TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
KVOS-TV LLC	Norman H. Shapiro 26 NORTH HALSTED STREET CHICAGO, IL 60661 United States	+1 (312) 705-2600	nshapiro@wciu.com	Limited Liability Company

Applicant

Address

Phone

Applicant Type

KVOS-TV LLC

Norman H. Shapiro

26 NORTH HALSTED STREET

CHICAGO, IL 60661

United States

+1 (312) 705-2600

nshapiro@wciu.com

Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant	Address	Phone	Email
[Confidential]

Preparer Contact Information

Preparer Contact Name and Information

Applicant	Address	Phone	Email
The Preparer is same as the reimbursement contact.

Broadcaster Information and Transition Plan

Question	Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information.	No
Briefly describe transition plan	See attached Transition Plan Narrative.

Transmitters

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

Primary Transmitter

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	QXD1
	Year	2009
	Type	Inductive Output Tube
	IOT Power Type	Single
	Power Capacity	33 kW

Primary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Primary (Main)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Manufacturer
	Model	THU9evo-12
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	19.0 kW
	Justification for New Transmitter	Existing transmitter is no longer supported by the manufacturer.

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	No
	Transformer (480V)	No
	Power	N/A
	Rigid Conduit and Wiring	No
	Size	N/A
	Length	N/A
	Other Electrical Service	No
	Description	N/A
HVAC Service	Does the replacement transmitter require HVAC Service?	No
	Type	N/A
	Size	N/A
	Other Size	N/A
Transmitter Building Addition/Modification or Leasehold Improvement	Does the Transmitter Building require an addition, modification, other leashold improvement?	No
	Size	N/A
Channel 14 Costs	Is an RF Consulting Engineer needed?	N/A
	Is a channel 14 Mask Filer needed?	N/A
	Is additional field engineering time needed?	N/A
	Number of Days	5

Primary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Primary Transmitter Installation	Installation of the new Primary Transmitter and removal of the existing transmitter.
Extended Group Delay Option	The Extended Group Delay Option was required for the main and backup exciter to correct for group delay issues discovered during initial operation as a result of the Channel 14 RF system.
Channel 14 Mask Filter Installation	Installation of the new Primary transmitter Channel 14 Mask Filter, RF system, and removal of the existing channel 35 RF system.
Electrical and Room Prep	Electrical distribution to new transmitter and removal of abandoned equipment to make space for the new equipment.

Antennas

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

Primary Antenna

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	Top Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels	N/A
	Design power capacity in use	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Other Antenna Type	N/A
	ERP:	580.0 kW
	Manufacturer
	Model	TFU-31JTH-R O4SP
	Year	2009

Primary Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Primary (Main)
	Description of Use	N/A
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	No
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Types	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels/Bays	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Design power capacity in use	N/A
	Other Antenna Type	N/A
	ERP:	535.0 kW
	Manufacturer
	Model	TFU-24JTH-R 04SP
	Year	2019
	Justification for New Antenna	Existing antenna is fixed on CH35 and is not retunable.

Primary Antenna

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	6 1/8 inches inches
Side Mount Brackets	Do you require the separate purchase of side mount brackets for a high power antenna?
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

Other Antenna Cost Not Listed

Information not provided.

Interim Antenna

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?	No
New Antenna Manufacturer and Type	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Broadband Slot
	Number of Stations Supported	1
	Number of Panels/Bays	16
	Lower Limit	470.00 MHz
	Upper Limit	602.00 MHz
	Design power capacity in use	100.0 %
	Other Antenna Type	N/A
	ERP:	100.0 kW
	Manufacturer
	Model	ATC-BCSH16S1-U1
	Year	2019
	Justification for New Antenna	Provide interim service on pre-auction or post-auction channel when top mount antenna is replaced with post-auction channel antenna.

Interim Antenna

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?	Yes
Sweep Test	Do you require the sweep testing of transmission line and antenna?	Yes

Interim Antenna

Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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	6 1/8 inches
	Other Diameter	N/A
	Segment Length	20 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	500 feet per run

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Name	Description
End Caps and Reducer	End caps for pressuring the existing line while the top mount antenna was removed and a reducer used to transition the existing 6-50 RF to the 4-50 transmission system.

