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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:
67485
Service:
DCA
Call Sign:
WFWC-CD
Channel:
16 (UHF)
File Number:
0000025903
FRN:
0026907345
Date Submitted:
08/18/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

HC2 STATION GROUP, INC.

Rebecca Hanson

450 PARK AVENUE 29TH FLOOR

NEW YORK, NY 10022

United States

 +1 (212) 339-5832 RHANSON@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 Station transmits a digital signal on RF ch. 45 using an Elettronika transmitter and Bogner directional antenna. Elettronika will modify the transmitter for RF ch. 16; Station will replace the antenna and transmission line and will be off 3 to 5 days.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Retune Existing
Use Primary (Main)
Ownership Owned
Owner N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer Elettronika
Model AUTV1500LD
Year 2005
Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 0.3 kW

Primary Transmitter

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Retuning Transmitter Costs

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

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Site Survey

Site Survey

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? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model AUTV1500LD
Year 2005
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 0.3 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 ELETXUD3000AAC
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 3.4 kW
Justification for New Transmitter The pre-existing transmitter was not able to manage the channel change due to age and support. New transmitter needed because of maximized facility.

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 No
Size N/A
Length N/A
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size Other
Other Size 3 tons
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 field engineering time

Additional field engineering time

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 1.62 kW
Manufacturer
Model ODD890310XH
Year 1989

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? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type 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: 1.0 kW
Manufacturer
Model 750 10068
Year 2017
Justification for New Antenna Existing antenna manufacturer is no longer is business and existing antenna will not operate on repacked channel.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? 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? 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

Name Description

New Combiner

New Combiner

Side Mount Brackets

Side Mount Brackets

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 Foam
Diameter 1 5/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 450 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Air
Diameter 3 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 495 feet per run
Justification for New Transmission Line Existing T-Line is very old and is likely to fail during the tower rigging.

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 Move Equipment
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1028214
Coordinates (NAD83) Latitude (NAD83) 41° 05' 56.9" N-
Longitude (NAD83) 085° 08' 42.0" W-
Overall Structure Height 420.93 feet
Support Structure Height 404.85 feet
Ground Elevation Above Mean Sea Level (AMSL) 766.07 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers, LLC.
Date Constructed 05/17/2005

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
183648 WCUH-LD LPD

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Minor Tower Reinforcement or Modification

Minor Tower Reinforcement or Modification

Tower Load Study

Tower Load Study

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 320
Explanation Project management, supervision and engineering oversight.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service 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

Internal Employee Time Costs

Internal Employee Time Costs

Legal Fees for Preparation of Required Reports

Fees for legal advice and work in connection with preparation of transition progress and other required reports regarding transition

Repacking Related Tax Services

Repacking Related Tax Services

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
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? No
Does this relocation require MVPD Notification of a Channel Change? 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 $206,215.00 $50,353.00 N/A $50,353.00 N/A
Total for all systems $551,992.16 $292,876.16 N/A $216,528.93 N/A
Primary Transmitter AUTV1500LD $2,750.00 $2,750.00 $2,750.00
Site Survey $2,750.00 $2,750.00 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $2,750.00 N/A
Primary Transmitter ELETXUD3000AAC $203,465.00 $47,603.00 $47,603.00
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW $155,600.00 $33,738.00 See attached quote from Elettronikia. $33,738.00 N/A
Other -- HVAC Service Type: C Size:3 (Other) $5,175.00 $5,175.00 N/A $5,175.00 N/A
Additional field engineering time $4,490.00 $4,490.00 N/A $4,490.00 N/A
Switchgear - industrial 800 amp $38,200.00 $4,200.00 N/A $4,200.00 N/A

Components

Actual Information Description File Name
Site Survey

Component Description:
Site survey. #D19050001
Amount:
$2,750.00
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW

Component Description:
Transmitter cost, upgrade excluded. #3678
Amount:
$33,738.00
Other -- HVAC Service Type: C Size:3 (Other)

Component Description:
3 ton system. #959
Amount:
$5,175.00
Additional field engineering time

Component Description:
Mobilization, installation and testing . #734
Amount:
$4,490.00
Switchgear - industrial 800 amp

Component Description:
1/5 of the total. #815
Amount:
$4,200.00

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 $41,832.15 $23,841.86 N/A $18,841.86 N/A
Total for all systems $551,992.16 $292,876.16 N/A $216,528.93 N/A
Primary Antenna 750 10068 $41,832.15 $23,841.86 $18,841.86
Sweep test of existing antenna $6,730.00 $5,000.00 N/A N/A N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $10,039.71 See attached quote from Kathrein $10,039.71 N/A
Side Mount Brackets $1,915.00 $1,915.00 N/A $1,915.00 N/A
New Combiner $6,887.15 $6,887.15 See attached quote from Kathrein. $6,887.15 N/A

Components

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

Component Description:
Antenna cost. #1269
Amount:
$10,039.71
Side Mount Brackets

