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:
6124
Service:
DTV
Call Sign:
KPBS
Channel:
19 (UHF)
File Number:
0000028658
FRN:
0002968360
Date Submitted:
08/19/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

BD. OF TRUSTEES, CAL. STATE UNIV. FOR SAN DIEGO STATE UNIV.

Doing Business As: BD. OF TRUSTEES, CAL. STATE UNIV. FOR SAN DIEGO STATE UNIV.

Leon Messenie

5200 CAMPANILE DRIVE

SAN DIEGO, CA 92182

United States

+1 (619) 594-1515 lmessenie@kpbs.org Government Entity

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. No
Briefly describe transition plan See Attachment - "KPBS Repack Project Plan ver2"

Transmitters

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

Primary Transmitter

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Add 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 ROHDE AND SCHWARZ
Model NV8620V
Year 2010
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 20 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 30 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

Name Description

Site Layout, Construction drawings, as-builds

Site construction drawings and as builds for the changes needed to the inside of the KPBS transmission facility

Inside RF System - Interconnection

Inside RF System interconnection components to connect transmitter to mask filter I/O, power monitor, and 4 port switch. Includes 4 port switch with switch controller.

Proof of Performance - Two Exciters

Transmitter Manufacturer to perform a Proof of Performance on the primary transmitter with two exciters operation on CH-19.

Auxiliary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Retune Existing
Use Auxiliary (Backup)
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 ROHDE AND SCHWARZ
Model NV8610V
Year 2010
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 10 kW

Auxiliary 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 30 kW
Other Power N/A
New Exciter Is a new exciter needed? No

Auxiliary 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

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Inside RF System - Interconnection

Inside RF System interconnection components to connect transmitter to mask filter I/O, RF Power Monitor, to 4 port switch.

Proof Of Performance - One Exciter

Transmitter Manufacturer to perform a Proof of Performance on the auxiliary transmitter with one exciter operating on CH-19.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization 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: 350.0 kW
Manufacturer
Model TFU-18GTH-R C170SP CH30
Year 2001

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 285.0 kW
Manufacturer
Model TFU18GTH/VP-R C170SP CH19
Year 2019
Justification for New Antenna The current DTV Antenna cannot be re-tuned from CH30 to CH19. Note: KPBS will be invoiced separately for the vertical component of the antenna. The FCC will not be charged for the vertical component of the new antenna.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Broadband
Feed Line Size 3 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Adapter plate to match tower top

Adapter plate need to mount new antenna to top of tower

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Rigid
Diameter 3 1/8 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 185 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? Yes
Type Rigid
Diameter 3 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 185 feet per run
Justification for New Transmission Line The current transmission line at 19'6" for CH30 is not recommended for use at CH19. 20 foot lengths is recommended

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Dehydrator System

Dehydrator needed to keep transmission line dry current system is limited in capacity and will not be able to keep new line pressurized.

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 Owned
Is this tower consider Complex? Candelabra
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? No
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1213483
Coordinates (NAD83) Latitude (NAD83) 32° 41' 52.7" N-
Longitude (NAD83) 116° 56' 06.3" W-
Overall Structure Height 214.00 feet
Support Structure Height 150.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 2495.00 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner KPBS
Date Constructed 07/17/2001


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 260
Explanation See Attachment " KPBS Further Justification for Form 399"
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 Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Construction Project Management

General Contractor Project Management (moved to Other Expenses by Leon Messenie)

Additional Legal Expenses

Additional legal expenses for University-license public TV station

Quarterly Progress Reports

FCC-required Quarterly Progress Reports

California Inspector

Site Inspection for compliance with California Building Code regulations (see attachment OConnor Proposal FCC399 Outside Professional Services - California Inspector

Project Management Consulting

SDSU Representative to interface between the University and General Contractor. see attachment Barrie Company Proposal FCC399 Outside Professional Services - Project Management Consulting

Other Expenses

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

Other Expenses

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Other Expenses Not Listed

Name Description

General Contractor Expenses

DRP Construction General Contractor Costs. See attachment July 28_2018 General Contractor Justification and Proposal.

