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:
57219
Service:
DTV
Call Sign:
KCEC
Channel:
32 (UHF)
File Number:
0000028025
FRN:
0002531630
Date Submitted:
06/11/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

SPANISH TELEVISION OF DENVER, INC.

Doing Business As: SPANISH TELEVISION OF DENVER, INC.

Christopher G. Wood

5999 CENTER DRIVE

LOS ANGELES, CA 90045

United States

+1 (310) 348-3600 CWOOD@UNIVISION.NET 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

Theodore Stoner

VP Distribution Technology Strategy

Univision Management Company

Theodore Stoner

9405 NW 41st Street

Miami, FL 33178

United States

+1 (513) 608-0308 tstoner@univision.net

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 Replace existing single-channel antenna with wideband antenna, allowing operation on both pre- and post- cutover channels. Install new mask filter and main/auxiliary transmitters. Details are provided in the attached Implementation Plan.

Transmitters

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

Auxiliary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Auxiliary (Backup)
Description of Use Operation during main transmitter maintenance, failure, or when reduced power is needed.
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 DHD30P1
Year 2005
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 7.25 kW

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model THU9-5evo
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 8.2 kW
Justification for New Transmitter Amplifiers of existing transmitter are incapable of operation above channel 26, have been discontinued by the manufacturer, and replacements are otherwise unavailable.

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 Yes
Description Installation of transformer, distribution apparatus, and conduit/wiring to provide power to transmitter and ancillaries
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

Information not provided.

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model CTT-U-DCX-2
Year 2003
Type Inductive Output Tube
IOT Power Type Two
Power Capacity 50 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model THU9-16Evo
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 25.5 kW
Justification for New Transmitter Channel change of existing IOT transmitter not supported. See attached replacement analysis document and R&S quote.

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 Installation of 480:400V transformer, distribution apparatus, and conduit/wiring to provide primary power to transmitter and ancillaries
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

Primary Transmitter - Other Expenses

Primary Transmitter - Other Expenses

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 Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 1000.0 kW
Manufacturer
Model TFU-22DSC-R 3S200 DC
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? 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 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: 650.0 kW
Manufacturer
Model SBBEP-24C170
Year 2018
Justification for New Antenna Existing antenna is incapable of operation on post-repack channel. There is no available aperture on the tower for a new antenna. Only a wideband antenna will permit continuity of operation across the cutover to the new channel.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? 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.

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 Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels/Bays 4
Lower Limit 470.00 MHz
Upper Limit 800.00 MHz
Design power capacity in use 85.0 %
Other Antenna Type N/A
ERP: 300.0 kW
Manufacturer
Model PHP-4
Year 1999
Justification for New Antenna Continuity of operation during replacement of main antenna - this request is for a new feed harness to distribute power to 4 existing panels stored at a sister station.

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? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? No

Interim Antenna

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Other Antenna Cost Not Listed

Name Description

Interim Antenna Shipping

Ship and crate expenses for borrowed interim antenna

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Utilize Existing
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer Dielectric
Type Rigid
Diameter 8 3/16 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 325 feet per run

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Transmission Line Equipment

Connectors and Flange Hardware

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 Flexible Air
Diameter 3 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 175 feet per run
Justification for New Transmission Line Feed temporary antenna to maintain service during replacement of KRMA-TV and KTFD-DT main antennas

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Interim Transmission Line Shipping

Ship and crate expenses for interim transmission line

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? Terrain Constrained
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 1023484
Coordinates (NAD83) Latitude (NAD83) 39° 40' 17.4" N-
Longitude (NAD83) 105° 13' 08.0" W-
Overall Structure Height 273.95 feet
Support Structure Height 271.98 feet
Ground Elevation Above Mean Sea Level (AMSL) 7685.60 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Bear Creek Development Corporation
Date Constructed 11/08/1988