Component Description:
Antenna mount. #719063-1
Amount:
$1,915.00
New Combiner

Component Description:
Combiner cost, 1/2 for WFWC. #1592
Amount:
$6,887.15

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 $29,205.00 $17,022.69 N/A $17,022.69 N/A
Total for all systems $551,992.16 $292,876.16 N/A $216,528.93 N/A
Primary Transmission Line $29,205.00 $17,022.69 $17,022.69
Flexible Air Transmission Line - dielectric, 3" $29,205.00 $17,022.69 Updated estimates including transmission, parts and shipping charges. See attached quote from Kathrein and SWR. $17,022.69 N/A

Components

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

Component Description:
Transmission line related cost. #19486
Amount:
$1,768.49

Component Description:
Transmission line cost. #1341
Amount:
$13,933.61

Component Description:
Transmission line related cost. #19483
Amount:
$1,320.59

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 $164,254.00 $120,054.00 N/A $81,799.00 N/A
Total for all systems $551,992.16 $292,876.16 N/A $216,528.93 N/A
Primary Tower GTOWER $164,254.00 $120,054.00 $81,799.00
Tower Load Study $5,837.50 $5,837.50 N/A $5,837.50 N/A
Short Tower (less than 500') $84,200.00 $40,000.00 N/A $40,000.00 N/A
Minor Tower Reinforcement or Modification $74,216.50 $74,216.50 N/A $35,961.50 N/A

Components

Actual Information Description File Name
Tower Load Study

Component Description:
Customer Structural. #A199527
Amount:
$600.00

Component Description:
Tower load study. #460219949
Amount:
$5,237.50
Short Tower (less than 500')

Component Description:
Tower crew cost. #734
Amount:
$40,000.00

Component Description:
Tower lighting material and installation cost. #460221280
Amount:
N/A
Minor Tower Reinforcement or Modification

Component Description:
CM for invoice #460221280
Amount:
($38,255.00)

Component Description:
Tower reinforcement. #460228736
Amount:
$40,961.50

Component Description:
Minor tower reinforcement/modifications (labor and materials). #460221280
Amount:
$33,255.00

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 $89,950.43 $67,634.03 N/A $40,999.03 N/A
Total for all systems $551,992.16 $292,876.16 N/A $216,528.93 N/A
Outside Professional Services $89,950.43 $67,634.03 $40,999.03
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), 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 $700.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $1,250.00 N/A $1,250.00 N/A
Prepare and or review reimbursement form $2,630.00 $7,577.49 The standard estimate is inadquate given the steps which must be taken, including updating CORES, Form 1876, and issues with completing Form 399. More time was added due to a dispute with regard to the reimbursibilty of transmission line replacement. $7,577.49 Item "need more information" should be removed.
Project management of the transition $50,560.00 $26,376.11 N/A $26,376.11 N/A
Repacking Related Tax Services $120.74 $120.74 N/A $120.74 N/A
Legal Fees for Preparation of Required Reports $6,000.00 $6,000.00 N/A $902.50 N/A
Internal Employee Time Costs $2,559.69 $2,559.69 N/A $2,559.69 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A $0.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $1,512.50 N/A

Components

Actual Information Description File Name
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepared technical sections of Form 2100 application for construction permit for modified facilities
Amount:
$700.00
Perform engineering study for new channel assignment and antenna development Information not provided.
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Address transition timing and coordination issues with other stations and wireless (cost per customer). #460221280
Amount:
$1,250.00
Prepare and or review reimbursement form

Component Description:
Provided technical review and information concerning cost components and assisted in preparing Form 399
Amount:
$875.00

Component Description:
Advised and assisted client in preparation and filing of financial information, information needed to gain access to financial module for reimbursement, and information for Form 399
Amount:
$1,568.75

Component Description:
Advise and represent client in addressing issues related to content of Form 399 reimbursement form and banking information for reimbursement
Amount:
$1,200.00

Component Description:
Advise and represent client with respect to reimbursement questions
Amount:
$65.00

Component Description:
Technical review and 399 preparation. #867
Amount:
$875.00

Component Description:
Advise and assist client in providing financial information necessary to obtain reimbursement
Amount:
$225.00

Component Description:
Advise and assist client in preparation and filing of financial forms and Form 399; represent client in interaction with FCC staff
Amount:
$706.25

Component Description:
Advise and assist client in preparation and filing of financial forms and Form 399; represent client in interaction with FCC staff concerning issues with form
Amount:
$1,489.99

Component Description:
Advise and assist client in preparation of revised Form 399 reimbursement form
Amount:
$150.00

Component Description:
Research, advise, and consult with project manager regarding reimbursement process and issues related to same
Amount:
$250.00

Component Description:
Advise, assist and represent client in preparation and filing of revised Form 399 for reimbursement
Amount:
$1,047.50
Project management of the transition

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 145 stations. #159
Amount:
$443.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 5 stations. #336
Amount:
$2,922.00

