Go to the Federal Communications Commission homepage at www.fcc.gov

FCC Form 399: Incentive Auction Relocation Reimbursement Fund System

Approved by OMB 3060-1178
Go to the Federal Communications Commission homepage at www.fcc.gov

(REFERENCE COPY - Not for submission)FCC Form 399: Incentive Auction Relocation Reimbursement Fund System

File Number:
0000028321
FRN:
0001529627
Facility ID:
68753
Repack Channel:
20 (UHF)
Entity:
Broadcaster
Filing Status:
Submitted
Date Submitted:
02/28/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

ENTRAVISION HOLDINGS, LLC

Mark Boelke

Suite 6000 West

2425 Olympic Boulevard

Santa Monica, CA 90404

United States

+1 (310) 447-3896 mboelke@entravision.com Limited Liability Company

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

Samuel Hariton

Widelity

4031 University Dr

Suite 100

Fairfax, VA 22030

United States

+1 (339) 222-8107 sam.hariton@widelity.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. Yes
Briefly describe transition plan The plan is for KTFN to replace the existing Channel 51 system with a new Channel 20 antenna, new 4-1/16" line, and a new transmitter.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use  
Ownership Owned
Owner  
Site  
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model Diamond CD
Year 2003
Type Solid state
IOT Power Type  
Description  
Power capacity  
Solid State Cooling Air
Solid State Power Capacity 5.41 kw
Other Transmitter Type  

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Description of Use  
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Manufacturer
Model ULXTE-40
Transmitter Type Solid state
IOT Power Type  
Other  
Power capacity  
Solid State Cooling Liquid
Solid State Power Capacity 8.5 kw
Other Transmitter Type  
Justification for New Transmitter New transmitter is necessary because the existing transmitter is not capable of being retuned to channel 20

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
Rigid Conduit and Wiring No
Size
Length
Other Electrical Service Yes
Description The new main transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, KTFN estimated the electrical work cost.
HVAC Service Does the replacement transmitter require HVAC Service? No
Type
Size
Other Size  
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size
Channel 14 Costs Is an RF Consulting Engineer needed?
Is a channel 14 Mask Filer needed?
Is additional field engineering time needed?
Number of Days  

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Freight

Freight to the transmitter location

Mask Filter

Mask filter for the new transmitter

RF Accessories

RF components for the new transmitter

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? Yes
Existing Antenna Manufacturer and Type Class Full Power
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: 250.00 kW
Manufacturer
Model ATW18H4-HSPA-51S
Year 2003

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? Yes
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? Yes
New Antenna Manufacturer and Type Class Full Power
Mounting Side-mount
Antenna position in stack Not in Stack
Polarization Elliptical
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: 1000.00 kW
Manufacturer
Model TFU-22DSC/VP-R BP285
Year 2017
Justification for New Antenna A new antenna is necessary because the existing antenna cannot be retuned to the new channel and is not capable of broadcasting on channel 20.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? 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.

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
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 Type Class Full Power
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: 150.00 kW
Manufacturer
Model TFU-12DSB BP285
Year 2019
Justification for New Antenna Required to remain on the air during transition.

Interim Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? 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

Interim Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 4 1/16 inches
Segment Length 20'
Other Segment Length
Number of parallel runs 1
Length 312 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 Rigid
Diameter 6 1/8 inches
Segment Length 19 ½ '
Other Segment Length
Number of parallel runs 1
Length 230 feet per run
Justification for New Transmission Line KTFN's previous transmission line is not capable of operating on the new channel, the segment lengths are different. A new transmission line will need to be installed in order to support the new channel.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Flexible Air
Diameter 4 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 230 feet per run
Justification for New Transmission Line To be utilized along with interim antenna to remain on the air during transition.

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Terrain Constrained
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 Yes
Is tower documented for structural analysis? No
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1202400
Coordinates (NAD83) Latitude (NAD83) 31° 48' 18.9" N-
Longitude (NAD83) 106° 29' 00.7" W-
Overall Structure Height 388.12 feet
Support Structure Height 340.88 feet
Ground Elevation Above Mean Sea Level (AMSL) 5604.92 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Pinnacle Towers LLC
Date Constructed 01/05/2000

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
36916 KTDO DTV
49832 KVIA-TV DTV
67760 KTSM-TV DTV
10202 KSCE DTV

