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:
71586
Service:
DTV
Call Sign:
KCNS
Channel:
39 (UHF)
File Number:
0000028449
FRN:
0020523114
Date Submitted:
09/06/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

NRJ TV SAN FRAN LICENSE CO, LLC

Robert Andrews

722 S DENTON TAP ROAD STE 130

COPPELL, TX 75019

United States

+1 (972) 947-3391 bob@nrjventures.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

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 Tower Mgt Co will manage all aspects of combiner and antenna installation. KCNS will install new transmitter and coordinate the transition with tower owner and other stations.

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 Paragon DCXP-2
Year 2007
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 40 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-72
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 47 kW
Justification for New Transmitter Cost of retuning (including interim transmitter) exceeds replacement cost. Proposed solid state replacement less expensive than IOT replacement. See attached statement.

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 Yes
Size 3 inches
Length 120.0 feet
Other Electrical Service Yes
Description Install additional 400A service disconnect, LV transformer, Surge suppressor
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Transmitter Cooling Installation

Installation of transmitter heat exchangers and cooling piping including required demo and modifications of existing facilities

Installation Crew Expenses

Travel, Per Diem, Lodging for installation crew

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 Retune Existing
Antenna Use Primary (Main)
Description of Use N/A
Ownership Leased
Owner Sutro Tower Inc
Site N/A
Is the existing antenna shared with another station or stations? Yes
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 Top
Polarization Elliptical
Type Broadband Panel
Number of Stations Supported 4
Number of Panels 14
Design power capacity in use 100.0 %
Lower Limit 518.00 MHz
Upper Limit 698.00 MHz
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer Dielectric
Model TUM20-C5SP-14/60H-2_R-T
Year 2007

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
35500 KQED

Primary Antenna

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Adjustment to Existing Antenna

Section Question Response
Sweep Test of Existing Antenna Do you need a sweep test of existing antenna? Yes

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? Yes
Type New
Number of channels supported 2
Frequencies of channels supported RF channel
Frequency N/A

Enter a list of RF channel numbers.

RF Channel Number
30
32

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Combiner HVAC Upgrade

New HVAC to handle heat load from new combiner

Auxiliary Antenna

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Add Antenna Information

Section Question Response
Existing Antenna Description Type of change Retune Existing
Antenna Use Auxiliary (Backup)
Description of Use Aux Backup
Ownership Leased
Owner Sutro Tower Inc
Site N/A
Is this antenna currently shared with any other stations? Yes
Is this 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 Bottom
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 5
Number of Panels 12
Design power capacity in use 100.0 %
Lower Limit 470.00 MHz
Upper Limit 860.00 MHz
Other Antenna Type N/A
ERP: 500.0 kW
Manufacturer Dielectric
Model TUA-C4SP-12/40U-1-S
Year 2007

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
58912 kpjk
35500 KQED
43095 KMTP-TV
51429 KFSF-DT
69619 KBCW

Auxiliary Antenna

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Adjustment to Existing Antenna

Section Question Response
Sweep Test of Existing Antenna Do you need a sweep test of existing antenna? Yes

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? Yes
Type New
Number of channels supported 4
Frequencies of channels supported RF channel
Frequency N/A

Enter a list of RF channel numbers.

RF Channel Number
28
30
32
34

Auxiliary Antenna

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Other Antenna Cost Not Listed

Name Description

Combiner HVAC Upgrade

New HVAC to handle heat load from new combiner

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 Utilize Existing
Use Primary (Main)
Description of Use N/A
Ownership Leased
Owner Sutro Tower Inc
Site N/A
Is the existing transmission line shared with another station or stations? Yes
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer Dielectric
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 950 feet per run

Facility ID's and Call Signs of all stations with whom the transmission line is shared.

Facility ID Call Sign
58912 kpjk
35500 KQED
43095 KMTP-TV

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Retune Existing Line

Retune line, Install additional components and test as necessary for new CH.

Auxiliary Transmission Line

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Add Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Utilize Existing
Use Auxiliary (Backup)
Description of Use Aux Backup
Ownership Leased
Owner Sutro Tower Inc
Site N/A
Is this transmission currently shared with any other stations? Yes
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer Dielectric
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length Broadband
Other Segment Length N/A
Number of parallel runs 1
Length 750 feet per run

Facility ID's and Call Signs of all stations with whom the transmission line is shared.

