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:
55083
Service:
DTV
Call Sign:
KXLA
Channel:
51 (UHF)
File Number:
0000027093
FRN:
0007519408
Date Submitted:
10/20/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

RANCHO PALOS VERDES BROADCASTERS, INC.

Ronald L. Ulloa

2323 CORINTH AVENUE

LOS ANGELES, CA 90064

United States

+1 (310) 478-0055 rulloa@kxlatv.com Corporation

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

Greg Best

Consulting Engineer

Greg Best Consulting, Inc.

16100 Outlook Ave.

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. No
Briefly describe transition plan File Interim STA. Replace interim backup antenna, transmitter & line. Install and sweep primary T-Line & antenna. Remove & replace primary transmitter .

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 Innovator
Year 2006
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 60 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 ULXTE-50
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 32 kW
Justification for New Transmitter Existing transmitter manufacturer is no longer in business and it is not possible to retune the existing transmitter to the repacked channel.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 3 inches
Length 200.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Interim Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Interim
Description of Use N/A
Change Type Purchase
Manufacturer
Model ULXTE-50
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 32 kW
Justification for New Transmitter Existing backup transmitter cannot be converted to repacked channel per manufacturer and manufacturer is no longer in business.

Interim Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 3 inches
Length 200.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A
Inside RF System Is an additional interior RF system required to support this interim transmitter? No

Interim Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

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? Yes
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 4
Number of Panels 30
Design power capacity in use 90.0 %
Lower Limit 578.00 MHz
Upper Limit 700.00 MHz
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model PHP30CA-CH51
Year 2006

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

Facility ID Call Sign
24518 KDOC-TV
14000 KJLA
4328 KOCE-TV

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? Yes
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 Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 670.0 kW
Manufacturer
Model ATW24H6-ESC170-30H
Year 2018
Justification for New Antenna Existing antenna cannot be converted to repacked channel per manufacturer. Quotes are provided for both Hpol and Epol antennas to clarify the cost differential and reimbursement request. KXLA expects to be reimbursed for Hpol only costs.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 6 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
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 Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 670.0 kW
Manufacturer
Model ATW24H6-ESC170-30H
Year 2018
Justification for New Antenna Existing antenna cannot be converted to repacked channel per manufacturer. Quotes are provided for both Hpol and Epol antennas to clarify the cost differential and reimbursement request

Interim Antenna

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Other Antenna Costs

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

Interim 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? Yes
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 4
Length 410 feet per run

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

Facility ID Call Sign
14000 KJLA
24518 KDOC-TV
4328 KOCE-tv

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 6 1/8 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 450 feet per run
Justification for New Transmission Line See attached document on station transmission line systems and justification for new equipment purchase.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Rigid
Diameter 6 1/8 inches
Segment Length 19 ½ '
Other Segment Length
Number of parallel runs 1
Length 400 feet per run
Justification for New Transmission Line See attached T-Line system description documentation regarding existing transmission line system and justification for purchase.

Interim 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 Modify Existing
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 1221073
Coordinates (NAD83) Latitude (NAD83) 34° 13' 35.3" N-
Longitude (NAD83) 118° 04' 00.9" W-
Overall Structure Height 403.87 feet
Support Structure Height 399.93 feet
Ground Elevation Above Mean Sea Level (AMSL) 5709.90 feet
Structure Type LTOWER - Lattice Tower
Tower Owner American Towers, LLC.
Date Constructed 07/15/2001

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
4328 KOCE-TV DTV
1234 KACV-FM FM
24518 KDOC-TV DTV
14000 KJLA DTV

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: Minor Reinforcements needed

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Ice Shield

Ice shield to protect equipment

Interim Tower

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Tower Construction Costs

Section Question Response
Construct New Tower Use Interim
Description of Use N/A
Height 99.10 feet
Justification for New Tower Interim antenna cannot be mounted on Main antenna tower

Interim Tower

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Tower Rigging Costs

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

Interim Tower

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Other Tower Expenses Not Listed

Name Description

structal engineering and mapping

cost for mapping Interim tower

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 595
Explanation Coordination with vendors, other stations, and logistics due to site conditions.
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 Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility 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 Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements 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

Name Description

Other Engineering Services

Other RF Engineering Services for the transition

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

Other Expenses

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Other Expenses Not Listed

Name Description

Forestry Approval

Forestry Approval

Sales or Use tax

Sales/use tax for purchases. KXLA receives a special rate of 3.75 percent.

