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:
19783
Service:
DTV
Call Sign:
KVEA
Channel:
25 (UHF)
File Number:
0000028173
FRN:
0019509470
Date Submitted:
05/31/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

NBC TELEMUNDO LICENSE LLC

Margaret L. Tobey

300 NEW JERSEY AVE, N.W.

SUITE 700

WASHINGTON, DC 20001

United States

+1 (202) 524-6401 MARGARET.TOBEY@NBCUNI.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

Margaret L Tobey

NBCUniversal, LLC

300 New Jersey Ave. NW

Suite 700

Washington, DC 20001

United States

+1 (202) 524-6401 Margaret.Tobey@nbcuni.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 Switch to new shared ATC interim antenna using existing IOT transmitter as interim transmitter. Remove old antenna and install new antenna and transmitter for new channel. Remove old transmitter after channel change.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model DCXP-2
Year 2010
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 52.9 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 THU9-48
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 73.5 kW
Justification for New Transmitter A new transmitter is required so that we can use the existing transmitter during the transition to maintain coverage. We have selected a solid state transmitter as it will be less expensive then a comparable IOT. IOT Proposal attached for reference.

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

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)
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 Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
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: 1000.0 kW
Manufacturer
Model TFU-20ETT/VP-R 4C160
Year 2010

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? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Top 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: 748.0 kW
Manufacturer
Model TFU-18ETT/VP-R 4C160
Year 2019
Justification for New Antenna Current antenna is channelized and will not work on new channel (Ch 25)

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? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 7 3/16 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? No

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Mounting Adapter

Wedding Cake Mounting Adapter

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Lease New
Ownership Leased
Owner American Tower
Is antenna shared? Yes
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 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: 350.0 kW
Manufacturer
Model TFU-16WB C160
Year 2019
Justification for New Antenna New antenna required to maintain coverage 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? Yes
Type New
Number of channels supported 3
Frequencies of channels supported Upper and lower frequency
Frequency 470.0 MHz - 698.0 MHz
Do you need a combiner output splitter/switcher for dual feed lines? No
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? B
Feed Line Size 6 1/8 inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for an 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

Interim Antenna

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Other Antenna Cost Not Listed

Name Description

Combiner Installation

Installation of combiner for interim antenna

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 7 3/16 inches
Other Diameter N/A
Segment Length 19 3/4 inches
Other Segment Length N/A
Number of parallel runs 1
Length 250 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 7 3/16 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 250 feet per run
Justification for New Transmission Line Current transmission line will not work on new channel (ch 25)

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 Rigid
Diameter 6 1/8 inches
Segment Length Broadband
Other Segment Length
Number of parallel runs 1
Length 320 feet per run
Justification for New Transmission Line New transmission line required to connect to new interim antenna

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 No
Is tower documented for structural analysis? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1213941
Coordinates (NAD83) Latitude (NAD83) 34° 12' 47.9" N-
Longitude (NAD83) 118° 03' 44.3" W-
Overall Structure Height 199.80 feet
Support Structure Height 199.80 feet
Ground Elevation Above Mean Sea Level (AMSL) 5428.08 feet
Structure Type LTOWER - Lattice Tower
Tower Owner SpectraSite Communications, LLC. through American Towers, LLC.
Date Constructed 07/01/2000

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
63865 KILM DTV
60026 KHTV-CD DTV
56384 KBEH DTV
35608 KSCI DTV
26231 KWHY-TV DTV
22161 KRCA DTV

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: Major 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? Yes

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Ground Permit Drawling Package

Ground & Building A&E Permit Drawing Package (Cost per ATC customer)

Migratory Bird Assessment

Migratory Bird Assessment / Permitting (Cost per ATC customer)

Auxiliary Tower

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Add Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Auxiliary (Backup)
Description of Use Used to maintain coverage when main antenna or transmitter is unavailable
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 No
Is tower documented for structural analysis? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? No
ASR Number
Coordinates (NAD83) Latitude (NAD83) 34° 12' 46.0" N-
Longitude (NAD83) 118° 03' 44.9" W-
Overall Structure Height 5624.00 feet
Support Structure Height 199.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 5425.00 feet
Structure Type LTOWER - Lattice Tower
Tower Owner American Tower
Date Constructed 06/19/2000

