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:
35434
Service:
DTV
Call Sign:
KOTV-DT
Channel:
26 (UHF)
File Number:
0000028007
FRN:
0015452238
Date Submitted:
05/15/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

GRIFFIN LICENSING, L.L.C.

Doing Business As: Griffin Licensing, L.L.C.

Trevor Wiseman

7401 N. KELLEY AVENUE

OKLAHOMA CITY, OK 73111

United States

+1 (405) 841-9106 trevor.wiseman@griffincommunications.net 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

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan Please see attached Transition Plan Narrative.

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 CDP3260P2
Year 2001
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 64.2 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 ULXTE-80
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 63 kW
Justification for New Transmitter See attached Transition Plan Narrative

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 Yes
Size 3 inches
Length 200.0 feet
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

Auxiliary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Auxiliary (Backup)
Description of Use Auxiliary (Backup)
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type 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: 869.6 kW
Manufacturer
Model TFU-28DSC-R O4
Year 2008

Auxiliary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Auxiliary (Backup)
Description of Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types 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: 730.0 kW
Manufacturer
Model TFU-30DSC O4A
Year 2018
Justification for New Antenna See attached Transition Plan Narrative.

Auxiliary 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? Broadband
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? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Auxiliary Antenna

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Other Antenna Cost Not Listed

Information not provided.

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? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Bottom
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: 840.0 kW
Manufacturer
Model TFU-30GBH-R O8
Year 2008

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? No
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Bottom
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: 574.0 kW
Manufacturer
Model TFU-25JBH/VP-R O8
Year 2018
Justification for New Antenna See attached Transition Plan Narrative.

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 6 1/8 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? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Auxiliary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Utilize Existing
Use Auxiliary (Backup)
Description of Use Auxiliary (Backup)
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 Dielectric
Type Rigid
Diameter 7 3/16 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 1680 feet per run

Auxiliary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Sweep Test

Sweep test of existing transmission line to verify ability to support post-auction channel 26

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 6 1/8 inches
Other Diameter N/A
Segment Length 19 3/4 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1950 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
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1950 feet per run
Justification for New Transmission Line See attached Transition Plan Narrative.

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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Add Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex?
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? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1011355
Coordinates (NAD83) Latitude (NAD83) 36° 01' 15.0" N-
Longitude (NAD83) 095° 40' 33.0" W-
Overall Structure Height 1838.89 feet
Support Structure Height 1838.89 feet
Ground Elevation Above Mean Sea Level (AMSL) 709.97 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner TULSA TOWER JOINT VENTURE
Date Constructed 09/01/1984

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
81517 KWTU FM
66586 KWGS FM
66195 KOED-TV DTV
59439 KJRH-TV DTV
37099 KWHB 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 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 Other
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Auxiliary antenna replacement

Replace auxiliary antenna

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 711
Explanation Please see Transition Plan Narrative.
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 Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
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 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 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 Yes
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

Name Description

Transmitter Installation

MARSAND is retained to install and commission transmitter.

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 No
Non-zoning permits No
BLM or NFS Coordination No
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? No
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

Name Description

Attorney Fee - FCC Filing Fee

FCC Filing fees associated with Repack.

Attorney Fee - Review Work Form 387

Review and Work on Form 387 for KO

Site Prep Equipment

To receive in equipment and move around parts for install a pallet jack was required to be purchased.

Aux Antenna - RFreight

Aux Antenna - RFreight, shipping, and handling as per Dielectric invoice attached SO 87002 KOTV Invoice MAN00153.pdf line item 30.

Main Antenna - RFreight

Main Antenna - RFreight, shipping, and handling as per Dielectric invoice attached SO 87002 KOTV Invoice MAN00153.pdf line item 32.

Tower Site Security

Tower site does not have security cameras. KOTV adding security cameras for security purposes of storing millions of dollars worth of repack at KOTV's building at tower site.

