amount:
$7.76

Component Description:
BGS 0413814 v201103pmv2
Amount:
$67.86

Component Description:
SCMS 121390 v201111pmv2
Amount:
$454.43

Component Description:
SCMS 121351 v201111pmv2
Amount:
$81.58

Component Description:
SCMS 122394 v201116pmv2
Amount:
$53.25

Component Description:
SCMS 122069 v201111pmv2
Amount:
$414.63
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
New Point to Point Microwave System: 6/11 GHz Licensed Part 101

Component Description:
Div Comm 23629431 v201229pmv3
Amount:
$720.00

Component Description:
Div Comm 23629174 v201104pmv2
Amount:
$1,198.27

Component Description:
SCMS 126388 v201111pmv2
Amount:
$97.01

Component Description:
SCMS 121351 v201111pmv2
Amount:
$5,161.83

Component Description:
Div Comm 23629769 v201104pmv2
Amount:
$1,973.99

Component Description:
SCMS 122394 v201116pmv2
Amount:
$402.68

Component Description:
SCMS 121390 v201111pmv2
Amount:
$5,494.98

Component Description:
SCMS 122069 v201111pmv2
Amount:
$2,206.83

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $307,432.09 $183,884.01 $145,759.01

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.

Jeffrey C Gehman

Engineering Associate


03/10/2022

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


03/10/2022

Attachments

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