California Sales Tax

California Sales Tax at 7.75 percent on all tangible items

California State University System Charge

Required California State University Fee for Financial fund administration. see July 28_2018 California State University System Charge

Shipping Freight

Shipping Antenna, Mask Filters, and other RF Componets to the WIS Storage Yard

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 $506,404.17 $496,510.17 N/A $298,510.17 N/A
Total for all systems $2,101,947.58 $1,824,613.43 N/A $1,186,980.52 N/A
Primary Transmitter NV8620V $308,841.17 $303,894.17 $204,894.17
UHF and VHF - minor banding issues $105,200.00 $99,000.00 N/A $0.00 N/A
Site Layout, Construction drawings, as-builds $8,500.00 $8,500.00 See attached reimbursement packet cover letter. file: 2019MAY04 KPBS Reimbursement Request 011.pdf $8,500.00 N/A
Proof of Performance - Two Exciters $9,890.00 $9,890.00 Actual cost came in higher than originally estimated. $9,890.00 see attachment 2020JULY18 KPBS REIMBURSEMENT REQUEST 015B.pdf for details. Part of Line 10 of DRP invoice. See Exhibit B.1 Line 7 for backup documentation. Cost was more than originally estimated
Inside RF System - Interconnection $152,651.17 $152,651.17 see attachment 2020JULY18 KPBS Reimbursement Request 015B.pdf. Cost overrun was due to the need for a new dummy load, installation, and having to deliver and install the system twice due to a faulty dummy load. $152,651.17 see attachment 2020JULY18 KPBS REIMBURSEMENT REQUEST 015B.pdf for details. Cost increase was due in part to additional work need to replace dummy load. This was done twice due to a major failure of the dummy load
30 kW mask filter $32,600.00 $33,853.00 Adjusted August 15, 2018. See attachment "August 15_2018 WIS-KPBS Repack turnkey proposal with KPBS Breakdown.pdf" for details. Leon Messenie $33,853.00 N/A
Auxiliary Transmitter NV8610V $197,563.00 $192,616.00 $93,616.00
Proof Of Performance - One Exciter $4,945.00 $4,945.00 Actual cost came in slightly higher than estimated $4,945.00 see attachment 2020JULY18 KPBS REIMBURSEMENT REQUEST 015B.pdf for details. Part of Line 10 of DRP invoice. See Exhibit B.1 Line 8 for backup documentation. Cost was more than originally estimated
Inside RF System - Interconnection $54,818.00 $54,818.00 Adjusted August 15, 2018. See attachment "August 15_2018 WIS-KPBS Repack turnkey proposal with KPBS Breakdown.pdf" for details. $6,368 Dielectric RF Components $48,450 Labor per WIS Proposal (1/2 of the estimated $96,900 labor cost per WIS proposal) $54,818.00 N/A
30 kW mask filter $32,600.00 $33,853.00 Adjusted August 15, 2018. See attachment "August 15_2018 WIS-KPBS Repack turnkey proposal with KPBS Breakdown.pdf" for details. Leon Messenie $33,853.00 N/A
UHF and VHF - minor banding issues $105,200.00 $99,000.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF and VHF - minor banding issues

Component Description:
N/A
Amount:
N/A
Site Layout, Construction drawings, as-builds

Component Description:
see attachment 2020JULY18 KPBS REIMBURSEMENT REQUEST 015B.pdf for details. Part of Line 10 of DRP invoice. See Exhibit B.1 Line 2 for backup documentation
Amount:
$300.00

Component Description:
see attached file 2019MAY14 KPBS Reimbursement Request 011.pdf, Item 10 under cover letter "Detail Breakdown" and Item 1 under "Justification for additional funds"
Amount:
$8,200.00
Proof of Performance - Two Exciters

Component Description:
see attachment 2020JULY18 KPBS REIMBURSEMENT REQUEST 015B.pdf for details. Part of Line 10 of DRP invoice. See Exhibit B.1 Line 7 for backup documentation
Amount:
$9,890.00
Inside RF System - Interconnection