Transmitter Shipping-Handling

Shipping - Handling for GatesAir Transmitter as per attached quote - KOTVULXTE80.pdf

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 $1,409,900.00 $1,407,400.00 N/A $929,603.23 N/A
Total for all systems $3,777,072.01 $3,961,621.01 N/A $1,255,772.90 N/A
Primary Transmitter ULXTE-80 $1,409,900.00 $1,407,400.00 $929,603.23
3" Rigid Conduit and Wiring (Cost per foot) $10,400.00 $9,800.00 N/A N/A N/A
UHF - Liquid Cooled Solid State Transmitter 63 kW $1,361,300.00 $1,361,300.00 Refer to quote GA-00023857 - KOTVULXTE80.PDF. The estimated cost on this quote was verified as part of 399 and according to our verfication letter was approved for this amount. The first third of this same quote was paid 11/2017. $929,603.23 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A

Components

Actual Information Description File Name
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
UHF - Liquid Cooled Solid State Transmitter 63 kW

Component Description:
Invoice 2 of 3 for Transmitter - 33% Prior to Ship Invoice - GatesAir - KOTV JW30004177-2
Amount:
$475,683.86

Component Description:
GatesAir 1/3 ARO - down payment for transmitter - As per Quote GA-00023857
Amount:
$453,919.37
Switchgear - industrial 800 amp 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 $624,920.00 $852,320.00 N/A $191,675.55 N/A
Total for all systems $3,777,072.01 $3,961,621.01 N/A $1,255,772.90 N/A
Primary Antenna TFU-25JBH/VP-R O8 $308,530.00 $538,520.00 $127,104.45
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $31,920.00 Please see transition plan narrative and attached Dielectric Main Antenna Quote for base and upgrade. $3,950.10 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 Please see transition plan narrative and attached Dielectric Main Antenna Quote for base and upgrade. $2,112.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $500,200.00 Antenna is the bottom antenna in a stacked set and pre-determined costs will likely double. For details, see attached Transition Plan Narrative and attached Dielectric Main Antenna Quote for base and upgrade. $121,042.35 N/A
Auxiliary Antenna TFU-30DSC O4A $316,390.00 $313,800.00 $64,571.10
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 N/A N/A N/A
UHF - High Power, Side Mount, basic slot antenna, 730 kW input, elliptically or circularly polarized $264,400.00 $264,400.00 See Transition Plan Narrative and attached Dielectric Aux Antenna Quote for base and upgrade. $53,088.75 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 Please see transition plan narrative and attached Dielectric Aux Antenna Quote for base and upgrade. $2,112.00 N/A
Elbow complex, broadband, at antenna input, per 7 3/16. feedline (if needed) $16,850.00 $16,000.00 Please see transition plan narrative and attached Dielectric Aux Antenna Quote for base and upgrade. $3,950.10 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 N/A $5,420.25 N/A

Components

Actual Information Description File Name
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)

Component Description:
Elbow Complex 6-75 Digit KOTV Main. Item 4 on invoice - first 33%
Amount:
$3,950.10
Sweep test of existing antenna

Component Description:
Sweep - on-site for KOTV Main. Item 33 on invoice, first 33%.
Amount:
$2,112.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
UHF Main Antenna, VPOL, Top Plate. Items 1,2,3 on invoice. First 33%.
Amount:
$121,042.35
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
UHF - High Power, Side Mount, basic slot antenna, 730 kW input, elliptically or circularly polarized

Component Description:
UHF - Side Mount Aux Antenna KOTV. Item 24 invoice. First 33%
Amount:
$53,088.75
Sweep test of existing antenna

Component Description:
Sweep on-site KOTV Aux. Item 31 on invoice. First 33%.
Amount:
$2,112.00
Elbow complex, broadband, at antenna input, per 7 3/16. feedline (if needed)

Component Description:
Elbow complex 6-75 KOTV Aux, item 27 on invoice. First 33%.
Amount:
$3,950.10
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
KOTV Aux Side Mounts, also includes scatter study. Item 26 on invoice. First 33%
Amount:
$5,420.25