ATC Site Coordination Meeting

ATC Capital contribution for the site coordination meeting

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 $2,246,287.33 $2,246,712.72 N/A $2,234,273.47 N/A
Total for all systems $4,422,884.05 $4,174,285.59 N/A $3,552,074.70 N/A
Interim Transmitter ULXTE-50 $1,118,522.96 $1,117,249.90 $1,110,614.15
3" Rigid Conduit and Wiring (Cost per foot) $10,400.00 $11,026.94 Per Estimated Cost Justification KXLA-180-Interim Transmitter-3in Rigid Conduit and Wiring v1 $10,903.53 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A $29,787.67 N/A
UHF - Liquid Cooled Solid State Transmitter 32 kW $1,069,922.96 $1,069,922.96 see Estimated Cost Justification KXLA-180-Interim Transmitter - UHF Liquid Cooled Solid State, 32 kW v0 $1,069,922.95 N/A
Primary Transmitter ULXTE-50 $1,127,764.37 $1,129,462.82 $1,123,659.32
UHF - Liquid Cooled Solid State Transmitter 32 kW $1,079,164.37 $1,079,164.37 see Estimated Cost Justification KXLA-110-1st Primary Transmitter - UHF Liquid Cooled Solid State, 32 kW v0 $1,079,164.37 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A $30,496.50 N/A
3" Rigid Conduit and Wiring (Cost per foot) $10,400.00 $13,998.45 see Estimated Cost Justification KXLA-110-1st Primary Transmitter - 3_ Rigid Conduit and Wiring v0 $13,998.45 N/A

Components

Actual Information Description File Name
3" Rigid Conduit and Wiring (Cost per foot)

Component Description:
1.00" - 1.24" Bus Drop Support
Amount:
$84.30

Component Description:
MKE M12 2PK BATTERIES 3 OAH
Amount:
$29.97

Component Description:
15A 125V 3-WIRE LIGHTED CONN, YELLOW
Amount:
$40.84

Component Description:
Dual rated lug 3/0-6
Amount:
$12.98

Component Description:
M12 2 PC 1.5AH BRUSHED DRI/TMP KIT
Amount:
$172.25

Component Description:
HEX BOLT
Amount:
$72.80

Component Description:
FLEX ALUM CONDUIT 2" X 25"
Amount:
$371.18

Component Description:
GOGGLES, BLK FRAME, GRN IR5 LENS
Amount:
$339.90

Component Description:
3/4" EMT CONDUIT X 10'
Amount:
$713.05

Component Description:
4" BLACK UV RESIST CABLE TIE 100PK
Amount:
$445.50

Component Description:
Advance Wholesale Electric, Inc.
Amount:
$43.75

Component Description:
3" X 2" Reducing Bushing
Amount:
$214.20

Component Description:
1LB LEAD FREE SILVER SOLDER
Amount:
$123.41

Component Description:
1-1/2 FLEX SCREW IN CONNECTOR
Amount:
$302.91

Component Description:
1-1/2IN CONDUIT PIPE HANGER
Amount:
$285.17

Component Description:
Labor
Amount:
$6,107.85

Component Description:
TAPCON 1/4X1-1/4 HEX HEAD, 75 PK
Amount:
$56.30

Component Description:
3-IN D/C S/SCR EMT CONN
Amount:
$6.79

Component Description:
FENDER WASHER ZINC
Amount:
$38.60

Component Description:
MILWAUKEE 18TPI M12 BANDSAWBLD 3PK
Amount:
$43.90

Component Description:
100PC CONICAL ANCHOR KIT
Amount:
$32.10

Component Description:
1/2 LITER WATER 24PK
Amount:
$74.46

Component Description:
1/4"X7" SDS DRILL BIT
Amount:
$78.40

Component Description:
3/4 EMT 90 DEGREE ELBOW
Amount:
$751.03

Component Description:
3" EMT Thinwall Conduit
Amount:
$585.30
Switchgear - industrial 800 amp

Component Description:
KXLA-180-Interim Transmitter - 800 Amp Switchgear
Amount:
$29,787.67
UHF - Liquid Cooled Solid State Transmitter 32 kW

Component Description:
ULXTE-50 Main Transmitter
Amount:
$80,317.26

Component Description:
Interim Transmitter
Amount:
$6,000.00

Component Description:
ULXTE-50 Transmitter
Amount:
$320,790.72

Component Description:
2nd 1/3 payment for interim transmitter
Amount:
$334,657.74