Component Description:
see attachment 2020JULY18 KPBS REIMBURSEMENT REQUEST 015B.pdf for details. Part of Line 10 of DRP invoice. See Exhibit B.1 Line 3, 6, 11 for backup documentation
Amount:
$41,322.92

Component Description:
see attached, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 1
Amount:
$20,638.90

Component Description:
Ties to DPR Invoice DPRB008964-2 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124BS rev 2. Line 3, 5, and 6.
Amount:
$24,415.60

Component Description:
Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 3, 5, 6, and 1/2 of Line 7.
Amount:
$54,744.50

Component Description:
see attachment 2019June17 KPBS Reimbursement Request 012.pdf cover letter for justification and detailed breakdown.
Amount:
$11,529.25
30 kW mask filter

Component Description:
Ties to DPR Invoice DPRB008964-2 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124BS rev 2. Line 1.
Amount:
$13,541.20

Component Description:
see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" Item 2
Amount:
$3,385.30

Component Description:
Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 1.
Amount:
$16,926.50
Proof Of Performance - One Exciter

Component Description:
see attachment 2020JULY18 KPBS REIMBURSEMENT REQUEST 015B.pdf for details. Part of Line 10 of DRP invoice. See Exhibit B.1 Line 8 for backup documentation
Amount:
$4,945.00
Inside RF System - Interconnection

Component Description:
N/A
Amount:
N/A

Component Description:
N/A
Amount:
N/A

Component Description:
see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section item 4
Amount:
$24,861.80

Component Description:
Ties to DPR Invoice DPRB008964-2 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124BS rev 2. Line 4.
Amount:
$2,547.20

Component Description:
Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 4, and 1/2 of Line 7.
Amount:
$27,409.00
30 kW mask filter

Component Description:
Ties to DPR Invoice DPRB008964-2 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124BS rev 2. Line 2.
Amount:
$13,541.20

Component Description:
see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 3.
Amount:
$3,385.30

Component Description:
Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 2.
Amount:
$16,926.50
UHF and VHF - minor banding issues 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 $575,750.00 $581,362.80 N/A $322,858.00 N/A
Total for all systems $2,101,947.58 $1,824,613.43 N/A $1,186,980.52 N/A
Primary Antenna TFU18GTH/VP-R C170SP CH19 $575,750.00 $581,362.80 $322,858.00
UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized $247,000.00 $256,186.80 ***System Notice: Estimate adjusted and locked because line has been superseded.***Adjusted 6/6/2018 by L. Messenie as a result of the Wireless Infrastructure Service Budgetary Proposal and Wireless Infrastructure Service Invoice 6124AS $256,186.80 N/A
Adapter plate to match tower top $23,180.00 $23,180.00 Adjusted 6/6/2018 by L. Messenie as a result of the Wireless Infrastructure Service Budgetary Proposal and Wireless Infrastructure Service Invoice 6124AS $20,862.00 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $284,652.00 Added by L. Messenie per FCC to show Horizontal and Vertical Polarity. See attachment 2019May14 KPBS Reimbursement Request #011.pdf Exhibit C Detailed Breakdown Line 1 justification. NOTE: KPBS will pay vertical polarity cost separately. $28,465.20 N/A
Sweep test of existing antenna $6,730.00 $7,360.00 Adjusted 6/6/2018 by L. Messenie as a result of the Wireless Infrastructure Service Budgetary Proposal and Wireless Infrastructure Service Invoice 6124AS $7,360.00 N/A
Elbow complex, broadband, at antenna input, per 3 1/8. feedline (if needed) $9,340.00 $9,984.00 Adjusted August 15, 2018. See attachment "August 15_2018 WIS-KPBS Repack turnkey proposal with KPBS Breakdown.pdf" for details. Leon Messenie $9,984.00 N/A

Components

Actual Information Description File Name
UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized

Component Description:
Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 8.
Amount:
$142,326.00