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
26929 KQMT FM
14040 KRMA-TV DTV
67844 KOSI FM
83535 KVOD FM
35574 KQKS FM
37101 KETD 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 Terrain constrained
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 520
Explanation Univision stations are only staffed for daily station operations and minor equipment changes, major projects are contracted out externally. The large volume of work associated with repack schedule requires using external project management resources.
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 Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers No
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 No
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? No
Does this relocation require MVPD Notification of a Channel Change? No

Other Expenses

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Other Expenses Not Listed

Name Description

Station Coordination

Coordinate proposed operation with Table Mountain

Equipment Rental

Equipment Rental

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 $1,531,770.27 $1,228,035.99 N/A $1,128,810.88 N/A
Total for all systems $2,842,288.65 $2,000,917.01 N/A $1,789,375.86 N/A
Primary Transmitter THU9-16Evo $1,007,807.27 $848,572.99 $845,634.60
Primary Transmitter - Other Expenses $6,090.27 $6,090.27 Please see Estimated Cost Justification KCEC-DT-110-1st Primary Transmitter - Other Expenses v0 $6,090.26 N/A
Other Electrical Service: Installation of 480:400V transformer, distribution apparatus, and conduit/wiring to provide primary power to transmitter and ancillaries $54,717.00 $54,717.00 See attached Greiner Electric Proposal EST# SE799. Costs are shared between auxiliary transmitter (35%) and primary transmitter (65%). $54,717.00 N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $787,765.72 see Estimated Cost Justification KCEC-DT-110-1st Primary Transmitter - UHF Liquid Cooled Solid State Transmitter 21-31 kW v1 $784,827.34 N/A
Auxiliary Transmitter THU9-5evo $523,963.00 $379,463.00 $283,176.28
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $494,500.00 $350,000.00 N/A $253,713.28 N/A
Other Electrical Service: Installation of transformer, distribution apparatus, and conduit/wiring to provide power to transmitter and ancillaries $29,463.00 $29,463.00 See attached Greiner Electric Proposal EST# SE799. Costs are shared between auxiliary transmitter (35%) and primary transmitter (65%). $29,463.00 N/A

Components

Actual Information Description File Name
Primary Transmitter - Other Expenses

Component Description:
Other
Amount:
$1,738.37

Component Description:
PO# LI 22 QT#262030.0. PO# LI#21 KCEC QT# 268717
Amount:
$4,351.89
Other Electrical Service: Installation of 480:400V transformer, distribution apparatus, and conduit/wiring to provide primary power to transmitter and ancillaries

Component Description:
Transmitter repack project
Amount:
$2,735.85

Component Description:
Per Original Proposal
Amount:
$51,981.15
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
"KCEC - Main transmitter Rebranding 16 amplifiers as per quotation #271107.0. KCEC-DT Main transmitter consolidation, storage and last mile delivery as described in Quote #248330.2"
Amount:
$6,086.00

Component Description:
35% Final Payment PO Line 1
Amount:
$346,749.68

Component Description:
Labor and Equipment
Amount:
$16,267.93

Component Description:
Diamond Disassemble/Crate
Amount:
$6,451.19

Component Description:
30% Downpayment PO Line 1
Amount:
$185,363.70

Component Description:
Diamond Disassemble/Crate
Amount:
$7,651.19

Component Description:
Invoice moved to correct business category.
Amount:
N/A

Component Description:
DP 35% Due Upon FAT PO Line 1
Amount:
$216,257.65
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW

Component Description:
35% due upon FAT
Amount:
$73,283.00

Component Description:
KCEC-DT-150-1st Auxiliary Transmitter - UHF Liquid Cooled Solid State 8.2-13 kW
Amount:
$5,222.07

Component Description:
35% Final Payment
Amount:
$112,394.21

Component Description:
30% down payment Rohde & Schwarz QT# 151967.1 THU9-5 EVO 8.2 kW ATSC
Amount:
$62,814.00
Other Electrical Service: Installation of transformer, distribution apparatus, and conduit/wiring to provide power to transmitter and ancillaries