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 $400,300.00 $411,000.00 N/A $105,218.93 N/A
Total for all systems $3,777,072.01 $3,961,621.01 N/A $1,255,772.90 N/A
Primary Transmission Line $393,900.00 $404,600.00 $105,218.93
Rigid Transmission Line - copper, 6 1/8" $393,900.00 $404,600.00 Please see transition plan narrative and attached Dielectric Main Antenna Quote for base and upgrade. $105,218.93 N/A
Auxiliary Transmission Line $6,400.00 $6,400.00 $0.00
Sweep Test $6,400.00 $6,400.00 Transmission line manufacturer recommends testing the line for ability to support post-auction channel 26. See attached Auxiliary line sweep recommendation. $0.00 N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 6 1/8"

Component Description:
Rigid Transmission Line, TLSCR's, Reducer, and Test port. Items 5, 9, 28, and 29 on invoice. First 33%.
Amount:
$105,218.93
Sweep Test 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 $791,600.00 $762,000.00 N/A $0.00 N/A
Total for all systems $3,777,072.01 $3,961,621.01 N/A $1,255,772.90 N/A
Primary Tower TOWER $791,600.00 $762,000.00 $0.00
Minor tower reinforcement/modifications $158,000.00 $150,000.00 N/A N/A N/A
Structural engineering tower load study for well documented tower $12,600.00 $12,000.00 N/A N/A N/A
Auxiliary antenna replacement $200,000.00 $200,000.00 N/A $0.00 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $400,000.00 Tower has a stacked antennas. Please see transition plan narrative. 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 $416,793.00 $404,192.00 N/A $16,260.50 N/A
Total for all systems $3,777,072.01 $3,961,621.01 N/A $1,255,772.90 N/A
Outside Professional Services $416,793.00 $404,192.00 $16,260.50
Transmitter Installation $160,600.00 $160,600.00 MARSAND to install and commission transmitter. Please see attached MARSAND quote 1756. 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 request for Special Temporary Authorization $3,680.00 $3,500.00 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 $440.50 N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $4,000.00 N/A $767.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $1,261.00 N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $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
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $2,000.00 N/A $1,850.00 N/A
Project management of the transition $112,338.00 $106,650.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $6,500.00 N/A
Prepare and or review reimbursement form $2,630.00 $3,192.00 Sub-Total over Predetermined and Estimated Cost due to only taken in account Engineering review. Additional cost(s) are related to attorney fees. $3,192.00 Sub-Total over Predetermined and Estimated Cost due to only taken in account Engineering review. Additional cost(s) are related to attorney fees.
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 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 $2,250.00 N/A

Components

Actual Information Description File Name
Transmitter Installation 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 request for Special Temporary Authorization Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Form 2100 - Schedule A Modificatoin App / Draft App to reassign to new channel pursuant to post-auction repack.
Amount:
$440.50
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application

Component Description:
Prepare draft app for new aux system, FCC Form 2100 aux antenna, finalize and file form 2100 aux antenna for KOTV.
Amount:
$767.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
FCC Form 2100 construction permit app for KOTV
Amount:
$630.50

Component Description:
Combined work on FCC form 2100 and 399. Finalize and file FCC form 2100 and 399 for KOTV.
Amount:
$436.50

Component Description:
Attorney call and prep work regarding KOTV FCC Form 2100 and 399.
Amount:
$194.00
Prepare request for Special Temporary Authorization Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application

Component Description:
Prepare engineering section of FCC Form 2100, CP (AUX).
Amount:
$1,850.00
Project management of the transition Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
Perform engineering study for new channel assignment and antenna development - complex system: multi-channel, shared combiner, multi-tenant site
Amount:
$6,500.00
Prepare and or review reimbursement form

Component Description:
KOTV Form 399 Preparation
Amount:
$291.00

Component Description:
Prepare and/or review reimbursement form.
Amount:
$2,500.00

Component Description:
Work on FCC form 399 for KOTV, submit FCC form 399 and minor mod app and download full file copies.
Amount:
$401.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepare engineering section of FCC Form 2100, CP Main
Amount:
$2,250.00