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
35078 KLOS FM
58978 KPXN-TV DTV
191101 KSFV-CD DTV

Auxiliary 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

Auxiliary 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

Auxiliary Tower

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Other Tower Expenses Not Listed

Name Description

Ground and Building Permit Drawing Package

Ground Drawling Package for permit filing (Cost per ATC customer)

Tower Permit Drawing Package

Tower Drawling Package for permit filing (Cost per ATC customer)

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 2080
Explanation Project oversight of transmitter install, electrical connectivity, tower work, and antenna installation. Additional time will be spent tracking financial and legal process and coordinating with other broadcasters.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development No
Prepare engineering section of Form FCC Construction Permit Application No
For Auxiliary Facility N/A
For Main Facility N/A
Prepare engineering section of Form FCC License to Cover Application No
For Auxiliary Facility N/A
For Main Facility N/A
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 Yes
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
For Main Facility Yes
Prepare request for Special Temporary Authority No
Quantity N/A
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 Yes
RF exposure measurements Yes
Additional Field Engineering Service Yes
Number of Days 40
Justification Ground level RF engineering

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 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? Yes
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

Name Description

Interim Antenna Rental

One time charge for rental during market repack period

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 $5,260,000.00 $3,048,942.27 N/A $1,016,314.09 N/A
Total for all systems $8,310,463.00 $5,477,465.77 N/A $1,649,082.91 N/A
Primary Transmitter THU9-48 $5,260,000.00 $3,048,942.27 $1,016,314.09
UHF - Liquid Cooled Solid State Transmitter 68.5 - 75 kW $1,999,000.00 $1,016,314.09 N/A $1,016,314.09 N/A
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW $1,788,000.00 $1,016,314.09 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $0.00 N/A
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW $1,473,000.00 $1,016,314.09 ***System Notice: Estimate adjusted and locked because line has been superseded.***See attached IOT proposal ($1,310,225) to justify Solid State replacement. $0.00 N/A

Components

Actual Information Description File Name
UHF - Liquid Cooled Solid State Transmitter 68.5 - 75 kW

Component Description:
Transmitter we are requesting is the THU9-48, which is the upgraded model we are ordering. See cover letter to see what we are asking to reimbursed for.
Amount:
$1,016,314.09
UHF - Liquid Cooled Solid State Transmitter 52 - 61 kW

Component Description:
Updated Estimate so we are requesting for a 55 kW transmitter. See updated invoice with cover letter. We are asking to only be reimbursed for Line 1 with proportional amount of tax. Line 2 is an upgrade which NBC will be responsible for paying for.
Amount:
$1,016,314.09
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW

Component Description:
See updated invoice with cover letter. We are asking to only be reimbursed for Line 1 with proportional amount of tax. Line 2 is an upgrade which NBC will be responsible for paying for.
Amount:
$1,016,314.09

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 $642,343.00 $562,057.00 N/A $375,029.10 N/A
Total for all systems $8,310,463.00 $5,477,465.77 N/A $1,649,082.91 N/A
Interim Antenna TFU-16WB C160 $320,613.00 $145,358.00 $0.00
Combiner Installation $3,333.00 $3,333.00 KVEA share of interim combiner cost N/A N/A
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized $189,500.00 $97,025.00 N/A N/A N/A
Sweep test of existing antenna $6,730.00 $5,000.00 N/A N/A N/A
New combiner, cost per channel (without antenna) $84,200.00 $32,000.00 KVEA share of interim combiner cost N/A N/A
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,700.00 $4,000.00 KVEA share of interim elbow complex cost N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $4,000.00 KVEA share of interim bracket cost N/A N/A
Primary Antenna TFU-18ETT/VP-R 4C160 $321,730.00 $416,699.00 $375,029.10
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $385,986.00 See attached quote "KVEA Main Antenna Quote" $347,387.40 N/A
Elbow complex, single channel, at antenna input, per 7 3/16. feedline (if needed) $13,900.00 $12,383.00 N/A $11,144.70 N/A
Mounting Adapter $18,330.00 $18,330.00 See attached main antenna quote $16,497.00 N/A