Component Description:
KCEC-DT-150-1st Auxiliary Transmitter - Other Electrical Service
Amount:
$27,989.85

Component Description:
KCEC-DT-150-1st Auxiliary Transmitter - Other Electrical Service
Amount:
$1,473.15

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 $402,380.00 $224,872.55 N/A $201,355.70 N/A
Total for all systems $2,842,288.65 $2,000,917.01 N/A $1,789,375.86 N/A
Interim Antenna PHP-4 $193,750.00 $20,862.55 $20,862.55
UHF – Broadband Panel, Side Mount Auxiliary/Interim, 300 horizontally polarized $0.00 $0.00 N/A N/A N/A
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized $189,500.00 $16,612.55 Radio Frequency Systems Quote #20058056 and Invoice #16465504 $16,612.55 N/A
Interim Antenna Shipping $4,250.00 $4,250.00 Please see Rex Industries Estimate 220-350, ATC Quote 220350 and 02385603 $4,250.00 N/A
Primary Antenna SBBEP-24C170 $208,630.00 $204,010.00 $180,493.15
UHF - High Power, Side Mount, basic slot antenna, 650 kW input, directional,, elliptically or circularly polarized $178,750.00 $178,750.00 per Estimated Cost Justification KCEC-DT-210-Primary Antenna - UHF High Power Side Mount, Directional, E-POL v0 $178,743.15 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $18,860.00 Includes 7.65% sales/use tax N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $1,750.00 N/A

Components

Actual Information Description File Name
UHF – Broadband Panel, Side Mount Auxiliary/Interim, 300 horizontally polarized Information not provided.
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized

Component Description:
PHP4A KCEC INTERIM ANTENNA
Amount:
$16,612.55
Interim Antenna Shipping

Component Description:
Shipping Equipment
Amount:
$750.00

Component Description:
Deliver-Offload Antenna
Amount:
$1,500.00

Component Description:
Antenna and small Crate
Amount:
$2,000.00
UHF - High Power, Side Mount, basic slot antenna, 650 kW input, directional,, elliptically or circularly polarized

Component Description:
BDS-INSTALL
Amount:
$6,498.60

Component Description:
Bridge Mount Kit
Amount:
$3,731.28

Component Description:
24 bay, side mounted, elliptically polarized
Amount:
$123,466.89

Component Description:
24 bay, side mounted, elliptically polarized broadband UHF antenna with 6-1
Amount:
$45,046.38
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
Sweep test of existing antenna

Component Description:
"K. Lahm - .Planning & remote control execution of repack channel antenna & line initial sweep test and report - 2/17, 3/16&30, 4/3&7/2020"
Amount:
$1,750.00

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 $68,325.00 $74,051.84 N/A $74,048.53 N/A
Total for all systems $2,842,288.65 $2,000,917.01 N/A $1,789,375.86 N/A
Interim Transmission Line $10,775.00 $16,501.84 $16,501.84
Interim Transmission Line Shipping $450.00 $450.00 Please see Rex Industries Estimate 220-350, ATC Quote 220350 and 02385603 $450.00 N/A
Flexible Air Transmission Line - dielectric, 3" $10,325.00 $16,051.84 Per RFS Invoice 16465503 & 16474757 $16,051.84 N/A
Primary Transmission Line $57,550.00 $57,550.00 $57,546.69
Transmission Line Equipment $57,550.00 $57,550.00 per Estimated Cost Justification KCEC-DT-310-Primary Transmission Line - Other Costs Not Listed v4 $57,546.69 N/A

Components

Actual Information Description File Name
Interim Transmission Line Shipping

Component Description:
KCEC-DT-380-Interim Transmission Line - Shipping $275.00
Amount:
$275.00

Component Description:
"KCEC-DT-380-Interim Transmission Line - Shipping $50.00"
Amount:
$50.00

Component Description:
KCEC-DT-380-Interim Transmission Line - Shipping $125.00
Amount:
$125.00
Flexible Air Transmission Line - dielectric, 3"

