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:
17830
Service:
DCA
Call Sign:
KGMM-CD
Channel:
36 (UHF)
File Number:
0000028152
FRN:
0028638583
Date Submitted:
12/20/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

CABALLERO III, LLC

Doing Business As: CABALLERO III, LLC

Randy Nonberg

15200 SUNSET BOULEVARD

SUITE 202

PACIFIC PALISADES, CA 90272

United States

+1 (310) 573-1600 RANDYNONBERG@CNZCOMMUNICATIONS.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

Gregory Best

Consulting Engineer

Greg Best Consulting, Inc.

16100 Outlook Avenue

Stilwell, KS 66085

United States

+1 (816) 792-2913 gbconsulting54@gmail.com

Broadcaster Information and Transition Plan

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

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 Retune Existing
Use Primary (Main)
Ownership Owned
Owner 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 R&S
Model 8300
Year 2014
Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 2 kW

Primary Transmitter

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Retuning Transmitter Costs

Section Question Response
New IOT Tubes Number of Tubes (including accessories) needed N/A
New Mask Filter
Power 1.5 kW
Other Power N/A
New Exciter Is a new exciter needed? No

Primary Transmitter

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Other Transmitter Costs

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

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

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 Unsupported xmtr
Year 2014
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 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 TMU9EVO-8
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 3 kW
Justification for New Transmitter See supporting letter regarding cost and circumstances regarding purchase of transmitter letter. Document file is KGMM-CD FCC REIMBURSEMENT RESPONSE 8-30-19.doc.

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 2 inches
Length 50.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 5 tons
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

XMTR REWORK

Modifications to xmtr tor proper operation.

Antennas

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Section Question Response
Antenna Related Expenses Do you have antenna related expenses? Yes

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? 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: 15.0 kW
Manufacturer
Model TLP-8E
Year 2014

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? No
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 Circular
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: 15.0 kW
Manufacturer
Model ALP16L3-CSO-36
Year 2019
Justification for New Antenna Existing antenna is not designed to operate on the repack channel. See attached transition plan. Existing licensed antenna is circular polarized so this is a like-for-like replacement.

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?
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? Yes
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

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 Flexible Air
Diameter 5 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 1100 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 Flexible Air
Diameter 4 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 560 feet per run
Justification for New Transmission Line The new channel assignment is also at a new location. See Document file KGMM-CD FCC REIMBURSEMENT RESPONSE 8-30-19.doc.

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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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 1054166
Coordinates (NAD83) Latitude (NAD83) 29° 17' 39.0" N-
Longitude (NAD83) 098° 15' 32.0" W-
Overall Structure Height 1517.37 feet
Support Structure Height 1513.43 feet
Ground Elevation Above Mean Sea Level (AMSL) 525.91 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner TELEMUNDO OF SAN ANTONIO LICENSE CORP
Date Constructed 09/01/1989

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
64969 KVDA DTV

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

Information not provided.

Primary Tower

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Add 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? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1214327
Coordinates (NAD83) Latitude (NAD83) 29° 26' 29.9" N-
Longitude (NAD83) 098° 30' 22.8" W-
Overall Structure Height 498.68 feet
Support Structure Height 498.68 feet
Ground Elevation Above Mean Sea Level (AMSL) 679.78 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers LLC
Date Constructed 07/12/2001

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
65329 KZEP-FM FM
60464 KVDF-CD DTV

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

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 240
Explanation Applicant has no internal resources capable of overseeing, identifying, purchasing, installing and commissioning this repack project. It will rely solely on outside services to manage all work required.
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 No
RF exposure measurements No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits Yes
BLM or NFS Coordination 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)? 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? No

Other Expenses

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Other Expenses Not Listed

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $229,420.08 $176,770.08 N/A $100,278.38 N/A
Total for all systems $691,195.08 $537,720.08 N/A $380,681.12 N/A
Primary Transmitter 8300 $0.00 $0.00 $0.00
Primary Transmitter TMU9EVO-8 $229,420.08 $176,770.08 $100,278.38
XMTR REWORK $14,070.08 $14,070.08 Xmtr required new cables and other items as initial operation caused component failure. Estimated amount includes engineering labor for installation and checkout. $0.00 N/A
5 Ton system $20,250.00 $19,250.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW $155,600.00 $105,000.00 N/A $100,278.38 N/A
Switchgear - industrial 800 amp $38,200.00 $37,150.00 N/A N/A N/A
2" Rigid Conduit and Wiring (Cost per foot) $1,300.00 $1,300.00 N/A N/A N/A

