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:
52425
Service:
DCA
Call Sign:
KSJF-CD
Channel:
19 (UHF)
File Number:
0000025228
FRN:
0021646880
Date Submitted:
10/08/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

KTV MEDIA, LLC

Doing Business As: KTV MEDIA

Larry Morton

17200 Chenal Parkway

Suite 300 - 267

Little Rock, AR 72223

United States

+1 (501) 476-1507 EQUITYLEM@GMAIL.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

Lindsey McGough

Lori E. Withrow, P.L.L.C.

Lindsey McGough

12410 Cantrell Rd.

Suite 100

LIttle Rock, AR 72223

United States

+1 (501) 227-2000 lmcgough@allenwithrow.com

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan This application is to convert Channel 50 to Channel 19. We will use the existing antenna and retune the transmitter and filter. The change that was assigned to us by the FCC resulted in a loss of population and coverage area. See attached explanation.

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 TRN-5X-4D-U-C
Year 2015
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity .50 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? No
Manufacturer
Model TRN-5X-4D-U-C
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity .5 kW
Justification for New Transmitter See KSJF-CD Project Description, items 2 and 3. It is cheaper to buy a used transmitter on frequency than to retune the existing transmitter.

Primary Transmitter

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Other Transmitter Costs

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

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

On-site engineering

It costs to set up the new transmitter and to hook it into the antenna system.

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 Owned
Owner N/A
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? No
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 2.0 kW
Manufacturer Antenna Concepts
Model ANTACS16A
Year 2004

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

Facility ID Call Sign
58284 KHMF-LD

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? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Primary Antenna

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Add 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 this antenna currently shared with any other stations? Yes
Is this antenna directional? Yes
Is antenna in operating condition? No
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 5.0 kW
Manufacturer
Model PSILPD12BA-34
Year 2019

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

Facility ID Call Sign
58284 KHMF-LD

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? Yes
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 2.0 kW
Manufacturer
Model PSILP12BA
Year 2019
Justification for New Antenna See attached Antenna Cost Increase Memo

Primary Antenna

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Other Antenna Costs

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

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Miscellaneous connectors

See attached Antenna Cost Increase

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 Owned
Owner N/A
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 Andrews
Type Flexible Foam
Diameter 1 5/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 225 feet per run

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

Facility ID Call Sign
58284 KHMF-LD

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Miscellaneous connectors

connectors to attach new antenna

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Move Equipment
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1275837
Coordinates (NAD83) Latitude (NAD83) 35° 31' 30.2" N-
Longitude (NAD83) 094° 22' 28.2" W-
Overall Structure Height 160.10 feet
Support Structure Height 146.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 1101.04 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner InSite Towers, LLC
Date Constructed 06/01/1994

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
58284 KHMF-LD LPD

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

TOWER CREW

Cost to hang the 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 50
Explanation To plan and oversee the transition from Channel 50 to Channel 34
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority No
Quantity N/A
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority No
Quantity N/A
NEPA Section 106 environmental review 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 No
Additional Field Engineering Service Yes
Number of Days 3
Justification Confirm proper installation. (One day for 2 people). Added 1 day for a new antenna installation.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Tower Climber

Climber to check and test the antenna after channel change

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

Other Expenses

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Other Expenses Not Listed

Name Description

Travel

Third party consultants travel reimbursement

Combiner

The current antenna will be shared with KQRY-LD

Construction Financing

Construction interest costs to build the project.

Contingency

5% Contingency factor for unexpected items and cost increases over the course of the construction project.

Sales Taxes

Not included in the item costs

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 $17,500.00 $17,500.00 N/A $17,287.50 N/A
Total for all systems $305,408.49 $135,563.49 N/A $82,602.40 N/A
Primary Transmitter TRN-5X-4D-U-C $17,500.00 $17,500.00 $17,287.50
On-site engineering $2,500.00 $2,500.00 We are requesting that this price be increased by $500 because the original proposal did not reflect the cost of installing a full service filter. $2,500.00 N/A
UHF - Air Cooled Solid State Transmitter .5 kW $15,000.00 $15,000.00 N/A $14,787.50 N/A

Components

Actual Information Description File Name
On-site engineering

Component Description:
Engineering to install the transmitter. Balance of the invoice is paid in travel expenses.
Amount:
$2,500.00
UHF - Air Cooled Solid State Transmitter .5 kW

Component Description:
Purchased and received the Transmitter
Amount:
$12,267.50

Component Description:
Per FCC instructions, the cost of the transmitter includes the Mask Filter. See the attached KSJF-CD Construction Permit requiring a full service mask filter. This amount was included in our estimate. We negotiated a discount off of list price.
Amount:
$2,520.00