Component Description:
HELIFLEX 3in Low Loss Air Dielectric Cable Standard Jacket
Amount:
$10,422.23

Component Description:
HELIFLEX 3in Low Loss Air Dielectric Cable Standard Jacket
Amount:
$5,629.61
Transmission Line Equipment

Component Description:
8-3/16" TO 6 1/8" REDUCER 75 OHM
Amount:
$8,511.95

Component Description:
ELBOW 8-75 EIA DIGIT 12 X 24
Amount:
$6,968.06

Component Description:
CO Sales Tax - Invoice 553032
Amount:
$163.20

Component Description:
GAS BARRIER 6 1/8
Amount:
$981.67

Component Description:
MACXLINE 8 3/16" 75 OHM CUSTOM SECTION
Amount:
$3,464.10

Component Description:
KCEC-DT-310-Primary Transmission Line - Other Costs Not Listed
Amount:
$2,699.09

Component Description:
CO Sales Tax - Invoice 550016
Amount:
$163.20

Component Description:
ELBOW 8-75 EIA DIGITLINE 12 X 12
Amount:
$30,515.42

Component Description:
ELB 8-75 DIGIT EHT 12 X 24
Amount:
$4,080.00

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 $591,600.00 $141,000.00 N/A $63,535.00 N/A
Total for all systems $2,842,288.65 $2,000,917.01 N/A $1,789,375.86 N/A
Primary Tower TOWER $591,600.00 $141,000.00 $63,535.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $60,000.00 N/A $59,450.00 N/A
Structural engineering tower load study for well documented tower $12,600.00 $6,000.00 N/A $4,085.00 N/A
Minor tower reinforcement/modifications $158,000.00 $75,000.00 N/A N/A N/A

Components

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

Component Description:
Cost per agreement dated 5-2-2018
Amount:
$52,250.00

Component Description:
Mobilized to Mount Morrison, CO job site. Installed two 3in connectors.
Amount:
$7,200.00
Structural engineering tower load study for well documented tower

Component Description:
Professional Engineering Services
Amount:
$4,085.00
Minor tower reinforcement/modifications Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $135,500.00 $224,598.25 N/A $218,341.37 N/A
Total for all systems $2,842,288.65 $2,000,917.01 N/A $1,789,375.86 N/A
Outside Professional Services $135,500.00 $224,598.25 $218,341.37
RF Exposure Measurements $21,050.00 $10,960.00 N/A $10,954.25 N/A
Project management of the transition $82,160.00 $182,950.00 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $182,948.87 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $182.25 Please see KCEC Attorney STA Budget Revision Justification Letter $182.25 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $3,818.25 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $3,818.25 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 $2,562.75 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $2,562.75 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $5,500.00 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $5,500.00 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $8,500.00 du Treil, Lundin & Rackley invoices #242884 & others $8,500.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $2,050.00 $3,875.00 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $3,875.00 N/A

Components

Actual Information Description File Name
RF Exposure Measurements

Component Description:
K. Lahm - RF exposure re-study - 8/15-22/2018
Amount:
$1,812.50

Component Description:
CONSULTING ENGINEERING SERVICES FOR CH. 32-DT BOULDER REPACKING
Amount:
$5,700.00

Component Description:
CONSULTING ENGINEERING SERVICES FOR CH. 32-DT BOULDER REPACKING
Amount:
$3,441.75
Project management of the transition

Component Description:
Project Management Services
Amount:
$475.54

Component Description:
Project Management Services
Amount:
$772.15

Component Description:
Project Management Services
Amount:
$136.50

Component Description:
Project Management Services
Amount:
$76.50

Component Description:
Project Management Services
Amount:
$241.80

Component Description:
Project Management Services
Amount:
$575.00

Component Description:
Project Management Services
Amount:
$75.00

Component Description:
Project Management Services
Amount:
$324.50

Component Description:
Project Management Services
Amount:
$313.95

Component Description:
Project Management
Amount:
$90.00

Component Description:
Project Management Services, including: supervision
Amount:
$318.60

