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:
13922
Service:
LPA
Call Sign:
W30EI-D
Channel:
30 (UHF)
File Number:
0000085105
FRN:
0003739364
Eligibility Status:
Eligible
Date Submitted:
06/29/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

CORNERSTONE TELEVISION, INC.

Doing Business As: CORNERSTONE TELEVISION, INC.

1 SIGNAL HILL DRIVE

WALL, PA 15148

United States

+1 (412) 349-4330 sjohnson@ctvn.org 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

JOSEPH C CHAUTIN

Hardy, Carey, Chautin & Balkin LLC

Joseph C Chautin

1080 West Causeway Approach

Mandeville, LA 70471

United States

+1 (985) 629-0777 jchautin@hardycarey.com

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 Prepare and execute equipment orders Prepare tower for new Antenna and transmission line Install Antenna and Transmission line Install Transmitter and related Begin testing on appropriate date

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 LU1000W
Year 2006
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1 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 UAXTE-3
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1 kW
Justification for New Transmitter Transmitter no longer supported and manufacturer will not retune

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Other Transmitter Costs
Does the transmitter installation require a Transmitter Building Site Survey/Installation? Yes
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 Transfer of electric wiring from the current transmitter to the replacement transmitter.
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

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Ownership Owned
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
Mounting Side Mount
Antenna position in stack Top
Polarization Horizontal
Type Slotted Coaxial
ERP: 8.9 kW
Manufacturer
Model SWLP80I/29
Year 2006

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? No
Is antenna directional? Yes
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 Horizontal
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model PSILP8OI-30
Year 2019
Justification for New Antenna Current antenna is frequency specific for channel 29 and will not work for channel 30.

Primary Antenna

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Other Antenna Costs

Section Question Response
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? 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? No

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) No
Others Types of Users Yes
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 1036482
Coordinates (NAD83) Latitude (NAD83) 41° 14' 17.0" N-
Longitude (NAD83) 080° 25' 49.0" W-
Overall Structure Height 311.68 feet
Support Structure Height 298.55 feet
Ground Elevation Above Mean Sea Level (AMSL) 1266.39 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner RADIO AIRWAYS INC
Date Constructed 07/01/1987


Other Types of Users

Users
Cellular
Paging

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? Yes
Number of Hours 194
Explanation W30EI-D does not have sufficient resource capacity and expertise in house for all activities necessary to facilitate on-time completion of the station's build. W30EI-D will hire an outside firm to ensure a timely and well managed transition.
Outside RF consulting Engineering Services Perform engineering study for displacement application 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
Prepare Form 601 No
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
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Form 399 assistance or other program management costs Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements Yes
Additional Field Engineering Service No

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Attorney Fees - Address transition timing and coordination issues with other stations and wireless

Attorney Services required to address transition timing and coordination issues with other stations and wireless providers

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? Yes
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 No

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 $119,250.00 $102,677.36 N/A $67,427.36 N/A
Total for all systems $261,032.00 $184,361.01 N/A $95,763.87 N/A
Primary Transmitter UAXTE-3 $119,250.00 $102,677.36 $67,427.36
Transmitter Building Site Survey/Installation $10,000.00 $10,000.00 N/A N/A N/A
5 Ton system $20,250.00 $20,250.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $84,000.00 $67,427.36 See Estimated Cost Justification W30EI-D-110-New Primary Transmitter - UHF Air Cooled Solid State, 1-2.5 kW v0 $67,427.36 N/A
Other Electrical Service: Transfer of electric wiring from the current transmitter to the replacement transmitter. $5,000.00 $5,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Transmitter Building Site Survey/Installation Information not provided.
5 Ton system Information not provided.
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
UAXTE-2R37 Transmitter per Quote Q-84114
Amount:
$3,029.25

Component Description:
UAXTE-2R37 Transmitter
Amount:
$64,398.11
Other Electrical Service: Transfer of electric wiring from the current transmitter to the replacement transmitter. Information not provided.

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $11,460.00 $11,460.00 N/A $5,680.36 N/A
Total for all systems $261,032.00 $184,361.01 N/A $95,763.87 N/A
Primary Antenna PSILP8OI-30 $11,460.00 $11,460.00 $5,680.36
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Horizontal $5,730.00 $5,730.00 N/A $5,680.36 N/A
Sweep test of transmission line and antenna $5,730.00 $5,730.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF-Low Power, Side Mount, Slotted Coaxial, 15.0kW input, Horizontal

Component Description:
UHF Slot Antenna
Amount:
$5,680.36
Sweep test of transmission line and antenna Information not provided.

Cost Information

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Transmission Line

Information not provided.