Component Description:
1/3 down payment
Amount:
$324,368.50

Component Description:
Field Service, TV
Amount:
$3,788.73
UHF - Liquid Cooled Solid State Transmitter 32 kW

Component Description:
ULXTE-50 Main Transmitter
Amount:
$80,613.57

Component Description:
UXLTE-50 Main Transmitter
Amount:
$319,359.85

Component Description:
KXLA-1st Primary Transmitter-UHF Liquid Cooled Solid State $7,654.00
Amount:
$3,865.27

Component Description:
2nd 1/3 main transmitter payment
Amount:
$340,957.18

Component Description:
1/3 down payment
Amount:
$324,368.50

Component Description:
KXLA-110-1st Primary Transmitter - UHF Liquid Cooled Solid State, 32 kW
Amount:
$6,000.00

Component Description:
WORK PERFORMED AT KXLA ON MT WILSON REMOVAL OF MAGIC TEES AND ASSOCIATED HARDWARE
Amount:
$4,000.00
Switchgear - industrial 800 amp

Component Description:
2-YEAR REPLACE PROTECT PLAN
Amount:
$27.06

Component Description:
14 IN. MULTIPURPOSE CHOP SAW
Amount:
$214.34

Component Description:
14"X36T MULTI-MATERIAL BLADE
Amount:
$54.72

Component Description:
KXLA-110-1st Primary Transmitter - 800 Amp Switchgear
Amount:
$29,870.47

Component Description:
ROD THREADED ZINC 72X3/8-16
Amount:
$356.97

Component Description:
Tool Purchases: 12IN BAG A,S HUSKY 12" TOOL BAG
Amount:
$58.09
3" Rigid Conduit and Wiring (Cost per foot)

Component Description:
ED3200
Amount:
$2,464.95

Component Description:
Parts
Amount:
$11,533.50

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 $533,096.12 $528,566.12 N/A $502,979.22 N/A
Total for all systems $4,422,884.05 $4,174,285.59 N/A $3,552,074.70 N/A
Interim Antenna ATW24H6-ESC170-30H $273,796.12 $271,606.12 $266,033.52
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 N/A $16,577.40 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,250.00 N/A
UHF - High Power, Side Mount, basic slot antenna, 670 kW input, directional,, elliptically or circularly polarized $238,656.12 $238,656.12 Please see Estimated Cost Justification KXLA-280-Interim Antenna - UHF High Power, Side Mount, Directional, E-POL v0 $238,656.12 N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $4,550.00 N/A $4,550.00 N/A
Primary Antenna ATW24H6-ESC170-30H $259,300.00 $256,960.00 $236,945.70
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 N/A $3,500.00 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 N/A $16,328.32 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $11,700.00 N/A $0.00 N/A
UHF - High Power, Side Mount, basic slot antenna, 670 kW input, directional,, elliptically or circularly polarized $211,860.00 $211,860.00 ERI proposal 20180124-864 like-for-like cost of $189,860, plus $22,00 for est taxes & freight. KXLA expects to pay for the difference between the Hpol and Epol antenna. $210,867.38 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,250.00 N/A

Components

Actual Information Description File Name
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
KXLA Interim Antenna Side Mount Brackets
Amount:
$1,500.00

Component Description:
KXLA Interim Antenna Side Mount Brackets
Amount:
$4,500.00

Component Description:
Interim Antenna Side Mount Brackets
Amount:
$6,077.40

Component Description:
30% payment for Interim side mounts
Amount:
$4,500.00
Sweep test of existing antenna

Component Description:
Interim Antenna Sweep Test
Amount:
$1,875.00

Component Description:
KXLA Interim Antenna Sweep Test
Amount:
$1,875.00

Component Description:
30% payment for Interim sweep test
Amount:
$1,875.00

Component Description:
KXLA Interim Antenna Sweep Test
Amount:
$625.00
UHF - High Power, Side Mount, basic slot antenna, 670 kW input, directional,, elliptically or circularly polarized

Component Description:
Interim Antenna
Amount:
$83,121.80

Component Description:
30% payment for Interim antenna
Amount:
$61,608.00

Component Description:
#12 Ice Shields Template
Amount:
$27,282.32

Component Description:
10% net invoice Interim Antenna
Amount:
$5,036.00

Component Description:
30% Payment for Interim Antenna per proposal: 20180124-863
Amount:
$61,608.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)