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $35,030.00 $18,800.00 N/A $16,781.00 N/A
Total for all systems $305,408.49 $135,563.49 N/A $82,602.40 N/A
Primary Antenna ANTACS16A $6,730.00 $5,000.00 $5,000.00
Sweep test of existing antenna $6,730.00 $5,000.00 N/A $5,000.00 N/A
Primary Antenna PSILP12BA $28,300.00 $13,800.00 $11,781.00
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $11,800.00 See attached KSJF-CD Antenna Cost Increase.pdf $11,781.00 N/A
Miscellaneous connectors $2,000.00 $2,000.00 See attached KSJF-CD Antenna Cost Increase.pdf N/A N/A

Components

Actual Information Description File Name
Sweep test of existing antenna

Component Description:
See letter attached to invoice. Engineering costs for the antenna sweeps (Typo corrected - no change in dollars). Balance of invoice in Travel expenses.
Amount:
$5,000.00
UHF - Lower Power Side Mount, Class A One Station antenna -- basic

Component Description:
See KSJF-CD Antenna Cost Increase Memo. Antenna - $11,781 & Shipping - $680.50
Amount:
$11,781.00
Miscellaneous connectors Information not provided.

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,000.00 $1,000.00 N/A $0.00 N/A
Total for all systems $305,408.49 $135,563.49 N/A $82,602.40 N/A
Primary Transmission Line $1,000.00 $1,000.00 $0.00
Miscellaneous connectors $1,000.00 $1,000.00 Connectors used to attach the new antenna. N/A N/A

Components

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 $94,200.00 $10,000.00 N/A $0.00 N/A
Total for all systems $305,408.49 $135,563.49 N/A $82,602.40 N/A
Primary Tower TOWER $94,200.00 $10,000.00 $0.00
Short Tower (less than 500') $84,200.00 $0.00 N/A N/A N/A
TOWER CREW $10,000.00 $10,000.00 This is based on a verbal quote from the tower crew. This is a not to exceed price. See attached Antenna Cost Increase Memo 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 $126,290.00 $56,750.00 N/A $29,000.00 N/A
Total for all systems $305,408.49 $135,563.49 N/A $82,602.40 N/A
Outside Professional Services $126,290.00 $56,750.00 $29,000.00
Tower Climber $2,000.00 $2,000.00 Climber to realign the STL on the tower and to check and test the antenna after a channel change. See attached KSJF-CD Antenna Cost Increase.pdf $1,750.00 N/A
Additional Field Engineering Service, 3 Days $1,000.00 $1,000.00 This is a one day cost in addition to the 2 days that were already in the budget. N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $20,000.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 If required. N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,000.00 See KSJF-CD License Filing Fee.pdf and KSJF-CD - License Filing Costs Memo.pdf $2,000.00 See attached KSJF-CD - License Filing Costs Memo.pdf
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $4,250.00 N/A $4,250.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $1,500.00 N/A
Project management of the transition $7,900.00 $5,000.00 N/A $5,000.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $2,500.00 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 $7,000.00 N/A $7,000.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $3,000.00 N/A
Additional Field Engineering Service, 2 Days $2,000.00 $2,000.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***Confirm proper installation (1 day for two people) plus one additional day for the new antenna. See attached KSJF-CD Antenna Cost Increase.pdf $2,000.00 N/A

Components

Actual Information Description File Name
Tower Climber

Component Description:
Tower work for installing our transmitter and connecting to the existing antenna.
Amount:
$1,750.00
Additional Field Engineering Service, 3 Days Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Legal fees for filing the application. FCC Fees ($335) recorded separately. See KSJF-CD License Filing Fee.pdf
Amount:
$2,000.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Payment of Legal fees for the Construction Permit
Amount:
$4,250.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Engineering fees for filing the KSJF License.
Amount:
$1,500.00
Project management of the transition

Component Description:
Project Management Fees are $5,000. $534.88 was paid for Travel expenses. See attached KSJF Site Management Memo.
Amount:
$5,000.00
Prepare and or review reimbursement form

Component Description:
Preparation and review of the Form 399. Paid receipts were in previous submissions.
Amount:
$2,500.00
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:
Perform engineering study for new channel assignment and antenna development
Amount:
$7,000.00

Component Description:
Channel 24 Repack Study and antenna development.
Amount:
$7,000.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Payment for preparation of the Engineering portion of Form 2100.
Amount:
$3,000.00

Component Description:
Payment for preparation of the Engineering portion of Form 2100.
Amount:
$3,000.00
Additional Field Engineering Service, 2 Days