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 $56,190.00 $4,000.00 N/A $4,000.00 N/A
Total for all systems $261,032.00 $184,361.01 N/A $95,763.87 N/A
Primary Tower TOWER $56,190.00 $4,000.00 $4,000.00
Tower Rigging Short Tower (less than 500') $56,190.00 $4,000.00 Please see MultiComm proposal dated 2/10/20 $4,000.00 N/A

Components

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

Component Description:
As per quote dated February 10,2020
Amount:
$4,000.00

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $70,187.00 $62,278.65 N/A $18,656.15 N/A
Total for all systems $261,032.00 $184,361.01 N/A $95,763.87 N/A
Outside Professional Services $70,187.00 $62,278.65 $18,656.15
Attorney Fees - Address transition timing and coordination issues with other stations and wireless $90.00 $90.00 Please see W30EI Transition Timing and Coordination Budget Revision Justification letter $90.00 N/A
RF Exposure Measurements $12,100.00 $12,100.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $3,262.50 $2,002.00 see Estimated Cost Justification W30EI-D-550-Attorney - Negotiation of Lease and Other Matters v1 $2,002.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,025.00 N/A $870.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,052.50 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,102.50 N/A N/A N/A
Perform engineering study for displacement application $1,800.00 $1,800.00 N/A $1,500.00 N/A
Form 399 assistance or other Program Management costs $23,000.00 $23,000.00 N/A N/A N/A
Project management of the transition $20,467.00 $13,819.15 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $13,819.15 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $1,710.00 N/A $375.00 N/A

Components

Actual Information Description File Name
Attorney Fees - Address transition timing and coordination issues with other stations and wireless

Component Description:
W30EI-D-550-Attorney - Address Transition timing and coordination
Amount:
$90.00
RF Exposure Measurements Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
Review draft NPRM
Amount:
$90.00

Component Description:
Prof. Services Rendered
Amount:
$1,020.00

Component Description:
Prof. Services Rendered
Amount:
$195.00

Component Description:
Prof. Services Rendered
Amount:
$90.00

Component Description:
Professional Services
Amount:
$519.00

Component Description:
W30EI-D-550-Attorney - Negotiation of Lease and Other Matters
Amount:
$88.00
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:
Review status
Amount:
$180.00

Component Description:
Professional Services
Amount:
$330.00

Component Description:
Review draft
Amount:
$180.00

Component Description:
Review granted displacement permit
Amount:
$90.00

Component Description:
Load and complete legal and other sections
Amount:
$90.00
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 Information not provided.
Perform engineering study for displacement application

Component Description:
W45BT Brookville: Channel Search and Application for LPTV Displacement
Amount:
$1,000.00

Component Description:
Professional Services
Amount:
$500.00
Form 399 assistance or other Program Management costs Information not provided.
Project management of the transition

Component Description:
Project Management
Amount:
$117.80

Component Description:
Project management
Amount:
$340.45

Component Description:
Project Management
Amount:
$77.50

Component Description:
Project management
Amount:
$58.90

Component Description:
Project Management
Amount:
$58.90

Component Description:
Project Management
Amount:
$1,047.80

Component Description:
Project Management
Amount:
$1,084.70

Component Description:
Project Management
Amount:
$1,266.70

Component Description:
Project Management
Amount:
$195.30

Component Description:
Project Management
Amount:
$207.65

Component Description:
Project Management
Amount:
$213.90

Component Description:
Project Management
Amount:
$503.75

Component Description:
Project Management
Amount:
$655.65

Component Description:
Project Management
Amount:
$20.15

Component Description:
Project Management
Amount:
$28.75

Component Description:
Project Management
Amount:
$764.30

Component Description:
Project Management
Amount:
$117.80

Component Description:
Project management
Amount:
$116.25

Component Description:
Project Management
Amount:
$312.50

Component Description:
Project Management
Amount:
$3,652.00

Component Description:
Project Management
Amount:
$77.50

Component Description:
Project Management
Amount:
$609.95

Component Description:
Project Management
Amount:
$1,850.85

Component Description:
Project Management
Amount:
$58.90

Component Description:
Project management
Amount:
$381.20
Prepare/ Review 399 reimbursement form

Component Description:
W30EI-D-510-Prepare/Review FCC 399 Reimbursement Form
Amount:
$90.00

Component Description:
Professional Services
Amount:
$150.00

Component Description:
W30EI-D-510-Prepare/Review FCC 399 Reimbursement Form
Amount:
$45.00

Component Description:
Professional Services
Amount:
$90.00

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 $3,945.00 $3,945.00 N/A $0.00 N/A
Total for all systems $261,032.00 $184,361.01 N/A $95,763.87 N/A
Other Expenses $3,945.00 $3,945.00 $0.00
Equipment Delivery and Handling Charges $2,500.00 $2,500.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,110.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $261,032.00 $184,361.01 $95,763.87

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. Yes
Construction of final facilities or all necessary modifications are complete. Yes
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator. Yes

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.

Steve Johnson

President & CEO


06/29/2022

Certification

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Section Question Response
Submission of Final Allocation or Accounting Information Statements

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.

  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. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

  2. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  3. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.

  4. 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.

  5. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  6. 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.

Steve Johnson

President & CEO


06/29/2022

Attachments

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