Component Description:
This item was changed by FCC request. The new antenna is Elliptical Polarization. Thus the change to this category in the 399.
Amount:
N/A

Component Description:
Ties to DPR Invoice DPRB008964-2 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124BS rev 2. Line 7.
Amount:
$113,860.80
Adapter plate to match tower top

Component Description:
Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 11.
Amount:
$11,590.00

Component Description:
Ties to DPR Invoice DPRB008964-2 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124BS rev 2. Line 9.
Amount:
$9,272.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 7
Amount:
$28,465.20
Sweep test of existing antenna

Component Description:
see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section item 6
Amount:
$3,680.00

Component Description:
Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 9.
Amount:
$3,680.00
Elbow complex, broadband, at antenna input, per 3 1/8. feedline (if needed)

Component Description:
Ties to DPR Invoice DPRB008964-2 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124BS rev 2. Line 8.
Amount:
$3,993.60

Component Description:
see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section item 5
Amount:
$998.40

Component Description:
Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 10.
Amount:
$4,992.00

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 $24,690.00 $46,005.00 N/A $28,271.00 N/A
Total for all systems $2,101,947.58 $1,824,613.43 N/A $1,186,980.52 N/A
Primary Transmission Line $24,690.00 $46,005.00 $28,271.00
Rigid Transmission Line - copper, 3 1/8" $19,240.00 $40,555.00 Adjusted August 15, 2018. See attachment "August 15_2018 WIS-KPBS Repack turnkey proposal with KPBS Breakdown.pdf" for details. Leon Messenie $28,271.00 N/A
Dehydrator System $5,450.00 $5,450.00 Adjusted August 15, 2018. See attachment "August 15_2018 WIS-KPBS Repack turnkey proposal with KPBS Breakdown.pdf" for details. Leon Messenie N/A N/A

Components

Actual Information Description File Name
Rigid Transmission Line - copper, 3 1/8"

Component Description:
Ties to DPR Invoice DPRB008964-2 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124BS rev 2. Line 10.
Amount:
$11,308.40

Component Description:
see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 8
Amount:
$2,827.10

Component Description:
Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 12.
Amount:
$14,135.50
Dehydrator System 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 $441,000.00 $154,800.00 N/A $142,800.00 N/A
Total for all systems $2,101,947.58 $1,824,613.43 N/A $1,186,980.52 N/A
Primary Tower TOWER $441,000.00 $154,800.00 $142,800.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $135,800.00 Original Estimate did not include review of rigging safety plan by General Contractor $135,800.00 see attachment 2020JULY18 KPBS REIMBURSEMENT REQUEST 015B.pdf for details. Rigging plan review was not included in original estimates
Structural engineering tower load study for a documented tower with candelabra $20,000.00 $19,000.00 N/A $7,000.00 N/A

Components

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

Component Description:
see attachment 2020JULY18 KPBS REIMBURSEMENT REQUEST 015B.pdf for details. Part of Line 10 of DRP invoice. See Exhibit B.1 Line 5 for backup documentation
Amount:
$14,980.00

Component Description:
see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 9
Amount:
$54,670.00

Component Description:
Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 13.
Amount:
$66,150.00
Structural engineering tower load study for a documented tower with candelabra

Component Description:
Line 2 Tower Mapping & Line 3 Structural Analysis
Amount:
$7,000.00