Interim Transmission Line

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	500 feet per run
	Justification for New Transmission Line	Provide interim service for current channel while re-assigned facility is built out.

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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
Existing Tower Structure Registration	ASR Number	1251758
Coordinates (NAD83)	Latitude (NAD83)	48° 40' 49.4" N-
	Longitude (NAD83)	122° 50' 26.4" W-
	Overall Structure Height	498.68 feet
	Support Structure Height	498.68 feet
	Ground Elevation Above Mean Sea Level (AMSL)	2270.31 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	Marsha Coulthurst ET AL.DBA Mt. Constitution Sites Inc
	Date Constructed	07/14/2006

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
14506	KWPZ	FM

Primary Tower

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:	No reinforcements needed

Primary Tower

Tower Rigging Costs

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

Primary Tower

Other Tower Expenses Not Listed

Name	Description
Interim Installation	Install interim antenna and transmission line

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	300
	Explanation	The ownership group has multiple transmitter sites (14 TV) and operates with minimal staff. It does not have personnel available for any of these tasks, nor is the staff trained to provide any of these services.
Outside RF consulting Engineering Services	Perform engineering study for new channel assignment and antenna development	Yes
	Prepare engineering section of Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare engineering section of Form FCC License to Cover Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	Yes
	Quantity	1
	Do you have Distributed Transmission System engineering services?	N/A
	Critical Facility	N/A
	Terrain-Shielded Facility	N/A
Attorney and Other Outside Consulting Services	Prepare and file Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare and file Form FCC License to Cover Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	Yes
	Quantity	1
	NEPA Section 106 environmental review	No
	Environmental Assessment	No
	ASR Modification	No
	FAA Consultation (including preparation of FAA Form 7460)	No
	Negotiation of Lease and other Matter for Shared Locations	No
	Prepare or Review FCC Form 399 for Reimbursement	Yes
	Address transition timing and coordination issues w/ other stations and wireless providers	No
RF Field Engineering Services	Comprehensive coverage verification via field study	No
	RF exposure measurements	No
	Additional Field Engineering Service	No
	Number of Days	N/A
	Justification	N/A

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Name	Description
Site Survey	Site visit to determine final layout and required equipment needed.

Other Expenses

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

Other Expenses Not Listed

Information not provided.

Cost Information

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	$967,049.39	$592,248.60	N/A	$592,248.60	N/A
Total for all systems	$1,893,497.52	$1,432,055.92	N/A	$1,432,055.92	N/A
Primary Transmitter THU9evo-12	$967,049.39	$592,248.60		$592,248.60
Electrical and Room Prep	$10,281.97	$10,281.97	Add distribution of electrical to new transmitter. Incorporates removal of some abandoned station equipment. Difficult access to this site.	$10,281.97	N/A
Channel 14 Mask Filter Installation	$27,900.00	$27,900.00	This is the cost for the installation of the Channel 14 Mask Filter system and the removal of the existing channel 35 RF system	$27,900.00	N/A
Extended Group Delay Option	$4,107.42	$4,107.42	Extended Group Delay option required to mitigate group delay issues discovered as a result of the complex Channel 14 RF system	$4,107.42	N/A
Primary Transmitter Installation	$37,500.00	$37,500.00	This is the cost for the installation of the Primary transmitter and the removal of the existing transmitter	$37,500.00	N/A
Channel 14 Mask Filter	$189,500.00	$112,912.16	N/A	$112,912.16	N/A
RF Consulting Engineer	$5,260.00	$4,255.57	N/A	$4,255.57	N/A
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW	$684,000.00	$386,791.48	N/A	$386,791.48	N/A
Channel 14 -- Additional field engineering time, 5 days	$8,500.00	$8,500.00	A technician from Dielectric was required to come back on site to address de-tuning issues as a result of the higher elevation of Mt Constitution and the extensive moving logistics.	$8,500.00	N/A