Facility ID Call Sign
58912 kpjk
35500 KQED
69619 KBCW
43095 KMTP-TV

Auxiliary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Retune Existing Line

Retune, install additional components and test lines for new channel

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? Candelabra
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1001289
Coordinates (NAD83) Latitude (NAD83) 37° 45' 19.0" N-
Longitude (NAD83) 122° 27' 10.0" W-
Overall Structure Height 976.69 feet
Support Structure Height 779.85 feet
Ground Elevation Above Mean Sea Level (AMSL) 833.98 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner SUTRO TOWER INC
Date Constructed 03/27/1998

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
6380 KOIT FM
65484 KOSF FM
43095 KMTP-TV DTV
35703 KTVU DTV
65526 KRON-TV DTV
51429 KFSF-DT DTV
35500 KQED DTV
70032 KSOL FM
34470 KGO-TV DTV
59964 KISQ FM
54770 KFOG FM
25452 KPIX-TV DTV
69619 KBCW 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 tower with candelabra
Tower Reinforcements Please select whether tower reinforcements are needed: No reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Candelabra
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 700
Explanation Complex tower and transition require substantial coordination with vendors, governments, and other tenants on Sutro tower. Transmitter installation logistics and planning. 125hr rate
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 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 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

Alternate Site Study

Engineering, antenna designs, architectural budgeting etc

Neighborhood RF Survey

Local RF Survey required by planning commision

Outside Consultant Expenses

Travel, Per Diem, Lodging etc for outside consultant on-site visits

Post Assignment Antenna Studies

Antenna design, application data, vertical sketches for structural eng, cost estimates

Schedule 387 quarterly reports

Legal fees for preparation and review of quarterly Schedule 387 progress reports

Architectural Engineering: Transmission Space Alteration

Detailed site layout planning for installation of transmitter, trans lines, and other equipment, including calculation of resultant floor and ceiling loads. Includes preparation of 3D construction drawings for local permitting process.

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 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? 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

Sales Tax

Sales tax on items pertaining to transmission lines, combiners , antennas and lines.

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 $1,617,322.00 $1,395,229.00 N/A $864,251.97 N/A
Total for all systems $3,547,067.28 $3,677,606.68 N/A $1,768,949.24 N/A
Primary Transmitter ULXTE-72 $1,617,322.00 $1,395,229.00 $864,251.97
Transmitter Cooling Installation $98,032.00 $98,032.00 Estimate is based on actual invoice $98,032.00 N/A
Other Electrical Service: Install additional 400A service disconnect, LV transformer, Surge suppressor $35,000.00 $35,000.00 Estimated cost for adding additional equipment for new transmitter. Required for proper pre-air testing. $6,688.98 N/A
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW $1,473,000.00 $1,251,267.00 N/A $759,530.99 N/A
3" Rigid Conduit and Wiring (Cost per foot) $6,240.00 $5,880.00 N/A N/A N/A
Installation Crew Expenses $5,050.00 $5,050.00 On-site for transmitter installation crew. Not included on transmitter quote. N/A N/A

Components

Actual Information Description File Name
Transmitter Cooling Installation

Component Description:
Transmitter Cooling System Installation
Amount:
$98,032.00
Other Electrical Service: Install additional 400A service disconnect, LV transformer, Surge suppressor

Component Description:
2nd payment of 33% of item C (Electrical) for GatesAir Transmitter, per Quote Q-78277
Amount:
$3,344.49

Component Description:
Down payment of 33% of item C (Electrical) for GatesAir Transmitter, per Quote Q-78277
Amount:
$3,344.49
UHF - Liquid Cooled Solid State Transmitter 35 - 50 kW

Component Description:
Down payment of 33% of items A, B, D and E on Quote Q-78277 for GatesAir Transmitter
Amount:
$376,615.76