Components

Actual Information Description File Name
XMTR REWORK

Component Description:
Engineering services: troubleshooting of R&R transmitter; corrected wiring and calibrated to full power.
Amount:
$7,819.42

Component Description:
Cost of components/materials used in the troubleshooting of the R&S transmitter.
Amount:
$3,012.97
5 Ton system Information not provided.
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW

Component Description:
Initial 25% downpayment for transmitter.
Amount:
$22,200.00

Component Description:
Balance of the cost of the transmitter.
Amount:
$73,925.99

Component Description:
Components/materials used in the installation of the transmitter.
Amount:
$4,152.39
Switchgear - industrial 800 amp Information not provided.
2" Rigid Conduit and Wiring (Cost per foot) 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 $33,030.00 $41,305.00 N/A $34,905.00 N/A
Total for all systems $691,195.08 $537,720.08 N/A $380,681.12 N/A
Primary Antenna ALP16L3-CSO-36 $33,030.00 $41,305.00 $34,905.00
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $34,905.00 KGMM currently has existing circular polarized antenna that is being replaced by a circular polarized antenna. See attached quote. $34,905.00 N/A

Components

Actual Information Description File Name
Sweep test of existing antenna Information not provided.
UHF - Lower Power Side Mount, Class A One Station antenna -- basic

Component Description:
Balance of the cost of antenna.
Amount:
$17,452.50

Component Description:
50% downpayment for antenna cost.
Amount:
$17,452.50

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $41,440.00 $66,000.00 N/A $63,467.50 N/A
Total for all systems $691,195.08 $537,720.08 N/A $380,681.12 N/A
Primary Transmission Line $41,440.00 $66,000.00 $63,467.50
Flexible Air Transmission Line - dielectric, 4" $41,440.00 $66,000.00 New transmission line is required as the site is moving and it is more economical to install new 4" line rather than try to move existing 5" line. See attached quote/invoice from ERI, SWE, and FCC response letter document. $63,467.50 N/A

Components

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

Component Description:
Cost of sales tax and freight for the antenna and transmission line system.
Amount:
$9,715.72

Component Description:
Balance of the cost of the transmission line system.
Amount:
$14,263.62

Component Description:
50% downpayment of the cost of the transmission line system.
Amount:
$14,263.62

Component Description:
ERI invoice billing 50% downpayment of cost of transmission line system.
Amount:
$14,263.62

Component Description:
Components/materials of the transmission line for the antenna installation.
Amount:
$25,224.54

Component Description:
ERI invoice billing: 1. 50% balance of cost of transmission line system 2. sales for antenna and transmission line 3. freight cost.
Amount:
$23,979.34

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 $294,700.00 $150,000.00 N/A $144,227.05 N/A
Total for all systems $691,195.08 $537,720.08 N/A $380,681.12 N/A
Primary Tower TOWER $210,500.00 $35,000.00 $31,663.51
Tall Tower (greater than 500') $210,500.00 $35,000.00 Removal of equipment at pre-repack KGMM-CD facility at location with ASR 1054166. $31,663.51 N/A
Primary Tower GTOWER $84,200.00 $115,000.00 $112,563.54
Short Tower (less than 500') $84,200.00 $115,000.00 Installation of new transmitter, antenna, and transmission line at location with ASR 1214327. Includes tower mapping and structural analysis and costs. Includes minor mod of tower. Includes labor cost to install and tune fine matching device for antenna. $112,563.54 N/A

Components

Actual Information Description File Name
Tall Tower (greater than 500')

Component Description:
Cost of engineering services and removal of all equipment and hardware from old KGMM site.
Amount:
$28,550.00

Component Description:
Cost of registration fees to gain access to site/facility.
Amount:
$1,995.00

Component Description:
Forklift operator labor cost.
Amount:
$115.80

Component Description:
Cost of forklift with crane hook attachment rental.
Amount:
$1,002.71
Short Tower (less than 500')

Component Description:
Construction project management (tower modification reinforcements and facilities); coordination with other stations and wireless.
Amount:
$5,000.00

Component Description:
Structural engineering tower load study for documented tower.
Amount:
$6,475.00

Component Description:
Cost of feedhorn, LNB, C band and cover plate for satellite dish.
Amount:
$635.00

Component Description:
Tower Engineering Services: ascend tower to antenna input location, installation of fine matching uhf networks, complete high power network analysis of antenna system, providing an improved VSWR at each termination.
Amount:
$14,550.00

Component Description:
Complete installation cost of antenna, transmitter and transmission line system.
Amount:
$68,550.00

Component Description:
Tower mapping and preparation of documentation for tower load study.
Amount:
$16,345.00