Component Description:
Project management
Amount:
$691.25

Component Description:
Project Management Services
Amount:
$248.98

Component Description:
Project Management Services
Amount:
$204.75

Component Description:
Project Management Services
Amount:
$66.00

Component Description:
Project Management
Amount:
$8,584.90

Component Description:
Project Management Services
Amount:
$204.00

Component Description:
Project management Services
Amount:
$388.75

Component Description:
Project Management
Amount:
$5,244.05

Component Description:
Project Management Services
Amount:
$160.50

Component Description:
Project management Services, including:
Amount:
$284.05

Component Description:
Project Management Services
Amount:
$571.12

Component Description:
Project Management Services
Amount:
$111.00

Component Description:
Project Management Services
Amount:
$382.32

Component Description:
Project Management
Amount:
$34.50

Component Description:
Project Management
Amount:
$529.82

Component Description:
Project management
Amount:
$227.50

Component Description:
Project management Services
Amount:
$317.50

Component Description:
Project Management Services
Amount:
$3,215.35

Component Description:
Project management
Amount:
$367.50

Component Description:
Project Management Services
Amount:
$1,011.26

Component Description:
Project management
Amount:
$532.50

Component Description:
Project Management
Amount:
$825.00

Component Description:
Project management Services
Amount:
$276.90

Component Description:
Project Management
Amount:
$1,402.30

Component Description:
Project Management
Amount:
$103.50

Component Description:
Project Management
Amount:
$37.50

Component Description:
Project Management Services
Amount:
$329.22

Component Description:
Project Management
Amount:
$6,875.95

Component Description:
Project Management
Amount:
$5,170.50

Component Description:
Project management Services
Amount:
$269.75

Component Description:
Project Management Services
Amount:
$674.96

Component Description:
Project management
Amount:
$6,654.95

Component Description:
Project Management
Amount:
$22.50

Component Description:
Project Management
Amount:
$262.50

Component Description:
Project management Services
Amount:
$400.40

Component Description:
Project Management
Amount:
$519.20

Component Description:
Project Management
Amount:
$9.00

Component Description:
Project management services
Amount:
$429.52

Component Description:
Project Management Services
Amount:
$217.75

Component Description:
Project Management Services
Amount:
$136.50

Component Description:
Project Management
Amount:
$6,778.10

Component Description:
Project Management
Amount:
$2,536.95

Component Description:
Project management
Amount:
$2,685.90

Component Description:
Project management Services
Amount:
$307.50

Component Description:
Project management services
Amount:
$623.75

Component Description:
Project Management Services
Amount:
$552.50

Component Description:
Invoice revisions to meet FCC submittal requirements
Amount:
$52.50

Component Description:
Project Management Services
Amount:
$21.00

Component Description:
Project management Services
Amount:
$547.30

Component Description:
Project Management
Amount:
$4,428.30

Component Description:
Project management Services
Amount:
$888.75

Component Description:
Project Management Services
Amount:
$330.20

Component Description:
Project Management
Amount:
$5,379.65

Component Description:
Project management Services
Amount:
$463.45

Component Description:
Project Management Services
Amount:
$115.50

Component Description:
Project management Services
Amount:
$337.35

Component Description:
Project Management Services
Amount:
$467.50

Component Description:
Project Management
Amount:
$448.40

Component Description:
Project management services
Amount:
$372.50

Component Description:
Project management Services
Amount:
$728.75

Component Description:
Project management Services
Amount:
$573.75

Component Description:
Project management Services
Amount:
$525.00

Component Description:
Project Management Services
Amount:
$640.25

Component Description:
Project Management Services
Amount:
$123.00

Component Description:
Project Management Services, including: supervision and publishing of
Amount:
$390.58