Component Description:
2nd payment of 33% of items A, B, D and E on Quote Q-78277 plus ChgOrder Q-80294 for GatesAir Transmitter
Amount:
$382,915.23
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Installation Crew Expenses 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 $324,231.50 $324,764.50 N/A $127,648.47 N/A
Total for all systems $3,547,067.28 $3,677,606.68 N/A $1,768,949.24 N/A
Primary Antenna TUM20-C5SP-14/60H-2_R-T $204,827.00 $223,690.00 $98,785.13
New combiner, cost per channel (without antenna) $84,200.00 $103,553.00 Very complex system as required by Sutro Tower. Incl design, purchase, install and remove old unit. Entire cost triggered by KCNS channel change because other user is not changing channel. See attachment KCNS.Sutro.Dec2018.CostEstimateRevisions.pdf $30,446.93 N/A
Combiner HVAC Upgrade $113,897.00 $113,897.00 See explanation and quotation included with Sutro Invoice 9115 $68,338.20 N/A
Sweep test of existing antenna $6,730.00 $6,240.00 N/A N/A N/A
Auxiliary Antenna TUA-C4SP-12/40U-1-S $119,404.50 $101,074.50 $28,863.34
Sweep test of existing antenna $6,730.00 $6,240.00 N/A N/A N/A
New combiner, cost per channel (without antenna) $84,200.00 $66,360.00 KCNS Share $11,778.64 N/A
Combiner HVAC Upgrade $28,474.50 $28,474.50 See explanation and quotation included with Sutro Invoice 9115 $17,084.70 N/A

Components

Actual Information Description File Name
New combiner, cost per channel (without antenna)

Component Description:
New Combiner for shared primary antenna system
Amount:
$11,300.63

Component Description:
Preliminary TL parts list, reconfiguration of combiners. See cover letter for explanation of why request is $217.50 lower than invoice
Amount:
$4,024.41

Component Description:
New Combiner for shared primary antenna system
Amount:
$12,658.79

Component Description:
Preliminary TL parts list, reconfiguration of combiners
Amount:
$2,463.10
Combiner HVAC Upgrade

Component Description:
60% progress billing - combiner HVAC
Amount:
$68,338.20
Sweep test of existing antenna Information not provided.
Sweep test of existing antenna Information not provided.
New combiner, cost per channel (without antenna)

Component Description:
New combiner for shared auxiliary antenna system
Amount:
$6,446.32

Component Description:
New Combiner for shared auxiliary antenna system
Amount:
$268.63

Component Description:
New Combiner for shared auxiliary antenna system
Amount:
$5,063.69
Combiner HVAC Upgrade

Component Description:
60% progress billing - Combiner HVAC
Amount:
$17,084.70

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 $387,676.00 $387,676.00 N/A $80,388.75 N/A
Total for all systems $3,547,067.28 $3,677,606.68 N/A $1,768,949.24 N/A
Primary Transmission Line $259,102.00 $259,102.00 $42,030.95
Retune Existing Line $259,102.00 $259,102.00 KCNS Share. Retune of lines required by Sutro system for new channel. See Sutro Cost Estimate attachment. $42,030.95 N/A
Auxiliary Transmission Line $128,574.00 $128,574.00 $38,357.80
Retune Existing Line $128,574.00 $128,574.00 KCNS Share. Retune of existing lines as required by Sutro system for new channel. See Sutro Cost Estimate attachment. $38,357.80 N/A

Components

Actual Information Description File Name
Retune Existing Line

Component Description:
Retune Primary Transmission Line
Amount:
$397.68

Component Description:
Retune Transmission Line
Amount:
$3,874.40

Component Description:
Retune Primary Transmission Line
Amount:
$4,678.47

Component Description:
Retune Primary Transmission Lines
Amount:
$33,080.40
Retune Existing Line

Component Description:
Retune Auxiliary Transmission Line
Amount:
$695.85

Component Description:
Retune Auxiliary Transmission Line
Amount:
$9,174.30

Component Description:
Retune auxililary transmission line
Amount:
$9,301.27

Component Description:
Retune Auxiliary Transmission Line
Amount:
$5,052.98

Component Description:
Retune Transmission Line
Amount:
$14,133.40

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 $441,000.00 $800,537.00 N/A $347,998.10 N/A
Total for all systems $3,547,067.28 $3,677,606.68 N/A $1,768,949.24 N/A
Primary Tower TOWER $441,000.00 $800,537.00 $347,998.10
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $779,824.00 See Attachment KCNS.Sutro.Dec2018.CostEstimateRevisions.pdf $327,291.47 N/A
Structural engineering tower load study for a documented tower with candelabra $20,000.00 $20,713.00 See attachment KCNS.Sutro.Dec2018.CostEstimateRevisions.pdf $20,706.63 N/A

Components

Actual Information Description File Name
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
VSWR Monitoring, Tower Worker Antenna Lockout, Replaces Symphony
Amount:
$1,762.03

Component Description:
Structural Reinforcement Level 6 and above
Amount:
$21,666.49

Component Description:
Architectural Plans, Building Mapping, TL locations, hole locations,outdoor cooling equipment location, plan submissions
Amount:
$340.56