Other Types of Users

Users
DEA
City of El Paso
59114 K26KJ-D
NOA

Primary Tower

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Tower Modification Costs

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

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Terrain constrained
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 712
Explanation KTFN does not have sufficient resource capacity and expertise in house to handle all of the reimbursement filing by the construction deadline for Phase 8 of March 13, 2020. KTFN will hire an outside firm to ensure a timely and well managed transition.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority No
Quantity N/A
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority No
Quantity N/A
NEPA Section 106 environmental review Yes
Environmental Assessment Yes
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

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 Yes
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? No
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $552,873.40 $316,840.56 N/A $158,420.26 N/A
Total for all systems $1,787,882.40 $1,488,134.16 N/A $338,304.42 N/A
Primary Transmitter ULXTE-40 $552,873.40 $316,840.56 $158,420.26
Freight $5,400.00 $5,400.00 Please see the attached Gatesair JW30004369-1 invoice N/A N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $481,500.00 $245,467.16 Please see the attached Gatesair JW30004369-1 invoice $158,420.26 N/A
Other Electrical Service: The new main transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, KTFN estimated the electrical work cost. $6,733.75 $6,733.75 Please see the attached Gatesair JW30004369-1 invoice N/A N/A
RF Accessories $29,821.89 $29,821.89 Please see the attached Gatesair JW30004369-1 invoice N/A N/A
Mask Filter $29,417.76 $29,417.76 Please see the attached Gatesair JW30004369-1 invoice N/A N/A

Components

Actual Information Description File Name
Freight Information not provided.
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW

Component Description:
50% Down payment for New Primary Transmitter
Amount:
$158,420.26
Other Electrical Service: The new main transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, KTFN estimated the electrical work cost. Information not provided.
RF Accessories Information not provided.
Mask Filter 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 $308,448.00 $266,838.00 N/A $25,393.50 N/A
Total for all systems $1,787,882.40 $1,488,134.16 N/A $338,304.42 N/A
Interim Antenna TFU-12DSB BP285 $93,550.00 $34,615.00 $25,393.50
Sweep test of existing antenna $6,550.00 $6,400.00 N/A N/A N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized $87,000.00 $28,215.00 N/A $25,393.50 N/A
Primary Antenna TFU-22DSC/VP-R BP285 $214,898.00 $232,223.00 $0.00
Side mount brackets for high power antennas (if not included in antenna base cost) $22,550.00 $16,425.00 N/A N/A N/A
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, directional,, elliptically or circularly polarized $185,798.00 $185,798.00 N/A N/A N/A
Sweep test of existing antenna $6,550.00 $30,000.00 Based on quote from Inspection Vendor. N/A N/A

Components

Actual Information Description File Name
Sweep test of existing antenna Information not provided.
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized

Component Description:
ANTENNA - UHF SIDE MOUNT
Amount:
$12,696.75

Component Description:
ANTENNA - UHF SIDE MOUNT ONE STATION, HORIZONTALLY POLARIZED TFU-12DSB BP285 ANTENNA FOR D51."
Amount:
$12,696.75
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
UHF - High Power, Side Mount, basic slot antenna, 1000 kW input, directional,, elliptically or circularly polarized Information not provided.
Sweep test of existing antenna Information not provided.

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 $61,870.00 $56,683.10 N/A $4,327.38 N/A
Total for all systems $1,787,882.40 $1,488,134.16 N/A $338,304.42 N/A
Interim Transmission Line $16,560.00 $4,808.20 $4,327.38
Flexible Air Transmission Line - dielectric, 4" $16,560.00 $4,808.20 N/A $4,327.38 N/A
Primary Transmission Line $45,310.00 $51,874.90 $0.00
Rigid Transmission Line - copper, 6 1/8" $45,310.00 $51,874.90 Dielectric quote 513320JKT Rev 5 N/A N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 4"

Component Description:
KTFN-380-Interim Transmission Line
Amount:
$2,163.69

Component Description:
KTFN-380-Interim Transmission Line
Amount:
$2,163.69
Rigid Transmission Line - copper, 6 1/8" 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 $588,600.00 $575,000.00 N/A $104,266.53 N/A
Total for all systems $1,787,882.40 $1,488,134.16 N/A $338,304.42 N/A
Primary Tower TOWER $588,600.00 $575,000.00 $104,266.53
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $25,600.00 $25,000.00 N/A $19,154.97 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $409,500.00 $400,000.00 N/A $85,111.56 N/A
Minor tower reinforcement/modifications $153,500.00 $150,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Tower mapping and prep of doc necessary for tower load study
Amount:
$17,015.76

