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:
14867
Service:
DTV
Call Sign:
KCBA
Channel:
11 (High VHF)
File Number:
0000028197
FRN:
0032551129
Date Submitted:
06/10/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

SEAL ROCK BROADCASTERS, L.L.C.

Doing Business As: SEAL ROCK BROADCASTERS, L.L.C.

Lance Anderson

67 GARDEN COURT

MONTEREY, CA 93940

United States

+1 (206) 669-8842 LANCE_333@MSN.COM Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

James Winston

Partner

Rubin, Winston, Diercks, Harris & Cooke, LLP

James Winston

1201 Connecticut Ave., NW

Suite 200

Washington, DC 20036

United States

+1 (202) 861-0870 jwinston@rwdhc.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 Because of structural limitations, the plan is for KCBA is to retune the existing channel 13 antenna system into a channel 11 antenna system. A new transmitter will be necessary. Due to space limitations, an interim transmitter in a temporary shelter.

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 Harris
Year 2006
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 3.52 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 TMV9-5
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 3.6 kW
Justification for New Transmitter The existing transmitter cannot be returned. This is the smallest size transmitter which generates the minimum TPO for the retuned antenna.

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 Yes
Description The new main transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, KCBA estimated the electrical work cost.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 10 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Site Survey

Site Survey required for repack

Primary Transmitter-Demolition

Primary Transmitter-Demolition

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 TMV9-3
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 2.2 kW
Justification for New Transmitter The current shelter is too small to hold both the existing transmitter and the new proposed transmitter. It is more cost effective to construct a temporary shelter for an interim transmitter than to expand the footprint of the existing permanent building

Interim Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) Yes
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring Yes
Size 2 inches
Length 60.0 feet
Other Electrical Service Yes
Description The new interim transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, WUNI estimated the electrical work cost.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 10 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? Yes
Size 238.0 square feet
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

Name Description

Additional icebridge and Line

KCBA will need to install 60 ft of 3 inch flex line with an ice bridge to connect the transmission line from the interim transmitter in the interim shelter to the main transmission line at the base of the tower.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? No
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Other
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 VHF Dipole
ERP: 19.75 kW
Manufacturer
Model ADDP2-V12 HSCX2-13
Year 2006

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Other
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 VHF Panel
ERP: 19.75 kW
Manufacturer
Model K523057
Year 2019
Justification for New Antenna Existing antenna cannot be retuned.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
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? Yes
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

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type Flexible Foam
Diameter Other
Other Diameter 3 inches
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 380 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Air
Diameter 1 5/8 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 340 feet per run
Justification for New Transmission Line New line required for new antenna.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change 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? 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? Yes
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1013158
Coordinates (NAD83) Latitude (NAD83) 36° 45' 22.0" N-
Longitude (NAD83) 121° 30' 10.0" W-
Overall Structure Height 354.98 feet
Support Structure Height 349.73 feet
Ground Elevation Above Mean Sea Level (AMSL) 3065.91 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Vertical Bridge S3 Assets, LLC
Date Constructed 02/01/1981


Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: No study needed
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 N/A
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Tower Structural Analysis

Tower Structural Analysis

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 KCBA does not have sufficient resource capacity and expertise in house to handle all of the reimbursement filing by the construction deadline for Phase 9 on May 1, 2020. KCBA will hire an outside firm to ensure a timely and well managed transition.
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 Yes
Environmental Assessment Yes
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements 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

Information not provided.