Components

Actual Information Description File Name
Combiner Installation Information not provided.
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized Information not provided.
Sweep test of existing antenna Information not provided.
New combiner, cost per channel (without antenna) Information not provided.
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
See lines 1 and 2 of invoice
Amount:
$173,693.70

Component Description:
See lines 1 and 2 of invoice
Amount:
$173,693.70
Elbow complex, single channel, at antenna input, per 7 3/16. feedline (if needed)

Component Description:
See line 3 of invoice
Amount:
$5,572.35

Component Description:
See line 3 of invoice
Amount:
$5,572.35
Mounting Adapter

Component Description:
See line 4 of invoice
Amount:
$8,248.50

Component Description:
See line 4 of invoice
Amount:
$8,248.50

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 $146,740.00 $155,942.50 N/A $115,868.26 N/A
Total for all systems $8,310,463.00 $5,477,465.77 N/A $1,649,082.91 N/A
Interim Transmission Line $74,240.00 $27,200.00 $0.00
Rigid Transmission Line - copper, 6 1/8" broadband $74,240.00 $27,200.00 KVEA share of cost for new interim antenna N/A N/A
Primary Transmission Line $72,500.00 $128,742.50 $115,868.26
Rigid Transmission Line - copper, 7 3/16" $72,500.00 $128,742.50 See lines 4 & 5 of main antenna quote $115,868.26 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 6 1/8" broadband Information not provided.
Rigid Transmission Line - copper, 7 3/16"

Component Description:
See lines 5-25 of invoice
Amount:
$57,934.13

Component Description:
See lines 5-25 of invoice
Amount:
$57,934.13

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 $1,611,715.00 $1,089,909.00 N/A $0.00 N/A
Total for all systems $8,310,463.00 $5,477,465.77 N/A $1,649,082.91 N/A
Primary Tower LTOWER $997,015.00 $692,098.00 $0.00
Migratory Bird Assessment $583.00 $583.00 KVEA share of Migratory Bird Assessment on primary tower N/A N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $400,000.00 N/A N/A N/A
Major tower reinforcement/modifications $421,000.00 $150,000.00 KVEA Share of Tower reinforcment N/A N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $13,383.00 KVEA Share of Tower Mapping ($6867) and structural engineering ($6517) costs N/A N/A
Tower Helicopter Lift $123,432.00 $123,432.00 Due to constraints in road to the site and the area around the tower we require a helicopter lift to remove our old antenna and install a new antenna. Proposal attached. N/A N/A
Ground Permit Drawling Package $4,700.00 $4,700.00 N/A N/A N/A
Auxiliary Tower LTOWER $614,700.00 $397,811.00 $0.00
Tower Permit Drawing Package $4,700.00 $4,700.00 N/A N/A N/A
Ground and Building Permit Drawing Package $4,700.00 $4,700.00 N/A N/A N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $300,000.00 N/A N/A N/A
Minor tower reinforcement/modifications $158,000.00 $75,000.00 KVEA Share of Tower costs N/A N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $13,411.00 KVEA Share of Tower mapping ($8173) and structural analysis ($5238)costs N/A N/A

Components

Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $490,985.00 $468,250.00 N/A $135,021.46 N/A
Total for all systems $8,310,463.00 $5,477,465.77 N/A $1,649,082.91 N/A
Outside Professional Services $490,985.00 $468,250.00 $135,021.46
Additional Field Engineering Service, 40 Days $40,000.00 $40,000.00 N/A N/A N/A
RF Exposure Measurements $21,050.00 $20,000.00 N/A N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A 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 - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $4,000.00 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 $302.40 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $662.76 N/A
Project management of the transition $328,640.00 $312,000.00 N/A $134,056.30 N/A

Components

Actual Information Description File Name
Additional Field Engineering Service, 40 Days Information not provided.
RF Exposure Measurements Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
See lines 1 & 2 of invoice, less 10% vendor discount.
Amount:
$189.00