Component Description:
KXLA-280-Interim Antenna - Pattern Scatter Analysis
Amount:
$1,050.00

Component Description:
Interim Antenna Patter Scatter Analysis
Amount:
$1,050.00

Component Description:
KXLA Interim Antenna Patter Scatter Analysis
Amount:
$1,050.00

Component Description:
KXLA Interim Antenna Patter Scatter Analysis
Amount:
$350.00

Component Description:
30% payment for Interim scatter study
Amount:
$1,050.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)

Component Description:
KXLA Primary Antenna Pattern Scatter Analysis
Amount:
$1,050.00

Component Description:
KXLA Primary Antenna Pattern Scatter Analysis
Amount:
$1,050.00

Component Description:
30% payment for Main scatter study
Amount:
$1,050.00

Component Description:
KXLA Primary Antenna Patter Scatter Analysis
Amount:
$350.00
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
KXLA Primary Antenna Side Mount Brackets
Amount:
$5,175.00

Component Description:
KXLA Primary Antenna Side Mount Brackets
Amount:
$1,500.00

Component Description:
30% payment for Main side mounts
Amount:
$4,500.00

Component Description:
KXLA-210-Primary Antenna - Side Mount Brackets, High Power
Amount:
$653.32

Component Description:
KXLA Primary Antenna Side Mount Brackets
Amount:
$4,500.00
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) Information not provided.
UHF - High Power, Side Mount, basic slot antenna, 670 kW input, directional,, elliptically or circularly polarized

Component Description:
30% deposit of Main antenna
Amount:
$64,570.20

Component Description:
30% Payment for primary Antenna per proposal 20180124-864
Amount:
$56,958.00

Component Description:
ES MAIN ANTENNA
Amount:
$8,754.46

Component Description:
30% payment ES Main Antenna
Amount:
$65,893.77

Component Description:
10% net invoice primary Antenna
Amount:
$14,690.95
Sweep test of existing antenna

Component Description:
KXLA Primary Antenna Sweep Test
Amount:
$1,875.00

Component Description:
KXLA Primary Antenna Sweep Test
Amount:
$1,875.00

Component Description:
30% payment for Main system sweep
Amount:
$1,875.00

Component Description:
KXLA Primary Antenna Sweep Test
Amount:
$625.00

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 $368,900.00 $200,653.21 N/A $200,653.18 N/A
Total for all systems $4,422,884.05 $4,174,285.59 N/A $3,552,074.70 N/A
Interim Transmission Line $173,600.00 $99,935.64 $99,935.61
Rigid Transmission Line - copper, 6 1/8" $80,800.00 $9,910.59 see Estimated Cost Justification KXLA-380-Interim Transmission Line - Rigid Copper, 6 1_8, Broadband v1 $9,910.56 N/A
Rigid Transmission Line - copper, 6 1/8" broadband $92,800.00 $90,025.05 ***System Notice: Estimate adjusted and locked because line has been superseded.***see Estimated Cost Justification KXLA-380-Interim Transmission Line - Rigid Copper, 6 1_8, Broadband v0 $90,025.05 N/A
Primary Transmission Line $195,300.00 $100,717.57 $100,717.57
Rigid Transmission Line - copper, 6 1/8" $90,900.00 $12,226.26 see Estimated Cost Justification KXLA-310-Primary Transmission Line - Rigid Copper, 6 1_8_, Broadband v1 $12,226.26 N/A
Rigid Transmission Line - copper, 6 1/8" broadband $104,400.00 $88,491.31 ***System Notice: Estimate adjusted and locked because line has been superseded.***Justifying Quote - KXLA Repack Project Budgetary Proposal Rev3 $88,491.31 x

Components

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

Component Description:
KXLA-380-Interim Transmission Line - Rigid Copper, 6 1/8", Broadband
Amount:
$2,979.56

Component Description:
KXLA-380-Interim Transmission Line - Rigid Copper, 6 1/8", Broadband
Amount:
$6,931.00
Rigid Transmission Line - copper, 6 1/8" broadband

Component Description:
KXLA Interim Transmission Line
Amount:
$24,438.16

Component Description:
KXLA-380-Interim Transmission Line - Rigid Copper, 6 1/8", Broadband
Amount:
$25.86