Other Expenses

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

Other Expenses

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Other Expenses Not Listed

Name Description

Antenna and Transmission Line Inspection

Inspection of the existing Antenna and Transmission line

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 $587,485.00 $622,230.58 N/A $386,005.71 N/A
Total for all systems $1,181,801.24 $1,202,957.12 N/A $568,168.40 N/A
Interim Transmitter TMV9-3 $365,960.00 $361,052.93 $170,940.49
Other -- Building Addition Size: 238.0 $12,000.00 $12,000.00 N/A N/A N/A
10 Ton system $60,500.00 $57,500.00 N/A N/A N/A
Other Electrical Service: The new interim transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, WUNI estimated the electrical work cost. $25,000.00 $25,000.00 N/A $15,887.57 N/A
2" Rigid Conduit and Wiring (Cost per foot) $1,560.00 $1,500.00 N/A N/A N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $35,000.00 N/A N/A N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A N/A N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $13,700.00 N/A N/A N/A
High VHF - Air Cooled Solid State Transmitter 1.1 . 4.4 kW $152,500.00 $155,052.93 see Estimated Cost Justification KCBA-180-Interim Transmitter High VHF v0 $155,052.92 N/A
Additional icebridge and Line $25,000.00 $25,000.00 N/A N/A N/A
Primary Transmitter TMV9-5 $221,525.00 $261,177.65 $215,065.22
Primary Transmitter-Demolition $3,200.00 $3,200.00 Please see DTVPros quote JEHQ1774, plus actual shipping as described on invoice 397-1, divided between categories as described on the attached cost breakdown $3,200.00 N/A
10 Ton system $38,900.00 $37,000.00 N/A N/A N/A
Other Electrical Service: The new main transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, KCBA estimated the electrical work cost. $25,000.00 $25,000.00 N/A $15,887.57 N/A
High VHF - Air Cooled Solid State Transmitter 1.1 . 4.4 kW $152,500.00 $194,052.65 see Estimated Cost Justification KCBA-110-1st Primary Transmitter - High VHF v0 $194,052.65 N/A
Site Survey $1,925.00 $1,925.00 Please see DTVPros quote JEHQ1774, plus actual shipping as described on invoice 397-1, divided between categories as described on the attached cost breakdown $1,925.00 N/A

Components

Actual Information Description File Name
Other -- Building Addition Size: 238.0 Information not provided.
10 Ton system Information not provided.
Other Electrical Service: The new interim transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, WUNI estimated the electrical work cost.

Component Description:
KCBA-180-Interim Transmitter - Other Electrical Services
Amount:
$15,887.57
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 300 KVA Information not provided.
Switchgear - industrial 800 amp Information not provided.
Service entrance 3 phase/800 amp/208 volt Information not provided.
High VHF - Air Cooled Solid State Transmitter 1.1 . 4.4 kW

Component Description:
TMV9-3 2,200W VHF ATSC - 1.1
Amount:
$52,673.40

Component Description:
TMV9-3 2, 200W VHF ATSC - 1.1
Amount:
$51,189.76

Component Description:
TMV9-3 2,200W VHF
Amount:
$51,189.76
Additional icebridge and Line Information not provided.
Primary Transmitter-Demolition

Component Description:
KCBA-110-1st Primary Transmitter - Demolition
Amount:
$3,200.00
10 Ton system Information not provided.
Other Electrical Service: The new main transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, KCBA estimated the electrical work cost.

Component Description:
Main Power for New Transmitter Equipment
Amount:
$15,887.57
High VHF - Air Cooled Solid State Transmitter 1.1 . 4.4 kW

Component Description:
2.1 TMV9-5 3,600W
Amount:
$90,037.26

Component Description:
N/A
Amount:
N/A

Component Description:
2.1 TMV9-5 3,600W VHF ATSC
Amount:
$90,037.26

Component Description:
2.1 TMV9-5 3,600W VHF ATSC
Amount:
$13,978.13
Site Survey

Component Description:
KCBA-110-1st Primary Transmitter - Site Survey
Amount:
$1,925.00

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $50,501.65 $40,955.29 N/A $34,370.29 N/A
Total for all systems $1,181,801.24 $1,202,957.12 N/A $568,168.40 N/A
Primary Antenna K523057 $50,501.65 $40,955.29 $34,370.29
Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed) $7,600.00 $6,585.00 N/A N/A N/A
High VHF - High Power Side Mount One Station horizontally polarized $13,021.65 $13,021.65 Please see attached DTVPros quote JEHQ1621-02 $13,021.65 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $14,948.64 Please see Estimated Cost Justification KCBA-210-Primary Antenna - Side Mount Brackets V0 $14,948.64 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,400.00 N/A

Components

Actual Information Description File Name
Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed) Information not provided.
High VHF - High Power Side Mount One Station horizontally polarized