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 $216,420.00 $208,802.05 N/A $82,615.68 N/A
Total for all systems $2,101,947.58 $1,824,613.43 N/A $1,186,980.52 N/A
Outside Professional Services $216,420.00 $208,802.05 $82,615.68
Project Management Consulting $13,500.00 $13,500.00 Project Management consulting services to interface between San Diego State University and the project General Contractor. Also looks out for SDSU interests during construction projects $13,099.05 N/A
California Inspector $5,400.00 $5,400.00 Required by the California State University system to ensure compliance with California Building codes N/A N/A
Quarterly Progress Reports $5,000.00 $5,000.00 Prepare and file FCC-required progress reports for repacked station throughout transition. $1,167.88 N/A
Additional Legal Expenses $17,000.00 $17,000.00 12-3-2018 (See attachment "KPBS Additional Legal Fee Justification" for explanation to overage and adjustment request for estimate increase.) $14,682.89 (See attachment "KPBS Additional Legal Fee Justification" for explanation to overage and adjustment request for estimate increase.)
Construction Project Management $0.00 $0.00 N/A N/A N/A
RF Exposure Measurements $21,050.00 $20,000.00 N/A $3,500.00 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A N/A N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A $750.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $895.31 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $1,169.82 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $500.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $1,687.50 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $1,037.50 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $3,652.05 See attachment 2019APR22 Additional Cost Justification.pdf $3,652.05 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $1,667.43 N/A
Project management of the transition $41,080.00 $39,000.00 N/A $38,806.25 N/A

Components

Actual Information Description File Name
Project Management Consulting

Component Description:
Processing General Contractor Agreement and Billings. Review documents for compliance with SDSU agreement. Work performed by S. Lantz of The Barrie Company for the billing period of January 2019
Amount:
$540.00

Component Description:
Processing General Contractor Agreement and Billings. Review documents for compliance with SDSU agreement. Work performed by S. Lantz of The Barrie Company for the billing period of December 2018
Amount:
$2,025.00

Component Description:
Processing General Contractor Agreement and Billings. Review documents for compliance with SDSU agreement. Work performed by S. Lantz of The Barrie Company for the billing period of February 2019
Amount:
$584.55

Component Description:
Processing General Contractor Agreement and Billings. Review documents for compliance with SDSU agreement. Work performed by S. Lantz of The Barrie Company for the billing period of March 2019
Amount:
$499.50

Component Description:
Processing General Contractor Agreement and Billing, Review and confirm contract compliance with SDSU agreement
Amount:
$3,240.00

Component Description:
Processing General Contractor Agreement and Billings. Review documents for compliance with SDSU agreement. Work performed by S. Lantz of The Barrie Company for the billing period of November 2018
Amount:
$675.00

Component Description:
Processing General Contractor Agreement and Billings. Review documents for compliance with SDSU agreement. Work performed by S. Lantz of The Barrie Company for the billing period of June 2018
Amount:
$1,350.00

Component Description:
Processing General Contractor Agreement and Billings. Review documents for compliance with SDSU agreement. Work performed by S. Lantz of The Barrie Company for the billing period of October 2018
Amount:
$405.00

Component Description:
Processing General Contractor Agreement and Billings. Review documents for compliance with SDSU agreement. Work performed by S. Lantz of The Barrie Company for the billing period of Sept 2018
Amount:
$3,780.00
California Inspector Information not provided.
Quarterly Progress Reports

Component Description:
see attachment 2019APR24 GrayMillerPershPLL Invoice 30147.pdf cover letter for breakdown explanation.
Amount:
$174.60

Component Description:
Line 2, 4, 7 of invoice 29817. see invoice for item details
Amount:
$388.00

Component Description:
Line 1 - Email regarding 2017 Third Quarter Progress Report
Amount:
$43.65

Component Description:
Line 2 - Analysis and review re repack transition quarterly progress report deadline and submission status for KPBS-TV
Amount:
$37.83

Component Description:
Invoice Line 1: Reminder about quarterly repack transition report due July 10,2018
Amount:
$43.65

Component Description:
Line 2 - Email Reminder of Quarterly Transition Progress Report due Jan 10, 2018
Amount:
$43.65

Component Description:
Line 2 - Work on Quarterly Progress Report for repack and review with Leon Messenie of KPBS
Amount:
$392.85

Component Description:
Line 2 of invoice 29322 Email reminder of quarterly progress report due
Amount:
$43.65
Additional Legal Expenses

Component Description:
See attachment 2019JUNE08 Gray Miller Persh PLL Invoice 30492.pdf for item details
Amount:
$87.30

Component Description:
Line 3,4,5,6,8,9,10,11,13,14 - See invoice for details
Amount:
$1,131.99