Component Description:
Structural Reinforcement Level 6 and above
Amount:
$18,421.87

Component Description:
VSWR Monitoring, Tower Worker Antenna Lockout, Replaces Symphony
Amount:
$1,960.00

Component Description:
Structural Reinforcement Level 6 and above
Amount:
$20,247.33

Component Description:
Architectural Plans, Building Mapping, TL locations, hole locations,outdoor cooling equipment location, plan submissions
Amount:
$5,780.19

Component Description:
Structural Reinforcement Level 6 and above
Amount:
$468.57

Component Description:
VSWR Monitoring, Tower Worker Antenna Lockout, Replaces Symphony
Amount:
$2,091.66

Component Description:
VSWR Monitoring, Tower Worker Antenna Lockout, Replaces Symphony
Amount:
$1,464.16

Component Description:
Structural Reinforcement Level 6 and above
Amount:
$20,247.33

Component Description:
Architectural Plans, Building Mapping, TL locations, hole locations,outdoor cooling equipment location, plan submissions
Amount:
$6,107.75

Component Description:
Structural Reinforcement Level 6 and above
Amount:
$35,421.06

Component Description:
Architectural Plans, Building Mapping, TL locations, hole locations,outdoor cooling equipment location, plan submissions
Amount:
$1,053.41

Component Description:
VSWR Monitoring, Tower Worker Antenna Lockout, Replaces Symphony
Amount:
$11,567.52

Component Description:
Architectural Plans, Building Mapping, TL locations, hole locations, outdoor cooling equipment location, plan submissions
Amount:
$10,460.43

Component Description:
VSWR Monitoring, Tower Worker Antenna Lockout, Replaces Symphony
Amount:
$10,092.46

Component Description:
VSWR Monitoring, Tower Worker Antenna Lockout, Replaces Symphony
Amount:
$34,714.49

Component Description:
Architectural Plans, Building Mapping, TL locations, hole locations, outdoor cooling equipment location, plan submissions
Amount:
$8,439.89

Component Description:
VSWR Monitoring, Tower Worker Antenna Lockout, Replaces Symphony
Amount:
$2,264.68

Component Description:
Architectural Plans, Building Mapping, TL locations, hole locations, outdoor cooling equipment location, plan submissions
Amount:
$10,067.49

Component Description:
VSWR Monitoring, Tower Worker Antenna Lockout, Replaces Symphony
Amount:
$4,183.54

Component Description:
Architectural Plans, Building Mapping, TL locations, hole locations, outdoor cooling equipment location, plan submissions
Amount:
$2,285.23

Component Description:
Architectural Plans, Building Mapping, TL locations, hole locations,outdoor cooling equipment location, plan submissions
Amount:
$1,038.80

Component Description:
Architectural Plans, Building Mapping, TL locations, hole locations,outdoor cooling equipment location, plan submissions
Amount:
$1,332.28

Component Description:
VSWR Monitoring, Tower Worker Antenna Lockout, Replaces Symphony
Amount:
$16,361.63

Component Description:
VSWR Monitoring, Tower Worker Antenna Lockout, Replaces Symphony
Amount:
$1,569.09

Component Description:
VSWR Monitoring, Tower Worker Antenna Lockout, Replaces Symphony
Amount:
$2,937.55

Component Description:
Architectural Plans, Building Mapping, TL locations, hole locations, outdoor cooling equipment location, plan submissions
Amount:
$854.73

Component Description:
VSWR Monitoring, Tower Worker Antenna Lockout, Replaces Symphony
Amount:
$4,241.86

Component Description:
VSWR Monitoring, Tower Worker Antenna Lockout, Replaces Symphony
Amount:
$1,822.11

Component Description:
Architectural Plans, Building Mapping, TL locations, hole locations,outdoor cooling equipment location, plan submissions
Amount:
$471.91

Component Description:
VSWR Monitoring, Tower Worker Antenna Lockout, Replaces Symphony
Amount:
$8,184.93

Component Description:
Architectural Plans, Building Mapping, TL locations, hole locations, outdoor cooling equipment location, plan submissions
Amount:
$1,744.63

Component Description:
Structural Reinforcement Level 6 and above
Amount:
$53,131.59

Component Description:
Architectural Plans, Building Mapping, TL locations, hole locations, outdoor cooling equipment location, plan submissions
Amount:
$7,103.48

Component Description:
Structural Reinforcement Level 6 and above
Amount:
($5,784.95)