Component Description:
2x2 K52 30 57 VHF-TV Band III
Amount:
$13,021.65
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
SHIPPING CHARGES - RFS FOR INVOICE 397 ITEMS 3-17 01-22-20 (ITEMS 1 - 2 FROM KATHREIN NOT INCLUDED)
Amount:
$2,108.64

Component Description:
KCBA-210-Primary Antenna - Side Mount Brackets
Amount:
$12,840.00
Sweep test of existing antenna

Component Description:
KCBA-210-Primary Antenna - Sweep Test
Amount:
$6,400.00

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 $11,220.00 $13,204.26 N/A $13,204.26 N/A
Total for all systems $1,181,801.24 $1,202,957.12 N/A $568,168.40 N/A
Primary Transmission Line $11,220.00 $13,204.26 $13,204.26
Flexible Air Transmission Line - dielectric, 1 5/8" $11,220.00 $13,204.26 Please see Estimated Cost Justification KCBA-310-Primary Transmission Line V0 $13,204.26 N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 1 5/8"

Component Description:
KCBA-310-Primary Transmission Line - 1 5/8"
Amount:
$3,349.60

Component Description:
KCBA-310-Primary Transmission Line - 1 5/8"
Amount:
$9,854.66

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 $88,450.00 $26,379.90 N/A $26,379.90 N/A
Total for all systems $1,181,801.24 $1,202,957.12 N/A $568,168.40 N/A
Primary Tower TOWER $88,450.00 $26,379.90 $26,379.90
Tower Structural Analysis $4,250.00 $4,250.00 Please see DTVPros quote JEHQ1774, plus actual shipping as described on invoice 397-1, divided between categories as described on the attached cost breakdown $4,250.00 N/A
Short Tower (less than 500') $84,200.00 $22,129.90 Please see DTVPros quote JEHQ1774, plus actual shipping as described on invoice 397-1, divided between categories as described on the attached cost breakdown $22,129.90 N/A

Components

Actual Information Description File Name
Tower Structural Analysis

Component Description:
KCBA-410-Tower Structural Analysis
Amount:
$4,250.00
Short Tower (less than 500')

Component Description:
KCBA-410-Tower Rigging
Amount:
$22,129.90

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 $166,810.00 $161,397.50 N/A $91,833.65 N/A
Total for all systems $1,181,801.24 $1,202,957.12 N/A $568,168.40 N/A
Outside Professional Services $166,810.00 $161,397.50 $91,833.65
RF Exposure Measurements $21,050.00 $20,000.00 N/A N/A N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $10,000.00 N/A N/A N/A
NEPA Section 106 environmental review, if needed $6,310.00 $6,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $540.00 Please see KCBA Attorney STA Budget Justification cover letter $540.00 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A $2,160.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $3,465.00 N/A
Prepare request for Special Temporary Authorization $2,050.00 $4,372.50 Please see KCBA RF Eng - STA Budget Justification Letter $4,372.50 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $1,126.25 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $728.75 N/A
Prepare and or review reimbursement form $2,630.00 $5,985.00 Please see Estimated Cost Justification KCBA-590-Prepare and Review Reimbursement Form v0 $5,985.00 N/A
Project management of the transition $94,010.00 $89,250.00 N/A $73,456.15 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A

Components

Actual Information Description File Name
RF Exposure Measurements Information not provided.
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet Information not provided.
NEPA Section 106 environmental review, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
KCBA-550-Attorney - STA
Amount:
$540.00
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
KCBA-550-Attorney Fees Lease Negotiation
Amount:
$450.00

Component Description:
KCBA-550-Attorney Fees Lease Negotiation
Amount:
$1,710.00
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

Component Description:
Prep of Construction Permit and Special Temporary Authority applications. Filed w/ FCC. Conv. w/ J. Snelson.
Amount:
$540.00

Component Description:
Legal Services
Amount:
$2,250.00

Component Description:
Legal services: prepare FCC Form 2100, Sch. 387, Form 1876 and CORES registration
Amount:
$2,340.00

Component Description:
KCBA-550-Attorney - Construction Permit Application (main)
Amount:
$675.00
Prepare request for Special Temporary Authorization