Component Description:
Line 1 - Prepare for Telephone call with KPBS team to discuss University procedures and amending the FCC Form 399
Amount:
$392.85

Component Description:
Line 1 & 2 Emails regarding Repack
Amount:
$130.95

Component Description:
Line 1 - Work on KPBS repack issues regarding University procurement processes.
Amount:
$87.30

Component Description:
Lines 1 of invoice. Email regarding government shutdown and how it relates to the FCC Repack
Amount:
$43.65

Component Description:
Invoice Line 4 and Line 5: Work on KPBS repack regarding documentation of CSU charges and reimbursement delays
Amount:
$523.80

Component Description:
Ties to Lines 1 - Line 10 of invoice 29509 for various legal correspondence, analysis, and repack issues involving coordination with other linked stations.
Amount:
$1,899.26

Component Description:
Line 1,3,4,5 - See invoice for details
Amount:
$331.74

Component Description:
Line 1 & 3 - Telephone call with Leon Messenie re repack and Review FCC Public Notice on initial allocation of repack funds
Amount:
$125.13

Component Description:
see attachment 2019APR24 GrayMillerPershPLL Invoice 30147.pdf cover letter for breakdown explanation.
Amount:
$891.43

Component Description:
Line 2,4,5,7,9,10,11 - See invoice for details
Amount:
$1,827.48

Component Description:
Legal services regarding reimbursement and amending the FCC 399 Form
Amount:
$2,531.70

Component Description:
Invoice Line 2, Line 3, and Line 4: Work on KPBS reimbursement issues regarding delays. Emails with C. Cavell (FCC) and with FCC staff regarding same. Prepare for Telephone call with C. Cavell (FCC) and M. Dowell (EY)
Amount:
$1,658.70

Component Description:
Line 2 & 4 - Email regarding tower status and Work on Repack cost reimbursement filings
Amount:
$439.41

Component Description:
Lines 1,6, and 7 are misc. legal issues. See attachment 2019APR22 Gray Miller Persh PLL Invoice 29999-REV1.pdf.
Amount:
$635.35

Component Description:
Invoice Lines 1-7; Work on Repack Reimbursement issues. (See attachment "KPBS Additional Legal Fee Justification" for explanation to overage and adjustment request for estimate increase.)
Amount:
$1,440.45

Component Description:
Line 1 - Work on Repack Issue regarding status of reimbursement payments
Amount:
$87.30

Component Description:
see attachment 2019MAY19 Gray Miller Persh PLL Invoice 30316.pdf for breakdown details
Amount:
$373.45

Component Description:
Line 1 - Email regarding FCC Auction Close
Amount:
$43.65
Construction Project Management Information not provided.
RF Exposure Measurements

Component Description:
see attachment 2020JULY18 KPBS REIMBURSEMENT REQUEST 015B.pdf for details. Part of Line 10 of DRP invoice. See Exhibit B.1 Line 9 for backup documentation
Amount:
$3,500.00
Comprehensive coverage verification via field study, if needed Information not provided.
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
ASR modification (prepare FCC Form 854)

Component Description:
Creation, Review, and filing of FAA 7460-1 ASR form by J. Davis
Amount:
$375.00

Component Description:
Line 2 - Prepare and Submit FAA Notification regarding Tower Height Change
Amount:
$375.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
see attachment 2019APR24 GrayMillerPershPLL Invoice 30147.pdf cover letter for breakdown explanation.
Amount:
$479.18

Component Description:
see attachment 2019MAY19 Gray Miller Persh LLP Invoice 30316.pdf for breakdown details
Amount:
$416.13
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
see attachment 2019APR24 GrayMillerPershPLL Invoice 30147.pdf cover letter for breakdown explanation.
Amount:
$87.30

Component Description:
Line 1,3,6,12 - see invoice for details
Amount:
$439.41

Component Description:
Line 1 - Prepare FCC Minor Change application
Amount:
$189.15