Component Description:
Architectural Plans, Building Mapping, TL locations, hole locations,outdoor cooling equipment location, plan submissions
Amount:
$612.05

Component Description:
Architectural Plans, Building Mapping, TL locations, hole locations,outdoor cooling equipment location, plan submissions
Amount:
$561.64
Structural engineering tower load study for a documented tower with candelabra

Component Description:
Tower Mapping
Amount:
$2,670.83

Component Description:
Tower Mapping
Amount:
$1,481.09

Component Description:
Tower Mapping
Amount:
$152.41

Component Description:
Tower Mapping
Amount:
$4,184.71

Component Description:
Tower Mapping
Amount:
$113.66

Component Description:
Tower Mapping
Amount:
$1,416.66

Component Description:
Tower Mapping
Amount:
$268.66

Component Description:
Tower Mapping
Amount:
$2,888.88

Component Description:
Tower Mapping
Amount:
$4,329.35

Component Description:
Tower Mapping
Amount:
$118.82

Component Description:
Tower Mapping
Amount:
$3,081.56

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 $416,513.78 $413,013.18 N/A $216,668.09 N/A
Total for all systems $3,547,067.28 $3,677,606.68 N/A $1,768,949.24 N/A
Outside Professional Services $416,513.78 $413,013.18 $216,668.09
Project management of the transition $110,600.00 $86,500.00 Includes Sutro Costs and KCNS costs for 40 hrs PM @ $100 hr $37,896.02 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $32,000.00 Complex tower situation requires extensive legal work with tower company (Sutro Tower Inc.) Revised estimate upwards Nov 15, 2018 based on actual expenses incurred to date. Revised again Feb 25 2019 - see cover letter Sutro Inv 8710 $24,978.81 N/A
Post Assignment Antenna Studies $15,563.00 $15,563.00 Required by Sutro Tower Inc. Very complex system. $5,099.14 N/A
Architectural Engineering: Transmission Space Alteration $54,500.00 $54,500.00 Tower landlord requires detailed engineering of alterations required for installation of transmitter and associated electrical, plumbing, etc. including calculations of floor and ceiling loading and 3D construction drawings suitable for use in permitting. $42,533.21 N/A
Schedule 387 quarterly reports $3,125.00 $3,125.00 $312.50 per quarter (1/2 hour legal time) times 10 quarters to end of Phase 8 $125.00 N/A
Outside Consultant Expenses $3,720.00 $3,720.00 Project Manager on-site expenses. N/A N/A
Neighborhood RF Survey $3,333.00 $3,333.00 Required by local planning board N/A N/A
Alternate Site Study $77,607.78 $77,607.78 Required by Sutro Tower Inc. Very complex system. Updated with actual final cost per Sutro Tower Inc invoice 7960 (attached) $77,607.78 Actual costs higher than original estimate because of cost of obtaining an option to procure an alternate site for repack facilities in the event San Francisco permitting for Sutro Tower modifications is not successful
RF Exposure Measurements $21,050.00 $7,844.29 N/A $0.00 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $75,000.00 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 $0.00 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
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $500.00 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
Perform engineering study for new channel assignment and antenna development $7,360.00 $24,570.11 KCNS Share. Very complex situation at Mt. Sutro. Requires extensive outside work using prime contractor Sutro Tower Inc. Updated with actual figure from invoice $24,481.63 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $0.00 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 $1,750.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $937.50 N/A
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $4,210.00 $4,000.00 N/A $759.00 N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Project Management
Amount:
$4,280.68

Component Description:
Project Management
Amount:
$1,183.92

Component Description:
Project Management
Amount:
$3,344.92

Component Description:
Project Management
Amount:
$293.75

Component Description:
Project Management
Amount:
$944.58

Component Description:
Project Management
Amount:
$812.07

Component Description:
Project Management
Amount:
$5,329.08

Component Description:
Project Management
Amount:
$938.74

Component Description:
Project Management
Amount:
$2,885.90

Component Description:
Project Management
Amount:
$889.58

Component Description:
Project Management
Amount:
$1,203.74

Component Description:
Project Management
Amount:
$738.22

Component Description:
Project Management
Amount:
$1,188.75

Component Description:
Project Management
Amount:
$956.25

Component Description:
Project Management
Amount:
$583.33

Component Description:
Project Management
Amount:
$1,032.50

Component Description:
Project Management
Amount:
$1,180.35

Component Description:
Project Management
Amount:
$4,248.72

Component Description:
Project Management
Amount:
$1,033.56

Component Description:
Project Management
Amount:
$1,709.37

Component Description:
Project Management
Amount:
$496.57

Component Description:
Project Management
Amount:
$146.87

Component Description:
Project Management
Amount:
$2,051.38

Component Description:
Project Management
Amount:
($3,020.07)