Component Description:
Project Management Services
Amount:
$228.75

Component Description:
Project Management
Amount:
$4,612.70

Component Description:
Project Management Services
Amount:
$169.50

Component Description:
Project Management Services
Amount:
$161.85

Component Description:
Project management
Amount:
$1,441.70

Component Description:
Project Management Services
Amount:
$385.86

Component Description:
Project Management
Amount:
$3,136.85

Component Description:
Project Management Services
Amount:
$129.00

Component Description:
Project Management Services
Amount:
$114.00

Component Description:
Project Management
Amount:
$4,306.80

Component Description:
Project Management Services
Amount:
$957.00

Component Description:
Project Management Services
Amount:
$180.00

Component Description:
Project Management Services
Amount:
$1,141.25

Component Description:
Project Management Services
Amount:
$342.50

Component Description:
Project Management Services
Amount:
$930.00

Component Description:
Project Management Services
Amount:
$2,768.30

Component Description:
Project Management Services
Amount:
$145.00

Component Description:
Project Management Services
Amount:
$2,536.55

Component Description:
Project management
Amount:
$3,904.30

Component Description:
Project management
Amount:
$268.75

Component Description:
K. Lahm - Evaluate KRMA temp use of KCEC temp antenna - 12/17/2018
Amount:
$37.50

Component Description:
Project Management Services
Amount:
$154.50

Component Description:
Project management Services
Amount:
$116.35

Component Description:
Project Management Services
Amount:
$93.00

Component Description:
Project management Services
Amount:
$455.00

Component Description:
Project Management
Amount:
$423.75

Component Description:
Project Management Services
Amount:
$102.00

Component Description:
Project Management
Amount:
$3,844.65

Component Description:
Project management Services
Amount:
$1,400.00

Component Description:
Project management Services
Amount:
$455.00

Component Description:
Project management Services
Amount:
$625.00

Component Description:
Project management Services
Amount:
$372.50

Component Description:
Project Management
Amount:
$526.28

Component Description:
Project management Services
Amount:
$208.00

Component Description:
Project management Services
Amount:
$406.90

Component Description:
Project Management Services
Amount:
$675.00

Component Description:
Project management Services
Amount:
$414.70

Component Description:
Project Management Services
Amount:
$590.00

Component Description:
Project management services
Amount:
$345.00

Component Description:
Project management
Amount:
$365.30

Component Description:
Project management Services
Amount:
$315.90

Component Description:
Project management Services
Amount:
$618.75

Component Description:
Project management Services
Amount:
$258.05

Component Description:
Project management
Amount:
$302.90

Component Description:
Project management Services
Amount:
$373.75

Component Description:
Project Management
Amount:
$2,087.35

Component Description:
Project management Services
Amount:
$428.34

Component Description:
Project Management
Amount:
$4,442.50

Component Description:
Project management Services
Amount:
$337.35

Component Description:
Project management Services
Amount:
$315.90

Component Description:
Project Management Services
Amount:
$548.75

Component Description:
Project management Services
Amount:
$601.25

Component Description:
Project Management Services
Amount:
$67.50

Component Description:
Project Management Services
Amount:
$477.00

Component Description:
Project Management
Amount:
$85.50

Component Description:
Project Management Services
Amount:
$411.82

Component Description:
Project Management Services
Amount:
$482.62

Component Description:
Project Management
Amount:
$2,705.55

Component Description:
Project Management Services
Amount:
$421.85

Component Description:
Project mgt
Amount:
$2,343.80

Component Description:
Project management Services
Amount:
$618.75

Component Description:
Project Management
Amount:
$112.50

Component Description:
Project Management
Amount:
$99.00

Component Description:
Project Management
Amount:
$2,769.35

Component Description:
Project Management
Amount:
$2,915.30

Component Description:
Project management Services
Amount:
$385.00

Component Description:
Project management Services
Amount:
$516.10

Component Description:
K. Lahm - Discussion of roof penetration sealing
Amount:
$62.50