Components

Actual Information Description	File Name
Electrical and Room Prep	Component Description: KVOS Primary Transmitter Electric Invoice Amount: $8,898.29 Component Description: KVOS Primary Transmitter Channel 14 Mast Filter Electrical Invoice Amount: $1,383.68 Component Description: KVOS Primary transmitter Channel 14 Mask Filter electrical final payment Amount: $1,480.97 Component Description: KVOS Primary transmitter electrical final payment Amount: $8,898.29 Component Description: KVOS Primary transmitter electrical cable tray installation final payment Amount: $930.00
Channel 14 Mask Filter Installation	Component Description: KVOS Primary transmitter channel 14 mask filter installation final payment Amount: $27,900.00
Extended Group Delay Option	Component Description: KVOS Primary transmitter extended group delay option invoice Amount: $4,107.42
Primary Transmitter Installation	Component Description: KVOS Primary transmitter installation final payment Amount: $37,500.00
Channel 14 Mask Filter	Component Description: KVOS Primary transmitter channel 14 mask filter final payment Amount: $112,912.16 Component Description: KVOS Primary transmitter Channel 14 Mask Filter freight from Seattle dock to tower site. The KVOS tower site is located in a remote area. Amount: $1,157.05 Component Description: KVOS Primary transmitter channel 14 mask filter retune final invoice Amount: $8,500.00 Component Description: KVOS Primary transmitter Channel 14 system load freight from Seattle dock to tower site. The KVOS tower site is located in a remote area. Amount: $274.86 Component Description: KVOS Primary transmitter Channel 14 Mask Filter transmission line installation kit freight from Seattle dock to tower site. The KVOS tower site is located in a remote area. Amount: $300.00
RF Consulting Engineer	Component Description: KVOS Primary transmitter RF Consulting final payment Amount: $4,255.57
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW	Component Description: KVOS Primary Transmitter Downpayment Amount: $89,452.24 Component Description: KVOS Primary transmitter shipping invoice Amount: $28,982.54 Component Description: KVOS Primary Transmitter Final Payment Amount: $268,356.70 Component Description: KVOS Primary Transmitter Sales Tax Invoice Amount: $28,982.54
Channel 14 -- Additional field engineering time, 5 days	Component Description: KVOS Primary Transmitter Channel 14 Mask Filter Retune Invoice Amount: $8,500.00 Component Description: Please see line 4 of the invoice - RF consulting engineer, initial CH14 interference survey. Amount: $281.25

Cost Information

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	$367,420.00	$344,413.69	N/A	$344,413.69	N/A
Total for all systems	$1,893,497.52	$1,432,055.92	N/A	$1,432,055.92	N/A
Interim Antenna ATC-BCSH16S1-U1	$101,390.00	$49,387.00		$49,387.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	$5,260.00	$0.00	N/A	N/A	N/A
Sweep test of existing antenna	$6,730.00	$1,250.00	N/A	$1,250.00	N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized	$89,400.00	$48,137.00	N/A	$48,137.00	N/A
Primary Antenna TFU-24JTH-R 04SP	$266,030.00	$295,026.69		$295,026.69
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	$12,300.00	$0.00	This is included in the antenna package	N/A	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$6,400.00	N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized	$247,000.00	$288,626.69	KVOS is located on top of Mt Constitution. Shipping costs are non-typical due to the difficult site location. The Elbow Complex, previously its own line item, is included in this category. Taxes are also included in the actual submitted costs.	$288,626.69	N/A

Components

Actual Information Description	File Name
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost)	Information not provided.
Sweep test of existing antenna	Component Description: KVOS Interim antenna system sweep Amount: $1,250.00 Component Description: KVOS Interim Antenna Sweep Invoice Amount: $1,250.00
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized	Component Description: KVOS Interim antenna downpayment Amount: $21,625.00 Component Description: KVOS Interim antenna inter-island freight invoice Amount: $371.76 Component Description: KVOS Interim antenna final payment Amount: $26,512.00
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed)	Information not provided.
Sweep test of existing antenna	Component Description: KVOS Primary antenna system sweep final payment Amount: $6,400.00
UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized	Component Description: KVOS Primary antena cut rigid line shipping final payment binder Amount: $288.05 Component Description: KVOS Primary antenna final payment Amount: $17,584.40 Component Description: KVOS Primary Antenna Shipping Sales Tax Invoice Amount: $1,189.18 Component Description: KVOS Primary Antenna Pre-Ship Invoice Amount: $116,214.30 Component Description: KVOS Primary Antenna Shipping Invoice Amount: $14,681.25 Component Description: KVOS Primary Antenna Downpayment Amount: $116,214.30 Component Description: KVOS Primary antenna end cap and reducer sales tax invoice Amount: $190.71 Component Description: KVOS Primary antenna end cap and reducer shipping sales tax invoice Amount: $4.69 Component Description: KVOS Primary antenna sales tax invoice Amount: $20,251.05 Component Description: KVOS Primary antenna downpayment Amount: $116,214.30 Component Description: KVOS Primary antenna pre-ship invoice Amount: $116,214.30 Component Description: KVOS Primary antenna cut rigid line sales tax invoice Amount: $149.12 Component Description: KVOS Primary antenna end cap and reducer final payment Amount: $2,354.00 Component Description: KVOS Primary antenna shipping sales tax invoice Amount: $1,189.18 Component Description: KVOS Primary antenna cut rigid line shipping sales tax invoice Amount: $23.33 Component Description: KVOS Primary antenna shipping invoice Amount: $14,681.25 Component Description: Shipping from Seattle dock to Mt Constitution on Orcas Island invoice Amount: $2,737.48 Component Description: KVOS Primary antenna end cap and reducer shipping invoice Amount: $57.89 Component Description: KVOS Primary antenna cut rigid line final payment Amount: $1,841.00