Component Description:
Additional Site engineering. See KSJF-CD Travel Cost Update.pdf for request of additional travel costs.
Amount:
$2,000.00

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 $31,388.49 $31,513.49 N/A $19,533.90 N/A
Total for all systems $305,408.49 $135,563.49 N/A $82,602.40 N/A
Other Expenses $31,388.49 $31,513.49 $19,533.90
Equipment Delivery and Handling Charges $1,000.00 $1,000.00 Shipping costs not included in individual items. $680.50 N/A
Sales Taxes $2,340.00 $2,340.00 Estimate of sales taxes owed for equipment and services. See Sales Tax Memo. N/A N/A
Contingency $2,877.45 $2,877.45 Allowance for items left out of the projections and cost increases during construction - 3%. See Contingency memo. N/A N/A
Construction Financing $433.33 $433.33 Interest costs for financing the construction. See Construction Loan and Fees memo. N/A N/A
Combiner $4,242.71 $4,242.71 To save construction costs, we are sharing the KQRY antenna. $4,242.71 N/A
Travel $2,500.00 $2,500.00 Travel reimbursement for third-party consultants travel. See Travel Memo. Initially, this was estimated at 1,500. As a result of the site change, the cost will be closer to $2,500. We will still be within the original budget. See KSJF-CD Travel Cost Update.pdf for request of additional travel costs. $1,551.57 When the initial estimate was made, we planned on using the current site. We actually had to move to a new site and that is resulting in additional travel costs.
MVPD Notification of Channel Change $2,000.00 $2,000.00 Cost to notify all MVPD providers of Channel Changes N/A N/A
Develop and air announcement of upcoming channel change $1,000.00 $1,000.00 Payment to third-party to prepare the proper notification of the channel change. $500.00 N/A
Local Zoning $2,000.00 $2,000.00 If required N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $4,785.00 Because we will have to file for a different channel to correct the interference our assigned channel receives we will be required to file Major Modification. See attached KSJF-CD Fee Waiver letter. $4,785.00 THERE WAS NO ESTIMATE FOR THIS BECAUSE WE WERE NOT EXPECTING TO HAVE TO FILE A MAJOR MODIFICATION BECAUSE OF EXISTING INTERFERENCE AND COVERAGE REDUCTION. See attached KSJF Robertson Letter-2 and KSJF 399 ADDITIONAL COST LETTER..
DTV Medical Facility Notification $11,550.00 $8,000.00 N/A $7,439.12 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 The FCC price increased to $335. See KSJF-CD License Filing Fee.pdf and KSJF-CD - License Filing Costs Memo.pdf $335.00 The cost is $10.00 more due to an increase in the FCC fees. See KSJF-CD License Filing Fee.pdf and KSJF-CD - License Filing Costs Memo.pdf

Components

Actual Information Description File Name
Equipment Delivery and Handling Charges

Component Description:
See KSJF-CD Antenna Cost Increase Memo. Antenna - $11,781 & Shipping - $680.50
Amount:
$680.50
Sales Taxes Information not provided.
Contingency Information not provided.
Construction Financing Information not provided.
Combiner

Component Description:
Combiner to allow us to share the antenna with KQRY-LD
Amount:
$4,242.71
Travel

Component Description:
Travel for antenna sweeps.
Amount:
$278.54

Component Description:
Travel for the transmitter installation. Balance of the invoice is in engineering fees to install the transmitter.
Amount:
$371.95

Component Description:
Travel related to the site engineering. See KSJF-CD Travel Cost Update.pdf for request of additional travel costs.
Amount:
$366.20

Component Description:
Travel expense for Site management. $5,000 was charged to Site Management. See attached KSJF Site Management Memo.
Amount:
$534.88
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change

Component Description:
Develop on air notifications.
Amount:
$500.00
Local Zoning Information not provided.
FCC Filing Fees - Form 2100 minor change CP application

Component Description:
Because the Auction Taskforce gave us incorrect advice we had to file in the window that required us to pay a Major Mod fee. This was an unexpected expense we had to pay the FCC. See Attached Waiver Letter.
Amount:
$4,785.00
DTV Medical Facility Notification

Component Description:
Payment for Medical Letters Notification
Amount:
$7,439.12
FCC Filing Fees - Form 2100 license to cover application

Component Description:
FCC Filing fee for KSJF license. This is $10 more than budgeted due to an FCC fee increase.
Amount:
$335.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $305,408.49 $135,563.49 $82,602.40

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. Yes
Construction of final facilities or all necessary modifications are complete. 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.

LARRY MORTON

MANAGER


10/08/2019

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.

Larry Morton

Manager


10/08/2019

Attachments

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