Component Description:
Line 1,2,7,12 - See invoice for details
Amount:
$453.96
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
see attachment 2019MAY19 Cheasapeake RF Consultants LLC Invoice 4982.pdf foe detail breakdown
Amount:
$500.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Line Item 2 - Develop ERP and parameters for initial CP application
Amount:
$1,687.50
Perform engineering study for new channel assignment and antenna development

Component Description:
Various discussions regarding implementation of repack to ch-19
Amount:
$262.50

Component Description:
Discussions regarding the amount of BeamTilt on the new CH19 antenna
Amount:
$250.00

Component Description:
Line Item 1 - Channel Assignment Review
Amount:
$525.00
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Line 3, 4, 5 of invoice 29322. Work on KPBS issues regarding coordination of Phase 2 transition dates with other stations
Amount:
$349.20

Component Description:
Lines 2,3,4,5,8. See attachment 2019APR22 Gray Miller Persh PLL Invoice 29999-REV1.pdf. With this submission KPBS is requesting the upwards adjustment of $1152.05 to cover the additional costs. See attachment 2019APR22 Additional Cost Justification.pdf
Amount:
$2,066.10

Component Description:
Ties to Line 1, 2, 3, 4, 5 of invoice 29639. Various work on repack coordination with other stations, consumer education requirements, and some timing issues with MVPD notification
Amount:
$974.85

Component Description:
Line 3, 5, 6 of invoice 29817. See invoice for item details
Amount:
$218.25

Component Description:
Line 2 - issues regarding timing of notifications to MVPD's
Amount:
$43.65
Prepare and or review reimbursement form

Component Description:
Line 3 - Telephone call re FCC Post auction Repack and 1876 Form
Amount:
$113.49

Component Description:
Invoice Line 2 and Line 3; Work on KPBS repack reimbursement issues, email to FCC staff (P.Gallant) regarding reimbursement issues.
Amount:
$436.50

Component Description:
Line 2 - Review 1876 form and channel assignment
Amount:
$87.30

Component Description:
Line 8 - Review and correspondence re 1876 form
Amount:
$113.49

Component Description:
Invoice Line 1 through Line 4: Work on the KPBS repack reimbursement issues regarding submission and processing of payments
Amount:
$916.65
Project management of the transition

Component Description:
see attachment 2020JULY18 KPBS REIMBURSEMENT REQUEST 015B.pdf for details. Part of Line 10 of DRP invoice. See Exhibit B.1 Line 1 for backup documentation.
Amount:
$6,812.50

Component Description:
see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 11
Amount:
$27,843.75

Component Description:
Line 1 Project Management & Engineering
Amount:
$4,150.00

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 $337,683.41 $337,133.41 N/A $311,925.67 N/A
Total for all systems $2,101,947.58 $1,824,613.43 N/A $1,186,980.52 N/A
Other Expenses $337,683.41 $337,133.41 $311,925.67
Shipping Freight $29,063.80 $29,063.80 Actual cost was higher than the estimate freight cost from Dielectric to deliver antenna, mask filters, transmission line and support items to tower rigger storage yard. $29,063.80 see attachment 2020JULY18 KPBS REIMBURSEMENT REQUEST 015B.pdf for details. Part of Line 10 of DRP invoice. See Exhibit B.1 Line 10 for backup documentation. Cost was more than originally estimated.
California State University System Charge $20,302.83 $20,302.83 California State University required fee for project fund financial administration. (see attachment July 28_2018 California State University System Charge) $1,769.43 N/A
California Sales Tax $36,286.89 $36,286.89 Actual cost was higher than original estimate due to additional transmission line segments needed inside the transmitter building and the need for a new dummy load. $36,286.89 see attachment 2020JULY18 KPBS REIMBURSEMENT REQUEST 015B.pdf for details. Part of Line 10 of DRP invoice. See Exhibit B.1 Line 13 for backup documentation. Cost was more than originally estimated due to dummy load with install.
Develop and air announcement of upcoming channel change $2,545.00 $2,545.00 Please see attached KPBS Rate Card, KPBS Production Estimate, and Calculation Document $2,545.00 N/A
Equipment Delivery and Handling Charges $17,450.00 $17,450.00 see attached file, 2019MAY04 KPBS Reimbursement Request 011.pdf. Reference cover letter "Justification for Additional Funds" section Item 2 $17,450.00 N/A
Equipment Storage $7,500.00 $7,500.00 N/A $7,000.00 N/A
MVPD Notification of Channel Change $1,845.00 $1,845.00 Cost was more than originally estimated. Price adjusted per FCC email. $1,845.00 The original estimate cost used for the 399 form was low. This is the current going price for notifying MVPD facilities.
General Contractor Expenses $199,139.89 $199,139.89 General Contractor costs per DPR Construction Executive Summary. Does not include Contingency or RF Sitework. (see attachment July 28, 2018 General Contractor Justification and Proposal) $199,139.89 Please see attachment 2020JULY18 KPBS Reimbursement Request 015B.pdf for detailed breakdown on costs.
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $4,825.66 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $12,000.00 $12,000.00 N/A $12,000.00 N/A