Component Description:
Legal services cost. #475052
Amount:
$194.00

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

Component Description:
Construction project management. #460221280
Amount:
$2,500.00

Component Description:
$1,399.33 credit to be split across 7 HC2 stations (see attached allocation) reimbursed for invoice 472568 (correct amount is $821.47).
Amount:
($164.29)

Component Description:
Legal services cost. #475479
Amount:
$50.00

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 15 stations. #471659
Amount:
$1,206.00

Component Description:
Legal services cost. #480866
Amount:
$75.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #472568
Amount:
$985.76

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

Component Description:
Assisted in developing plans for transition, price quotes, and financial info., co-ordinated with engineer and attorney for filing required forms, co-ordinated and assisted with FCC site survey, and general project management tasks
Amount:
$1,375.00

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 23 stations. #474243
Amount:
$1,304.02

Component Description:
Legal services cost. #2020-WFWC
Amount:
$41.00

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

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 23 stations. #1163
Amount:
$607.03

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 4 stations. #405
Amount:
$420.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1118
Amount:
$1,609.03

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #187
Amount:
$540.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1112
Amount:
$521.40

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1104
Amount:
$644.80

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

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 15 stations. #472232
Amount:
$901.10

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 10 stations. #178
Amount:
$416.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1096
Amount:
$714.93

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 27 stations. #115
Amount:
$467.12

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. #130
Amount:
$450.81

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 15 stations. #1116
Amount:
$1,254.03
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
Legal Fees for Preparation of Required Reports

Component Description:
Advise client with regard to required translation plan progress report
Amount:
$50.00

Component Description:
Advice and assistance with preparation and filing of required repack transition progress report.
Amount:
$390.00

Component Description:
Legal fees for assistance with required transition progress report
Amount:
$150.00

Component Description:
Legal advice in connection with and preparation of draft of required transition plan progress report.
Amount:
$312.50
Internal Employee Time Costs

Component Description:
Internal time costs. #IL-HC3-08312020-IM
Amount:
$188.35

Component Description:
Internal time costs. #IL-HC2-09302021-PD
Amount:
$27.04

Component Description:
Internal time costs. #IL-HC2-10012021-RI
Amount:
$1,484.07

Component Description:
Internal time costs. #IL-HC2-08312020-DD
Amount:
$513.41

Component Description:
Internal time costs. #IL-HC2-08312020-AG
Amount:
$346.82
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Provided advice and counsel concerning preparation of Form 2100, checked with client and consulted and reported internally on progress of preparation of application for c.p. for modification of facilities to ensure timely filing
Amount:
$500.00

Component Description:
Advise and assist in preparation and filing of Form 2100 application for c.p. for modification of facilities
Amount:
$300.00

Component Description:
Advise and assist in preparation of Form 2100 modification application; monitor progress to ensure on track for timely filing
Amount:
$412.50

Component Description:
Advised and assisted client in monitoring progress of modification application and grant of same; forwarded c.p. to client
Amount:
$150.00

Component Description:
Advice and counsel to client regarding requirement to file Form 2100 c.p. application and applicable deadline for same.
Amount:
$150.00

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 $20,535.58 $13,970.58 N/A $7,513.35 N/A
Total for all systems $551,992.16 $292,876.16 N/A $216,528.93 N/A
Other Expenses $20,535.58 $13,970.58 $7,513.35
Equipment Delivery and Handling Charges $4,355.58 $4,355.58 N/A $4,355.58 N/A
Non-zoning permits $1,250.00 $1,250.00 N/A $1,250.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
Local Zoning $1,000.00 $1,000.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $5,000.00 N/A $1,777.77 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $1,850.00 $1,850.00 N/A $130.00 N/A

Components

Actual Information Description File Name
Equipment Delivery and Handling Charges

Component Description:
Shipping expense. #719056-2
Amount:
$300.00

Component Description:
Filter shipping. #29001013522
Amount:
$332.09

Component Description:
Transmitter freight. #3726
Amount:
$1,278.84

Component Description:
Shipping of power supply cord. #6-840-38981
Amount:
$10.65

Component Description:
Shipping cost. #734
Amount:
$1,000.00

Component Description:
Shipping of temp tx. #3049
Amount:
$1,434.00

Component Description:
Temp transmitter shipping. #3049
Amount:
$1,434.00
Non-zoning permits

Component Description:
Migratory Bird Assessment/permitting. #460221280
Amount:
$1,250.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
Local Zoning Information not provided.
DTV Medical Facility Notification

Component Description:
Medical notification services. #INV-001868
Amount:
$1,777.77
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Disposal cost. #815
Amount:
$130.00

Cost Information

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Grand Total

Predetermined
Cost Estimate 		Estimated Cost Actual Cost
Total for all systems $551,992.16 $292,876.16 $216,528.93

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.

Michael Voge

Director of Engineering Operations


08/18/2022

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.

Michael Voge

Director of Engineering Operations


08/18/2022

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.

Michael Voge

Director of Engineering Operations


08/18/2022

Attachments

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