Component Description:
KXLA Interim Transmission Line
Amount:
$8,146.05

Component Description:
please deny this invoice
Amount:
N/A

Component Description:
Interim Transmission Line
Amount:
$32,976.82

Component Description:
30% payment for Interim transmission line
Amount:
$24,438.16
Rigid Transmission Line - copper, 6 1/8"

Component Description:
3IN Aluminum Flex Conduit 25PK
Amount:
$252.17

Component Description:
KXLA-310-Primary Transmission Line - Rigid Copper, 6 1/8", Broadband
Amount:
$1,131.00

Component Description:
6-1/8" 50 OHM END TERMINAL
Amount:
$2,979.56

Component Description:
KXLA-310-Primary Transmission Line - Rigid Copper, 6 1/8", Broadband
Amount:
$7,863.53
Rigid Transmission Line - copper, 6 1/8" broadband

Component Description:
30% payment for Main transmission line
Amount:
$25,587.33

Component Description:
KXLA Primary Transmission Line
Amount:
$25,587.33

Component Description:
KXLA Primary Transmission Line
Amount:
$8,529.11

Component Description:
please deny this invoice
Amount:
N/A

Component Description:
KXLA Primary Transmission Line
Amount:
$28,761.68

Component Description:
3/8" GRID RUNG
Amount:
$25.86

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 $768,220.00 $604,161.94 N/A $347,007.50 N/A
Total for all systems $4,422,884.05 $4,174,285.59 N/A $3,552,074.70 N/A
Interim Tower $495,160.00 $168,894.00 $102,622.50
New tower $18,260.00 $18,260.00 See attached Wireless Infrastructure Services quote dated 10/30/19 $0.00 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $94,734.00 N/A $70,155.00 N/A
structal engineering and mapping $55,900.00 $55,900.00 Justifying Quote - KXLA Repack Project Budgetary Proposal Rev3 $32,467.50 N/A
Primary Tower LTOWER $273,060.00 $435,267.94 $244,385.00
Ice Shield $18,260.00 $18,260.00 See attached Wireless Infrastructure Services quote dated 10/30/19 $9,880.00 N/A
Structural engineering tower load study for well documented tower $12,600.00 $51,399.94 per cost estimate apportioned per ATC; Justifying Quote - KXLA Repack Project Budgetary Proposal Rev3 $26,710.00 N/A
Minor tower reinforcement/modifications $158,000.00 $157,813.00 Per Wireless Infrastructure Services Proposal Rev 3 $0.00 N/A
Short Tower (less than 500') $84,200.00 $207,795.00 per Estimated Cost Justification KXLA-410-Existing Primary Tower - Tower Rigging, Short Tower v0 $207,795.00 N/A

Components

Actual Information Description File Name
New tower Information not provided.
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
KXLA-490-Interim Tower - Tower Rigging, Complex Tower
Amount:
$70,155.00
structal engineering and mapping

Component Description:
Broadcast Tower Mapping, Broadcast Structural
Amount:
$26,820.00

Component Description:
PE SEALED DOCUMENT
Amount:
$1,000.00

Component Description:
KXLA-490-Interim Tower - Structural Engineering Load Study, Tower Mapping
Amount:
$1,950.00

Component Description:
KXLA-Interim Tower - Structural Engineering Load Study and Tower Mapping
Amount:
$1,560.00

Component Description:
KXLA-490-Interim Tower - Structural Engineering Load Study and Tower Mapping
Amount:
$1,137.50
Ice Shield

Component Description:
Labor
Amount:
$9,130.00

Component Description:
PO Line 1 - KXLA CH 30 ICE SHIELD
Amount:
$750.00
Structural engineering tower load study for well documented tower

Component Description:
Broadcast structural
Amount:
$1,440.00

Component Description:
Broadcast Tower Mapping, Broadcast Structural
Amount:
$22,320.00

Component Description:
KXLA-410-Existing Primary Tower - Structural Engineering Tower Load Study
Amount:
$1,950.00

Component Description:
PE SEALED DOCUMENT
Amount:
$1,000.00
Minor tower reinforcement/modifications Information not provided.
Short Tower (less than 500')

Component Description:
Electric equipment monitoring, installation & removal
Amount:
$2,520.00

Component Description:
Demolition of broadband antenna system internal equipment on Tower #5 per ATC requirements (KXLA Repack)
Amount:
$23,000.00

Component Description:
Installation- Tower rigging complex tower- Main (Includes demo if existing broadband antenna system)
Amount:
$182,275.00