Component Description:
Project Management
Amount:
$1,162.50

Component Description:
Project Management
Amount:
$125.00

Component Description:
Project Management
Amount:
$759.37

Component Description:
Project Management
Amount:
$1,396.39
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
Legal Fees-Multi-Station Project Control
Amount:
$44.78

Component Description:
Legal Fees-Multi-Station Project Control
Amount:
$655.57

Component Description:
Legal Fees - Multi-Station Project Control
Amount:
$509.43

Component Description:
Legal Fees - Multi-Station Project Control
Amount:
$143.31

Component Description:
Legal Fees - Multi-Station Project Control
Amount:
$634.20

Component Description:
Legal Fees-Multi-Station Project Control
Amount:
$12,651.89

Component Description:
Removing this from the 399. See cover letter.
Amount:
N/A

Component Description:
Legal Fees - Multi-Station Project Control
Amount:
($2,547.67)

Component Description:
Legal Fees - Multi-Station Project Ctrl
Amount:
$217.68

Component Description:
Legal Fees - Multi-Station Project Control
Amount:
$280.04

Component Description:
Legal Fees - Multi-Station Project Control
Amount:
$537.93

Component Description:
Legal Fees - Multi-Station Project Control
Amount:
$551.47

Component Description:
Legal Fees- Multi-Station Project Control
Amount:
$934.48

Component Description:
Legal Fees - Multi-Station Project Control
Amount:
$2,001.96

Component Description:
Legal Fees - Multi-Station Project Control
Amount:
$283.49

Component Description:
Legal Fees - Multi-Station Project Control
Amount:
$100.54

Component Description:
Legal Fees - Multi-Station Project Control
Amount:
$435.33

Component Description:
Legal Fees - Multi-Station Project Control
Amount:
$1,276.56

Component Description:
Legal Fees - Multi-Station Project Control
Amount:
$1,519.20

Component Description:
Legal Fees - Multi-Station Project Control
Amount:
$2,281.73

Component Description:
Legal Fees - Multi-Station Project Control
Amount:
$238.05

Component Description:
Legal Fees-Multi-Station Project Control
Amount:
$367.17

Component Description:
Legal Fees - Multi-Station Project Control
Amount:
$1,587.60

Component Description:
Legal Fees - Multi-Station Project Control
Amount:
$274.07
Post Assignment Antenna Studies

Component Description:
Post Assignment Antenna Studies--antenna design, application data, vertical sketches for structural engineering, cost estimates
Amount:
$20.83

Component Description:
Post AssignmentAntenna Studies--antenna design,application data, verticalsketches for structural engineering, costestimates
Amount:
$3,890.83

Component Description:
Post Assignment Antenna Studies--antenna design, application data, vertical sketches for structural engineering, cost estimates
Amount:
$62.50

Component Description:
RF Eng - Post Assignment Antenna Studies
Amount:
$570.83

Component Description:
Post Assignment Antenna Studies--antenna design, application data, vertical sketches for structural engineering, cost estimates
Amount:
$229.16

Component Description:
Post Assignment Antenna Studies--antenna design, application data, vertical sketches for structural engineering, cost estimates
Amount:
$91.66

Component Description:
Removed component per revised invoices from Sutro; this cost was reallocated to other stations at Sutro
Amount:
N/A

Component Description:
Post Assignment Antenna Studies
Amount:
$233.33
Architectural Engineering: Transmission Space Alteration

Component Description:
Architectural engineering services for alteration of existing space to accommodate new transmission equipment
Amount:
$4,628.50

Component Description:
Architectural engineering services for alteration of existing space to accommodate new transmission equipment
Amount:
$3,378.00

Component Description:
Architectural engineering services for alteration of existing space to accommodate new transmission equipment
Amount:
$2,784.00

Component Description:
Architectural engineering services for alteration of existing space to accommodate new transmission equipment
Amount:
$4,182.60

Component Description:
Architectural engineering services for alteration of existing space to accommodate new transmission equipment
Amount:
$3,143.00

Component Description:
Architectural engineering services for alteration of existing space to accommodate new transmission equipment
Amount:
$15,135.11