Component Description:
Cost of alignment of satellite dishes, connecting cables to dishes and running conduit.
Amount:
$1,008.54

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 $67,110.00 $78,750.00 N/A $29,672.00 N/A
Total for all systems $691,195.08 $537,720.08 N/A $380,681.12 N/A
Outside Professional Services $67,110.00 $78,750.00 $29,672.00
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $787.50 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $3,266.50 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 engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $1,925.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $175.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A $1,260.00 N/A
Project management of the transition $37,920.00 $51,000.00 Estimate includes project management of site services of $14480. $19,955.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $2,303.00 N/A

Components

Actual Information Description File Name
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:
Engineering repack services for June 2019: KGMM license to cover application; prepared and filed transition progress reports.
Amount:
$787.50
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Consultation with attorney regarding changes to repack CP and relocation costs.
Amount:
$1,251.00

Component Description:
attorney fees: revise and edit response to Fund Administrator regarding reimbursement of KGMM interim facility.
Amount:
$1,737.50

Component Description:
Attorney fees: telephone conference with FCC staff regarding construction status.
Amount:
$278.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Repack engineering services: review and revision of transmitter system; minor modification to CP application for antenna and correct height.
Amount:
$1,925.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Engineering repack services: Qtr 3 2018 reports.
Amount:
$87.50

Component Description:
Engineering repack services: Qtr4 2017 reports.
Amount:
$87.50
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Attorney services: consultation regarding PSIP channel in repacking; telephone conference with FCC staff; review PSIP rules and options for moving PSIP; review minor modification application.
Amount:
$625.50

Component Description:
KGMM repack attorney's services: discussions regarding technical problems and protential waiver.
Amount:
$634.50
Project management of the transition

Component Description:
Project management of the transition; address transition timing and coordination issues with other stations and wireless.
Amount:
$9,480.00

Component Description:
Repack engineering services: site engineering application, transmission layout, update form 399.
Amount:
$3,150.00

Component Description:
Repack project management services.
Amount:
$2,250.00

Component Description:
Engineering repack services: investigation of interim equipment and assistance with 399 preparation in response to FCC inquiry.
Amount:
$5,075.00
Prepare and or review reimbursement form

Component Description:
Engineering repack services: prepare CP and assist with 399 preparation and review for repacked channel.
Amount:
$525.00

Component Description:
Repack engineering services: review and partial completion of revision of 399 forms to indicate correct transmission equipment and associated costs.
Amount:
$700.00

Component Description:
Attorney fees: review fund administrator response to KGMM repack reimbursement request.
Amount:
$278.00

Component Description:
Repack engineering services from 9/1 to 9/28/2019; follow-up with FCC regarding 399 response to FCC inquiry.
Amount:
$800.00

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 $25,495.00 $24,895.00 N/A $8,131.19 N/A
Total for all systems $691,195.08 $537,720.08 N/A $380,681.12 N/A
Other Expenses $25,495.00 $24,895.00 $8,131.19
Develop and air announcement of upcoming channel change $2,500.00 $2,500.00 N/A N/A N/A
Equipment Storage $2,000.00 $2,000.00 N/A $1,710.00 N/A
Equipment Delivery and Handling Charges $2,000.00 $2,000.00 N/A $1,909.04 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,000.00 $2,000.00 N/A $1,562.15 N/A
Non-zoning permits $2,000.00 $2,000.00 N/A N/A N/A
Local Zoning $2,000.00 $2,000.00 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 $11,000.00 N/A $2,950.00 N/A

Components

Actual Information Description File Name
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage

Component Description:
Cost of moving transmitter from storage to facility.
Amount:
$1,710.00
Equipment Delivery and Handling Charges

Component Description:
Made arrangements for deliveries: forklift, antenna, transmission line, etc; also, took care of trash and crate removal.
Amount:
$804.08

Component Description:
Cost for equipment rental to pickup and deliver transmitter; including disposal of shipping materials.
Amount:
$1,104.96
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Cost of trash disposal fees and moving of trash from site to landfill.
Amount:
$1,562.15
Non-zoning permits Information not provided.
Local Zoning 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

Component Description:
Medical notification requirements for KGMM repack.
Amount:
$2,950.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $691,195.08 $537,720.08 $380,681.12

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. Yes
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.

David Nonberg

Vice President


12/20/2019

Certification

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Section Question Response
Submission of Final Allocation or Accounting Information Statements

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

  1. The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

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

  3. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.

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

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

  6. 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.

David Nonberg

Vice President


12/20/2019

Attachments

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