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 $219,344.60 $307,720.60 N/A $203,636.83 N/A
Total for all systems $4,422,884.05 $4,174,285.59 N/A $3,552,074.70 N/A
Outside Professional Services $219,344.60 $307,720.60 $203,636.83
Other Engineering Services $10,424.60 $10,424.60 Estimated Cost Justification KXLA-590-Other Engineering Services v0 $10,424.60 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A $6,377.63 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A $0.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $0.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $0.00 N/A
Prepare request for Special Temporary Authorization $2,050.00 $3,425.00 Please see Estimated Cost Justification KXLA-530-RF Eng - Special Temporary Authorization v0 $3,425.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $450.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $1,137.50 Greg Best 1215 $1,137.50 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $6,300.00 N/A
Project management of the transition $94,010.00 $185,975.00 see Estimated Cost Justification KXLA-510-Project Management v1 $168,013.60 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A $2,500.00 N/A
Prepare and or review reimbursement form $2,630.00 $5,008.50 Greg Best Consulting Invoice #1047, #1101, #1110, #993, #1071 $5,008.50 N/A

Components

Actual Information Description File Name
Other Engineering Services

Component Description:
Cover Dismantling of KXLA analog transmitter at your Mt. Wilson site
Amount:
$2,809.60

Component Description:
Electronic equipment monitoring
Amount:
$390.00

Component Description:
KXLA-590-Other Engineering Services
Amount:
$900.00

Component Description:
KXLA-Repack Engineering Service performed by Greg Best
Amount:
$1,050.00

Component Description:
KXLA-590-Other Engineering Services
Amount:
$175.00

Component Description:
KXLA-590-Other Engineering Services
Amount:
$175.00

Component Description:
KXLA-590-Other Engineering Services
Amount:
$175.00

Component Description:
KXLA-590-Other Engineering Services
Amount:
$4,750.00
Comprehensive coverage verification via field study, if needed

Component Description:
KXLA Repack Engineering Services from 1-1-19 through 2-1-19 performed by Greg Best
Amount:
$6,377.63
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization

Component Description:
Repack Engineering Services performed by Greg Best from 2-2-19 through 3-31-19.
Amount:
$525.00

Component Description:
Service through 8-4-18. Interim STA extra exhibits and conference with FCC regarding STA facility potential interference with Mexican stations.
Amount:
$1,225.00

Component Description:
KXLA-Repack Engineering services
Amount:
$450.00

Component Description:
KXLA-530-RF Eng - Special Temporary Authorization
Amount:
$1,225.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
KXLA-550-Attorney - License to Cover Application (Main)
Amount:
$450.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Repack Engineering Services. Creation and upload of exhibits for CP mod for revised antenna. Creation of supplemental exhibit for "largest station in the market" comparison.
Amount:
$1,137.50
Perform engineering study for new channel assignment and antenna development

Component Description:
KXLA-530-RF Eng - Engineering Study for New Channel Assignment
Amount:
$1,575.00

Component Description:
Engineering repack services from 8-1-18 to 9-1-18 performed by Greg Best for KXLA.
Amount:
$1,050.00

Component Description:
Engineering repack services 10-1-18 through 11-2-18 performed by Greg Best.
Amount:
$1,750.00

Component Description:
KXLA-530-RF Eng - Engineering Study for New Channel Assignment
Amount:
$1,050.00

Component Description:
Engineering Repack Service 11-30-17 through 12/31/17 performed by Greg Best
Amount:
$875.00
Project management of the transition

Component Description:
Project Management
Amount:
$3,133.70

Component Description:
Project Management
Amount:
$7,614.20

Component Description:
Project Management
Amount:
$9,231.65

Component Description:
Project Management
Amount:
$5,820.95

Component Description:
Project Management
Amount:
$7,098.20

Component Description:
Project Management
Amount:
$2,533.55

Component Description:
Project Management
Amount:
$7,134.05

Component Description:
Project Management
Amount:
$1,872.85

Component Description:
Project Management
Amount:
$3,508.35

Component Description:
Project Management
Amount:
$11,336.10

Component Description:
PO Line 2
Amount:
$9,480.00

Component Description:
Project Management
Amount:
$6,924.15

Component Description:
Project Management
Amount:
$5,115.40

Component Description:
Project Management
Amount:
$10,309.25

Component Description:
Project Management
Amount:
$2,295.15

Component Description:
KXLA-510-Project Management
Amount:
$27,500.00

Component Description:
Project Management
Amount:
$5,133.80

Component Description:
Project Management
Amount:
$12,410.40

Component Description:
Project Management
Amount:
$4,861.45

Component Description:
Project Management
Amount:
$6,340.60

Component Description:
Project Management
Amount:
$13,630.60

Component Description:
Project Management
Amount:
$4,729.20
Address transition timing and coordination issues w/ other stations and wireless