Component Description:
Broadcast tower structural analysis
Amount:
$2,139.21
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
For Station KTFN, 50% upon acceptance.
Amount:
$85,111.56
Minor tower reinforcement/modifications Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $179,043.00 $175,987.50 N/A $45,896.75 N/A
Total for all systems $1,787,882.40 $1,488,134.16 N/A $338,304.42 N/A
Outside Professional Services $179,043.00 $175,987.50 $45,896.75
RF Exposure Measurements $20,500.00 $20,000.00 N/A N/A N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,050.00 $2,000.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,050.00 $2,000.00 N/A N/A N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,240.00 $10,000.00 N/A N/A N/A
NEPA Section 106 environmental review, if needed $6,140.00 $6,000.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,095.00 $4,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,305.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,120.00 $5,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,535.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,070.00 $4,437.50 See attached invoices for RF engineering services related to CP application. $4,437.50 N/A
Perform engineering study for new channel assignment and antenna development $7,170.00 $7,000.00 N/A $437.50 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,560.00 $2,500.00 N/A N/A N/A
Project management of the transition $109,648.00 $106,800.00 N/A $41,021.75 N/A
Prepare and or review reimbursement form $2,560.00 $2,500.00 N/A N/A N/A

Components

Actual Information Description File Name
RF Exposure Measurements Information not provided.
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
ASR modification (prepare FCC Form 854) Information not provided.
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet Information not provided.
NEPA Section 106 environmental review, if needed Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations 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 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:
CP Mod./DA Change Profoessinal Services
Amount:
$500.00

Component Description:
Preparation of the engineering section of FCC Form 2100
Amount:
$2,562.50

Component Description:
Preparation of the engineering section of FCC Form 2100
Amount:
$250.00

Component Description:
Preparation of the engineering section of FCC From 2100
Amount:
$1,125.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Engineering study work for new channel assignment including antenna development
Amount:
$437.50
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Project management of the transition

Component Description:
Project Management
Amount:
$2,231.30

Component Description:
Project Management
Amount:
$2,502.00

Component Description:
Project management
Amount:
$1,193.70

Component Description:
Project Management
Amount:
$2,226.90

Component Description:
Project management
Amount:
$1,385.85

Component Description:
Project Management
Amount:
$3,187.00

Component Description:
Project Management
Amount:
$2,267.35

Component Description:
Project management
Amount:
$971.95

Component Description:
Project management
Amount:
$1,053.15

Component Description:
Project Management
Amount:
$1,713.80

Component Description:
Project management
Amount:
$2,351.70

Component Description:
Project Management
Amount:
$1,911.75

Component Description:
Project Management
Amount:
$1,398.40

Component Description:
Project management
Amount:
$778.60

Component Description:
Project Management
Amount:
$2,331.15

Component Description:
Project Management
Amount:
$1,680.05

Component Description:
Project Management
Amount:
$1,637.85

Component Description:
Project Management
Amount:
$3,615.40

Component Description:
Project Management
Amount:
$2,429.20

Component Description:
Project Management
Amount:
$1,945.35

Component Description:
Project Management
Amount:
$2,061.10

Component Description:
Project management
Amount:
$148.20
Prepare and or review reimbursement form Information not provided.

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 $97,048.00 $96,785.00 N/A $0.00 N/A
Total for all systems $1,787,882.40 $1,488,134.16 N/A $338,304.42 N/A
Other Expenses $97,048.00 $96,785.00 $0.00
MVPD Notification of Channel Change $500.00 $500.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $15,000.00 $15,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $26,200.00 $26,200.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $10,000.00 $10,000.00 N/A N/A N/A
Non-zoning permits $2,500.00 $2,500.00 N/A N/A N/A
Local Zoning $5,000.00 $5,000.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $333.00 $325.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,070.00 $1,070.00 N/A N/A N/A
DTV Medical Facility Notification $11,250.00 $11,000.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
BLM or NFS Coordination $25,000.00 $25,000.00 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 $1,787,882.40 $1,488,134.16 $338,304.42

Construction Status

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Question Response
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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.

Manuel Cavazos , III .

EVP - Director of Technology


02/28/2019

Certification

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Section Question Response
Submission of Actual Cost Documentation 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.

  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 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).

  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 certifies that the cost information/documents submitted reflect costs actually incurred.

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

  7. 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.

Manuel Cavazos , III .

EVP - Director of Technology


02/28/2019

Attachments

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