Component Description:
Preparation of CP and minor change application
Amount:
$113.40
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
See lines 3-5 of invoice, less 10% vendor discount.
Amount:
$499.86

Component Description:
Review of Form 399
Amount:
$43.65

Component Description:
Review of Form 399
Amount:
$43.65

Component Description:
Review additional information required for 399.
Amount:
$75.60
Project management of the transition

Component Description:
Project Management
Amount:
$29,923.00

Component Description:
Project Management
Amount:
$150.00

Component Description:
Project Management
Amount:
$900.00

Component Description:
Project Management Invoice
Amount:
$5,225.00

Component Description:
November 2018 Project Management
Amount:
$3,750.00

Component Description:
Point B Project Management January 2019
Amount:
$3,000.00

Component Description:
Project management and travel expenses
Amount:
$7,080.60

Component Description:
June 2018 Project Management
Amount:
$4,605.00

Component Description:
October 2018 Project Management
Amount:
$600.00

Component Description:
July 2018 Project Management
Amount:
$5,040.00

Component Description:
June 2018 Project Management - KVEA portion (line 2)
Amount:
$150.00

Component Description:
Project Management Services
Amount:
$600.00

Component Description:
Project Management Services
Amount:
$2,470.00

Component Description:
Project Management Services
Amount:
$1,072.50

Component Description:
Project Management Services
Amount:
$3,965.00

Component Description:
Project management
Amount:
$6,900.00

Component Description:
August 2018 Project Management
Amount:
$8,245.00

Component Description:
Project Management Services
Amount:
$1,275.00

Component Description:
Project Management Services
Amount:
$975.00

Component Description:
September 2018 Project Management
Amount:
$1,745.38

Component Description:
Project Management Services. See last page for explanation of variance.
Amount:
$3,689.84

Component Description:
Project Management Services
Amount:
$348.95

Component Description:
June 2018 Project Management
Amount:
$750.00

Component Description:
August 2018 Project Management
Amount:
$300.00

Component Description:
Project management
Amount:
$6,900.00

Component Description:
Point B project management services for the month of February 2019. See line item.
Amount:
$3,150.00

Component Description:
September 2018 Project Management
Amount:
$9,075.00

Component Description:
AFF Consulting January 2019 - Status Call
Amount:
$150.00

Component Description:
Jan 2018 Project Management
Amount:
$9,750.00

Component Description:
October 2018 Project Management
Amount:
$7,031.63

Component Description:
Project management
Amount:
$5,239.40

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 $158,680.00 $152,365.00 N/A $6,850.00 N/A
Total for all systems $8,310,463.00 $5,477,465.77 N/A $1,649,082.91 N/A
Other Expenses $158,680.00 $152,365.00 $6,850.00
Interim Antenna Rental $57,600.00 $57,600.00 Interim antenna lease costs (see proposal from ATC) N/A N/A
MVPD Notification of Channel Change $12,000.00 $12,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $25,000.00 $25,000.00 N/A N/A N/A
Equipment Storage $5,000.00 $5,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $12,000.00 $12,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $20,000.00 $20,000.00 N/A $6,850.00 N/A
BLM or NFS Coordination $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
DTV Medical Facility Notification $11,550.00 $5,250.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
Local Zoning $2,500.00 $2,500.00 N/A N/A N/A

Components

Actual Information Description File Name
Interim Antenna Rental Information not provided.
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Asbestos abatement monitoring during vinyl floor tile removal
Amount:
$2,350.00

Component Description:
Floor tile removal
Amount:
$4,500.00
BLM or NFS Coordination Information not provided.
Non-zoning permits Information not provided.
DTV Medical Facility Notification Information not provided.
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.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $8,310,463.00 $5,477,465.77 $1,649,082.91

Reimbursement Status

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

Certification

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Section Question Response
Submission of Estimated Expenses Statements

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

  1. The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.

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

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

  4. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).

  5. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.

  6. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.

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

  8. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Margaret L Tobey

Assistant Secretary


05/31/2019

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.

Margaret L Tobey

Assistant Secretary


05/31/2019

Attachments

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