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 $133,559.01 $124,709.01 N/A $13,014.69 N/A
Total for all systems $3,777,072.01 $3,961,621.01 N/A $1,255,772.90 N/A
Other Expenses $133,559.01 $124,709.01 $13,014.69
Tower Site Security $1,751.89 $1,751.89 Tower site does not have security cameras. KOTV adding security cameras for security purposes of storing millions of dollars worth of repack at KOTV's building at tower site. $1,751.89 N/A
Main Antenna - RFreight $22,318.00 $22,318.00 Main Antenna - RFreight, shipping, and handling as per Dielectric invoice attached SO 87002 KOTV Invoice MAN00153.pdf line item 32. $7,364.94 N/A
Aux Antenna - RFreight $9,678.00 $9,678.00 Aux Antenna - RFreight, shipping, and handling as per Dielectric invoice attached SO 87002 KOTV Invoice MAN00153.pdf line item 30. $3,193.74 N/A
MVPD Notification of Channel Change $750.00 $750.00 Please see attached MVPD Notification Quote. N/A N/A
Attorney Fee - FCC Filing Fee $1,070.00 $1,070.00 FCC Filing Fees - KOTV Repack - Attorney fees $0.00 N/A
Attorney Fee - Review Work Form 387 $1,000.00 $1,000.00 Attorney Fees associated with reviewing FCC Form 387 for KOTV. $403.00 N/A
Transmitter Shipping-Handling $13,500.00 $13,500.00 Shipping - Handling for GatesAir Transmitter as per attached quote - KOTVULXTE80.pdf N/A N/A
Site Prep Equipment $301.12 $301.12 To receive in equipment and move around heavy equipment for install a pallet jack was required to be purchased. $301.12 N/A
Develop and air announcement of upcoming channel change $43,000.00 $43,000.00 Cost estimates associated with outsourcing the production of the viewer announcements for the upcoming channel change. Refer to KOTV GMSRepackRescanEstimate.pdf in the attachments. $0.00 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $27,000.00 $27,000.00 Existing transmitter removal and fluid recovery. Remove and dispose of existing main and auxiliary antennas and transmission line. See attached MARSAND quote 1755. $0.00 N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 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 - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $2,755.00 N/A N/A N/A

Components

Actual Information Description File Name
Tower Site Security

Component Description:
Tower site does not have security cameras. KOTV adding security cameras for security purposes of storing millions of dollars worth of repack at KOTV's building at tower site.
Amount:
$1,751.89
Main Antenna - RFreight

Component Description:
Main Antenna Freight, Shipping, and Handling - 1/3 ARO invoice amount as per invoice line item 32 - SO 827002 KOTV Invoice MAN00153.pdf
Amount:
$7,364.94
Aux Antenna - RFreight

Component Description:
Aux Antenna Freight, Shipping, and Handling - 1/3 ARO invoice amount as per invoice line item 30 - SO 827002 KOTV Invoice MAN00153.pdf
Amount:
$3,193.74
MVPD Notification of Channel Change Information not provided.
Attorney Fee - FCC Filing Fee

Component Description:
KOTV Repack FCC Filing Fees - Attorney Fees
Amount:
$1,070.00
Attorney Fee - Review Work Form 387

Component Description:
Work on KOTV FCC Form 387 quarterly filing.
Amount:
$106.00

Component Description:
Work on KOTV FCC Form 387 quarterly filing.
Amount:
$100.00

Component Description:
Review draft KOTV schedule 387 3Q 2017 report.
Amount:
$97.00

Component Description:
Review KOTV Form 387
Amount:
$100.00
Transmitter Shipping-Handling Information not provided.
Site Prep Equipment

Component Description:
To receive in equipment and move around parts for install a pallet jack was required to be purchased.
Amount:
$301.12
Develop and air announcement of upcoming channel change Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
DTV Medical Facility Notification Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,777,072.01 $3,961,621.01 $1,255,772.90

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.

Trevor L Wiseman

VP of Technology


05/15/2019

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.

Trevor L Wiseman

VP of Technology


05/15/2019

Attachments

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