Component Description:
Capital Contribution - Wilson, MT, T5 CA / 7510
Amount:
$2,500.00
Prepare and or review reimbursement form

Component Description:
Repack Engineering Service 4-1-18 through 4/18/18 performed by Greg Best.
Amount:
$1,050.00

Component Description:
Repack Engineering Service from 6-1-18 through 6-31-18 performed by Greg Best.
Amount:
$787.50

Component Description:
Engineering Repack Service 1-1-18 through 2/3/18 performed by Greg Best.
Amount:
$525.00

Component Description:
Professional Services
Amount:
$458.50

Component Description:
Service thru 11/2/17. Repack engineering Services Assist with response to FCC regarding 399 form verification.
Amount:
$612.50

Component Description:
"Repack Engineering Services 2-1-18 through 3/2/18 performed by Greg Best. KXLA 399 form revision and FCC support."
Amount:
$1,050.00

Component Description:
Repack Engineering Service 5-2-18 through 6-1-18 performed by Greg Best.
Amount:
$525.00

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 $280,636.00 $280,071.00 N/A $63,524.50 N/A
Total for all systems $4,422,884.05 $4,174,285.59 N/A $3,552,074.70 N/A
Other Expenses $280,636.00 $280,071.00 $63,524.50
ATC Site Coordination Meeting $5,000.00 $5,000.00 Please see the attached invoice from American Tower Corp (ATC) # 460211945 $2,500.00 N/A
Sales or Use tax $174,864.00 $174,864.00 Sales/use tax for purchases. KXLA receives a special rate of 3.75 percent. $0.00 N/A
Forestry Approval $2,500.00 $2,500.00 N/A $2,500.00 N/A
MVPD Notification of Channel Change $3,500.00 $3,500.00 N/A $0.00 N/A
Equipment Storage $2,500.00 $2,500.00 Per Wireless Infrastructure Services Quote $2,500.00 N/A
Equipment Delivery and Handling Charges $5,000.00 $5,000.00 Per Wireless Infrastructure Services Quote $5,000.00 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $50,246.00 $50,246.00 JTD Consulting $33,078.50 N/A
BLM or NFS Coordination $5,000.00 $5,000.00 N/A $0.00 N/A
Non-zoning permits $17,946.00 $17,946.00 Please see the attached invoice from JTD Consulting, Inc. Dba: Wireless Infrastructure Services #060818S1 $17,946.00 N/A
Local Zoning $2,000.00 $2,000.00 N/A $0.00 N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A $0.00 N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A $0.00 N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $0.00 N/A

Components

Actual Information Description File Name
ATC Site Coordination Meeting

Component Description:
KXLA American Tower Site Coordination Meeting
Amount:
$2,500.00
Sales or Use tax Information not provided.
Forestry Approval

Component Description:
KXLA-610-Forestry Approvals
Amount:
$2,500.00
MVPD Notification of Channel Change Information not provided.
Equipment Storage

Component Description:
KXLA-610-Equipment Storage
Amount:
$2,500.00
Equipment Delivery and Handling Charges

Component Description:
KXLA-610-Equipment Deliver and Handling Charges
Amount:
$5,000.00
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Labor and equipment to remove 4 each 3500 pound electrical transformers
Amount:
$750.00

Component Description:
KXLA-610-Disposal Costs
Amount:
$3,500.00

Component Description:
Services rendered for dispose of glycol stored
Amount:
$2,332.50

Component Description:
removal of KXLA main transmitter electrical system
Amount:
$12,420.00

Component Description:
Removal of KXLA interim transmitter electrical system
Amount:
$14,076.00
BLM or NFS Coordination Information not provided.
Non-zoning permits

Component Description:
KXLA-610-Non-zoning permits
Amount:
$17,946.00
Local Zoning Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
DTV Medical Facility Notification Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $4,422,884.05 $4,174,285.59 $3,552,074.70

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.

Eddie hernandez

Director of Engineering


10/20/2020

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.

Eddie hernandez

Director of Engineering


10/20/2020

Attachments

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