Component Description:
Project management Services
Amount:
$585.00

Component Description:
Project management Services
Amount:
$315.00

Component Description:
Project Management
Amount:
$2,857.20

Component Description:
Project Management Services
Amount:
$354.00

Component Description:
Project management Services
Amount:
$516.10

Component Description:
Project Management
Amount:
$6,904.95

Component Description:
Project management Services
Amount:
$1,956.25

Component Description:
Project management Services
Amount:
$653.75

Component Description:
Project management Services
Amount:
$384.80

Component Description:
Project Management
Amount:
$4,909.15

Component Description:
Project management Services
Amount:
$116.35

Component Description:
Project Management
Amount:
$4,199.50

Component Description:
Project Management Services
Amount:
$156.00

Component Description:
"K. Lahm - Project management consultations - 6/19,7/5,10/9,11/9,11/15 /2018,"
Amount:
$225.00

Component Description:
Project Management
Amount:
$115.50

Component Description:
Project Management
Amount:
$21.00

Component Description:
Project Management
Amount:
$3,637.95

Component Description:
Project management
Amount:
$214.50

Component Description:
Project Management
Amount:
$333.33

Component Description:
Project management
Amount:
$552.50

Component Description:
K. Lahm - Antenna air leak consultations - 3/1/19
Amount:
$225.00

Component Description:
Project Management
Amount:
$3,322.10

Component Description:
Project Management
Amount:
$5,390.15
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Legal Services
Amount:
$182.25
Attorney Fees - Negotiation of lease and other matters for shared locations

Component Description:
Legal Services
Amount:
$418.50

Component Description:
Legal Services
Amount:
$1,631.25

Component Description:
Legal Services
Amount:
$195.75

Component Description:
Legal Services
Amount:
$177.75

Component Description:
Legal Services
Amount:
$906.75

Component Description:
Legal Services
Amount:
$488.25
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:
KCEC-DT-550-Attorney - Construction Permit Application (Main)
Amount:
$2,562.75
Perform engineering study for new channel assignment and antenna development

Component Description:
KCEC-DT-590-Outside RF consulting Engineering Services
Amount:
$125.00

Component Description:
K. Lahm - NTIA Table Mountain protection review - 7/2/2018
Amount:
$62.50

Component Description:
Transmission facility analysis & design- antenna optimization
Amount:
$2,750.00

Component Description:
Antenna & ERP optimization analysis - STA preparation support
Amount:
$500.00

Component Description:
K. Lahm - Antenna lead discussion & sweep test planning
Amount:
$562.50

Component Description:
Advise measurements on temp antenna
Amount:
$62.50

Component Description:
KCEC-DT-590-Outside RF consulting Engineering Services
Amount:
$125.00

Component Description:
K. Lahm - Line elbow replacement planning 4/3&4/2019
Amount:
$187.50

Component Description:
K. Lahm - Review as-built radiation pattern data
Amount:
$187.50

Component Description:
AUCTION REPACK WORK
Amount:
$500.00

Component Description:
K. Lahm - As-built TPO update
Amount:
$62.50

Component Description:
KCEC-DT-590-Outside RF consulting Engineering Services
Amount:
$125.00

Component Description:
KCEC-DT-590-Outside RF consulting Engineering Services
Amount:
$250.00
Prepare and or review reimbursement form Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepare an amendment to KCEC-DT's repack application (proposal 7/6/2018) to protect the Table Mountain facility
Amount:
$250.00

Component Description:
Engineering study work for new channel assignment including antenna development (Custom Antenna) and preparation of the engineering section of FCC Form 2100 (90 day construction permit application).
Amount:
$1,750.00

Component Description:
Engineering study work for new channel assignment including antenna development. Preparation of the engineering section of FCC Form 2100.
Amount:
$2,000.00

Component Description:
RF Eng - Construction Permit Applicaiton (Main)
Amount:
$250.00

Component Description:
Modify CP based on RFE and notify Table Mountain.
Amount:
$2,500.00

Component Description:
Professional Services
Amount:
$875.00

Component Description:
Prepare an amendment to KCEC-DT's repack application (proposal 7/6/2018) to protect the Table Mountain facility
Amount:
$875.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare request for Special Temporary Authorization