Component Description:
Architectural engineering services for alteration of existing space to accommodate new transmission equipment
Amount:
$9,282.00
Schedule 387 quarterly reports

Component Description:
0.2 hrs at $625 to review quarterly 387 report
Amount:
$125.00
Outside Consultant Expenses Information not provided.
Neighborhood RF Survey Information not provided.
Alternate Site Study

Component Description:
Alternate Site Study--engineering, antenna designs, architectural ,budgeting, etc.
Amount:
$44,903.11

Component Description:
Alternate Site Study--engineering, antenna designs, architectural, budgeting, etc.
Amount:
$7,882.05

Component Description:
Alternate Site Study--engineering, antenna designs, architectural, budgeting, etc.
Amount:
$5,849.86

Component Description:
Alternate Site Study--engineering, antenna designs, architectural, budgeting, etc.
Amount:
$6,056.10

Component Description:
Alternate Site Study--engineering, antenna designs, architectural ,budgeting, etc.
Amount:
$12,916.66
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 Information not provided.
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.
Prepare and or review reimbursement form

Component Description:
0.8 hrs at $625 legal fees to assist with 399 reimbursement form
Amount:
$500.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
Preliminary Repacking Study-- engineering,studies, antenna designs,budgeting, architectural, etc.
Amount:
$24,481.63
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application

Component Description:
Prep of engineering portion of KCNS-DT FCC App for Construction Permit for auxiliary facility
Amount:
$1,750.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
0.9 hrs at $625 Legal for initial post-auction CP application
Amount:
$562.50

Component Description:
Legal fees for initial post-auction CP application
Amount:
$375.00
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application

Component Description:
Professional Services
Amount:
$759.00

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 $360,324.00 $356,387.00 N/A $131,993.86 N/A
Total for all systems $3,547,067.28 $3,677,606.68 N/A $1,768,949.24 N/A
Other Expenses $360,324.00 $356,387.00 $131,993.86
Local Zoning $202,108.00 $202,108.00 Super complex project requires extensive zoning work. KCNS portion. See Sutro Cost Estimate attachment $100,547.25 N/A
Sales Tax $35,082.00 $35,082.00 See attachment KCNS.Sutro.Dec2018.CostEstimateRevisions.pdf $7,387.64 N/A
MVPD Notification of Channel Change $5,000.00 $5,000.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $500.00 $500.00 N/A N/A N/A
Equipment Storage $1,200.00 $1,200.00 Storage for KCNS only equipment N/A N/A
Equipment Delivery and Handling Charges $78,469.00 $78,469.00 Complex site requires substantial handling equipment and charges. KCNS Portion $17,045.84 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $24,775.00 $24,775.00 See attachment KCNS.Sutro.Dec2018.CostEstimateRevisions.pdf $5,943.13 N/A
DTV Medical Facility Notification $11,550.00 $7,668.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A $1,070.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A

Components

Actual Information Description File Name
Local Zoning

Component Description:
Permit Public Relations
Amount:
$364.28

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental ImpactReport, etc.and Permit Public Relations
Amount:
$19,207.92

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental ImpactReport, etc.and Permit Public Relations
Amount:
$714.32

Component Description:
Permit Public Relations
Amount:
$525.00

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental Impact Report, etc.and Permit Public Relations
Amount:
$407.31

Component Description:
Permit Public Relations
Amount:
$137.50

Component Description:
Permit Public Relations
Amount:
$387.50

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental Impact Report, etc
Amount:
$1,685.06

Component Description:
Permit Public Relations
Amount:
$310.71

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental Impact Report, etc.and Permit Public Relations
Amount:
$704.66

Component Description:
Permit Public Relations
Amount:
$62.50

Component Description:
Permit Public Relations
Amount:
$705.37

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental Impact Report, etc.
Amount:
$7,529.19

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental ImpactReport, etc.and Permit Public Relations
Amount:
$5,379.43

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental Impact Report, etc.
Amount:
$5,171.32

Component Description:
Permit Public Relations
Amount:
$150.00

Component Description:
Permit Public Relations
Amount:
$137.50

Component Description:
Permit Public Relations
Amount:
($700.57)

Component Description:
Permit Public Relations
Amount:
$396.42

Component Description:
Permit Public Relations
Amount:
$942.85

Component Description:
Permit Public Relations
Amount:
$439.28

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental Impact Report, etc.and Permit Public Relations
Amount:
$357.43

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental ImpactReport, etc.and Permit Public Relations
Amount:
$2,266.79