Components

Actual Information Description File Name
Shipping Freight

Component Description:
see attachment 2020JULY18 KPBS REIMBURSEMENT REQUEST 015B.pdf for details. Part of Line 10 of DRP invoice. See Exhibit B.1 Line 10 for backup documentation
Amount:
$29,063.80
California State University System Charge

Component Description:
NOTE: KPBS is unable to obtain a quote for this service as requested by the FCC reviewer. Builders Risk Insurance and Seismic Self Insurance Premium
Amount:
$1,769.43
California Sales Tax

Component Description:
see attachment 2020JULY18 KPBS REIMBURSEMENT REQUEST 015B.pdf for details. Part of Line 10 of DRP invoice. See Exhibit B.1 Line 13 for backup documentation
Amount:
$36,286.89
Develop and air announcement of upcoming channel change

Component Description:
see attachment 2019JUNE08 KPBS Production Services Invoice 109361.pdf for invoice details
Amount:
$2,545.00
Equipment Delivery and Handling Charges

Component Description:
see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 13.
Amount:
$17,450.00
Equipment Storage

Component Description:
see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 14
Amount:
$7,000.00
MVPD Notification of Channel Change

Component Description:
(New Attachment has Invoice and Estimate per FCC Request) MVPD Notification Service for KPBS
Amount:
$1,845.00
General Contractor Expenses

Component Description:
see attachment file 2020JULY18 KPBS Reimbursement Request 015B.pdf for detailed breakdown on invoice lines 1, 2, 3, 4, 5, 6, 7, 8 ,9, 11, 12
Amount:
$30,328.80

Component Description:
Ties to DPR Invoice DPRB008964-1 Lines 1, 2, 3, 4, 5, 6, 7, 8, 10
Amount:
$15,122.00

Component Description:
Ties to Lines 1, 2, 3, 4, 5, 6, 7, 8, 11
Amount:
$55,803.15

Component Description:
Ties to DPR Invoice DPRB008964-2 Line 1, 2, 3, 4, 5, 6, 7, 8, 10
Amount:
$8,328.00

Component Description:
(Corrected to show cents) Ties to DPR Invoice DPRB009919-3 Lines 2, 3, 4, 5, 6, 7, 8, 9, 10, 11
Amount:
$89,557.94
DTV Medical Facility Notification

Component Description:
see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 12
Amount:
$4,750.00

Component Description:
Invoice Line 1: Analysis, review and respond to correspondence re KPBS Post-incentive auction spectrum repack facility channel change modifications, health care facility notifications, and online inspection file posting requirements.
Amount:
$75.66
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
see attachment 2020JULY18 KPBS REIMBURSEMENT REQUEST 015B.pdf for details. Part of Line 10 of DRP invoice. See Exhibit B.1 Line 4 for backup documentation
Amount:
$12,000.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,101,947.58 $1,824,613.43 $1,186,980.52

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.

Leon Messenie

Director of Engineering


08/19/2020

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.

Leon Messenie

Director of Engineering


08/19/2020

Attachments

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