Component Description:
Prepare KCEC Ch 15 STA Professional Services
Amount:
$1,500.00

Component Description:
KCEC-DT-530-RF Eng - Special Temporary Authorization
Amount:
$1,000.00

Component Description:
KCEC-DT-530-RF Eng - Special Temporary Authorization
Amount:
$375.00

Component Description:
KCEC-DT-530-RF Eng - Special Temporary Authorization
Amount:
$1,000.00

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $112,713.38 $108,358.38 N/A $103,284.38 N/A
Total for all systems $2,842,288.65 $2,000,917.01 N/A $1,789,375.86 N/A
Other Expenses $112,713.38 $108,358.38 $103,284.38
Equipment Rental $4,370.00 $4,370.00 Please see EagleEngineering Proposal 1461R $4,370.00 N/A
Station Coordination $750.00 $750.00 N/A $500.00 N/A
Equipment Delivery and Handling Charges $32,644.00 $32,644.00 Please see Rohde and Schwarz quotes 248351.3 and 248330.2, plus taxes on invoice 9500120490 $31,395.00 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $43,861.38 $43,861.38 Please see Estimated Cost Justification KCEC-DT-610-Disposal Costs v1 $43,861.38 Please see submitted invoices
Local Zoning $500.00 $500.00 Please see KCEC-DT Local Zoning Budget Revision Justification Letter $500.00 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 $7,000.00 N/A $3,750.00 N/A
Equipment Storage $18,508.00 $18,508.00 See Estimated Cost Justification KCEC-DT-610-Equipment Storage v1 $18,508.00 N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $400.00 Please see Estimated Cost Justification KCEC-DT-610-FCC Filing Fee - Special Temporary Authorization v0 $400.00 N/A

Components

Actual Information Description File Name
Equipment Rental

Component Description:
KCEC-DT-610-Equipment Rental track needed @ $2,185.00
Amount:
$2,185.00

Component Description:
KCEC-DT-610-Equipment Rental track needed @ $2,185.00
Amount:
$2,185.00
Station Coordination

Component Description:
Coordinate proposed KTFS-DT operation with Table Mountain
Amount:
$500.00
Equipment Delivery and Handling Charges

Component Description:
KCEC-DT-610-Equipment Delivery and Handling
Amount:
$15,050.00

Component Description:
KCEC-DT-610-Equipment Delivery and Handling
Amount:
$16,345.00
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
KCEC Denver CO Electrical demo
Amount:
$5,212.50

Component Description:
KCEC Denver CO
Amount:
$13,110.19

Component Description:
KCEC Denver CO Demo
Amount:
$13,110.19

Component Description:
Beam Supplies: Remove and Dispose
Amount:
$7,216.00

Component Description:
Electrical demo
Amount:
$5,212.50
Local Zoning

Component Description:
KCEC - Jefferson County zoning telecommunications permit application for antenna change
Amount:
$500.00
FCC Filing Fees - Form 2100 license to cover application Information not provided.
DTV Medical Facility Notification

Component Description:
Medical Notification
Amount:
$3,750.00
Equipment Storage

Component Description:
KCEC-DT-610-Equipment Storage $500.00
Amount:
$500.00

Component Description:
"KCEC-DT Aux transmitter consolidation, storage and last mile delivery as described in quotation 248351.3. Tax on Order"
Amount:
$5,658.00

Component Description:
KCEC-DT-610-Equipment Storage
Amount:
$12,300.00

Component Description:
July 2020 storage
Amount:
$50.00
FCC Filing Fees - Special Temporary Authorization request

Component Description:
STA Extension
Amount:
$200.00

Component Description:
Engineering STA
Amount:
$200.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $2,842,288.65 $2,000,917.01 $1,789,375.86

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.

Jose Franchi , Franchi .

VP Finance


06/11/2021

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.

Jose Franchi , Franchi .

VP Finance


06/11/2021

Attachments

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