Component Description:
RF Consulting Services
Amount:
$4,372.50
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
KCBA-530-License to Cover Application
Amount:
$1,126.25
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
KCBA-530-RF Eng - Engineering Study for New Channel and Antenna Development
Amount:
$728.75
Prepare and or review reimbursement form

Component Description:
Correspondence with G.
Amount:
$5,985.00
Project management of the transition

Component Description:
Project Management
Amount:
$1,310.00

Component Description:
Project Management
Amount:
$3,635.35

Component Description:
Project management
Amount:
$2,655.10

Component Description:
Project management
Amount:
$4,150.55

Component Description:
Project Management
Amount:
$3,188.55

Component Description:
Project Management
Amount:
$1,743.75

Component Description:
Project management
Amount:
$348.75

Component Description:
Project Management
Amount:
$2,899.15

Component Description:
Project Management
Amount:
$1,950.00

Component Description:
Project Management
Amount:
$5,909.35

Component Description:
Project Management
Amount:
$1,225.00

Component Description:
Project Management
Amount:
$978.75

Component Description:
Project Management
Amount:
$51.25

Component Description:
Project Management
Amount:
$1,867.90

Component Description:
Project Management
Amount:
$1,490.00

Component Description:
Project Management
Amount:
$60.00

Component Description:
Project Management
Amount:
$4,957.10

Component Description:
Project Management
Amount:
$431.25

Component Description:
Project Management
Amount:
$5,107.50

Component Description:
Project Management
Amount:
$202.95

Component Description:
Project Management
Amount:
$2,419.85

Component Description:
Project Management
Amount:
$600.00

Component Description:
Project Management
Amount:
$232.50

Component Description:
Project Management
Amount:
$1,022.50

Component Description:
Project Management
Amount:
$180.00

Component Description:
Project Management
Amount:
$2,204.80

Component Description:
Project Management
Amount:
$1,338.75

Component Description:
Project management
Amount:
$1,633.90

Component Description:
Project Management
Amount:
$2,565.45

Component Description:
Project Management
Amount:
$729.00

Component Description:
Project Management
Amount:
$3,942.65

Component Description:
Project management
Amount:
$285.00

Component Description:
Project Management
Amount:
$1,796.25

Component Description:
Project Management
Amount:
$1,573.75

Component Description:
Project Management
Amount:
$3,403.70

Component Description:
Project management
Amount:
$5,365.80
Address transition timing and coordination issues w/ other stations and wireless Information not provided.

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 $83,004.59 $74,389.59 N/A $16,374.59 N/A
Total for all systems $1,181,801.24 $1,202,957.12 N/A $568,168.40 N/A
Other Expenses $83,004.59 $74,389.59 $16,374.59
Antenna and Transmission Line Inspection $12,424.59 $12,424.59 Please see the attached invoice # 20081918 from H.C. Jeffries Tower Co., Inc. $12,424.59 N/A
MVPD Notification of Channel Change $1,000.00 $1,000.00 N/A $1,000.00 N/A
Develop and air announcement of upcoming channel change $15,000.00 $15,000.00 N/A N/A N/A
Equipment Storage $10,000.00 $10,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $15,000.00 $15,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $10,000.00 $10,000.00 N/A N/A N/A
Non-zoning permits $2,500.00 $2,500.00 N/A N/A N/A
Local Zoning $5,000.00 $5,000.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $2,950.00 Please see Widelity quote KCBA Medical Notification $2,950.00 N/A

Components

Actual Information Description File Name
Antenna and Transmission Line Inspection

Component Description:
Invoice resubmitted
Amount:
N/A

Component Description:
Inspection
Amount:
$12,424.59
MVPD Notification of Channel Change

Component Description:
MVPD Notification
Amount:
$1,000.00
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
Non-zoning permits Information not provided.
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

Component Description:
Medical Notification
Amount:
$2,950.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,181,801.24 $1,202,957.12 $568,168.40

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. No
Construction of final facilities or all necessary modifications are complete. No
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator. No

Certification

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Section Question Response
Submission of Estimated Expenses Statements

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

  1. The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.

  2. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

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

  4. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).

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

  6. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.

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

  8. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Kim Meyenberg

Programming Manager


06/10/2021

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.

Kim Meyenberg

Programming Manager


06/10/2021

Attachments

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