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental Impact Report, etc.
Amount:
$966.15

Component Description:
Permit Public Relations
Amount:
$512.50

Component Description:
Permit Public Relations
Amount:
$237.50

Component Description:
Permit Public Relations
Amount:
$375.00

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental Impact Report, etc.
Amount:
$12,260.62

Component Description:
Permit Public Relations
Amount:
$337.50

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental Impact Report, etc.and Permit Public Relations
Amount:
$292.68

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental Impact Report, etc.
Amount:
$523.29

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental Impact Report, etc.
Amount:
($6,048.17)

Component Description:
Permit Public Relations
Amount:
$62.50

Component Description:
Removing this item. See Cover letter
Amount:
N/A

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental Impact Report, etc.
Amount:
$11,378.44

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental Impact Report, etc.and Permit Public Relations
Amount:
$9,761.92

Component Description:
Permit Public Relations
Amount:
$312.50

Component Description:
Permit Public Relations
Amount:
$139.28

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental Impact Report, etc.
Amount:
$10,478.13

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental Impact Report, etc.
Amount:
$8,688.85

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental Impact Report, etc.and Permit Public Relations
Amount:
$812.09

Component Description:
Building Permits--Serious modifications--SF Planning--Environmental Impact Report, etc.
Amount:
$2,174.70
Sales Tax

Component Description:
Sales Tax
Amount:
$4,650.12

Component Description:
Sales Tax
Amount:
$885.58

Component Description:
Sales Tax
Amount:
$1,851.94
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

Component Description:
Shipping/Storage/Equipment Delivery/Handling
Amount:
$1,022.48

Component Description:
Fork Lift Rental
Amount:
$757.78

Component Description:
Fork Lift Rental
Amount:
($1,348.80)

Component Description:
Fork Lift Rental
Amount:
$757.78

Component Description:
Shipping/Storage/Equipment Delivery/Handling
Amount:
($262.41)

Component Description:
Equipment Delivery and Handling
Amount:
$378.04

Component Description:
Fork Lift Rental
Amount:
$757.78

Component Description:
Equipment Delivery and Handling (incl Fork Lift Rental)
Amount:
$858.33

Component Description:
Equipment Delivery and Handling (incl Fork Lift Rental)
Amount:
$1,146.78

Component Description:
Fork Lift Rental
Amount:
$757.78

Component Description:
Shipping/Storage/Equipment Delivery/Handling
Amount:
$1,801.45

Component Description:
Fork Lift Rental
Amount:
$858.33

Component Description:
Fork Lift Rental
Amount:
$858.33

Component Description:
Fork Lift Rental
Amount:
$858.33

Component Description:
Equipment Delivery and Handling
Amount:
$89.58

Component Description:
Fork Lift Rental
Amount:
$757.78

Component Description:
Forklift Rental
Amount:
$858.33

Component Description:
Fork Lift Rental
Amount:
$757.78

Component Description:
Shipping/Storage/Equipment Delivery/Handling
Amount:
$7.93

Component Description:
Equipment Delivery and Handling Charges (Forklift Rental)
Amount:
$858.33

Component Description:
Equipment Delivery and Handling (incl Fork Lift Rental)
Amount:
$1,534.68

Component Description:
Fork Lift Rental
Amount:
$858.33

Component Description:
Equipment Delivery and Handling (incl Fork Lift Rental)
Amount:
$1,113.64

Component Description:
Fork Lift Rental
Amount:
$858.33

Component Description:
Shipping/Storage/Equipment Delivery/Handling
Amount:
$149.15
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Disposal Costs
Amount:
$4,506.66

Component Description:
Disposal Cost
Amount:
$2,218.66

Component Description:
Disposal, remove old line hardware, wall patch, painting, vinyl floor patch, patch roof holes, debris disposal, etc.
Amount:
$208.33

Component Description:
Disposal, remove old line hardware, wall patch, painting, vinyl floor patch, patch roof holes, debris disposal, etc.
Amount:
($990.52)
DTV Medical Facility Notification Information not provided.
FCC Filing Fees - Form 2100 minor change CP application

Component Description:
Filing fee for CP to modify auxiliary transmission facility to post-repack channel 32.
Amount:
$1,070.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,547,067.28 $3,677,606.68 $1,768,949.24

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.

Jeff Hazelrigg

CFO


09/06/2019

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.

Jeff Hazelrigg

CFO


09/06/2019

Attachments

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