Cost Information

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	$31,916.98	$30,514.98	N/A	$30,514.98	N/A
Total for all systems	$1,893,497.52	$1,432,055.92	N/A	$1,432,055.92	N/A
Interim Transmission Line	$29,500.00	$28,098.00		$28,098.00
Flexible Air Transmission Line - dielectric, 3"	$29,500.00	$28,098.00	N/A	$28,098.00	N/A
Primary Transmission Line	$2,416.98	$2,416.98		$2,416.98
End Caps and Reducer	$2,416.98	$2,416.98	End caps for pressuring the existing line while the top mount antenna was removed and a reducer used to transition the existing 6-50 RF to the 4-50 transmission system.	$2,416.98	N/A

Components

Actual Information Description	File Name
Flexible Air Transmission Line - dielectric, 3"	Component Description: KVOS Interim transmission line downpayment Amount: $9,716.00 Component Description: KVOS Interim transmission line dehydrator final payment Amount: $2,565.00 Component Description: KVOS Interim Line Hardware Receipt Amount: $701.00 Component Description: KVOS Interim transmission line final payment Amount: $15,116.00 Component Description: KVOS Interim transmission line mounting hardware-standoffs Amount: $701.00
End Caps and Reducer	Component Description: KVOS Primary Antenna End Caps and Reducer Shipping Invoice Amount: $57.89 Component Description: KVOS Primary Antenna End Caps and Reducer Shipping Sales Tax Invoice Amount: $4.69 Component Description: KVOS Primary Antenna End Caps and Reducer Invoice Amount: $2,354.40

Actual Information Description

File Name

Flexible Air Transmission Line - dielectric, 3"

Component Description:: KVOS Interim transmission line downpayment
Amount:: $9,716.00

Component Description:: KVOS Interim transmission line dehydrator final payment
Amount:: $2,565.00

Component Description:: KVOS Interim Line Hardware Receipt
Amount:: $701.00

Component Description:: KVOS Interim transmission line final payment
Amount:: $15,116.00

Component Description:: KVOS Interim transmission line mounting hardware-standoffs
Amount:: $701.00

End Caps and Reducer

Component Description:: KVOS Primary Antenna End Caps and Reducer Shipping Invoice
Amount:: $57.89

Component Description:: KVOS Primary Antenna End Caps and Reducer Shipping Sales Tax Invoice
Amount:: $4.69

Component Description:: KVOS Primary Antenna End Caps and Reducer Invoice
Amount:: $2,354.40

Cost Information

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	$433,600.00	$449,442.10	N/A	$449,442.10	N/A
Total for all systems	$1,893,497.52	$1,432,055.92	N/A	$1,432,055.92	N/A
Primary Tower TOWER	$433,600.00	$449,442.10		$449,442.10
Structural engineering tower load study for well documented tower	$12,600.00	$2,250.00	N/A	$2,250.00	N/A
Interim Installation	$0.00	$0.00	Included in quote for tower rigging work.	N/A	N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	$421,000.00	$447,192.10	Cost includes the installation of the side mount Interim antenna and transmission line, Washington state taxes. KVOS is located on Mt Constitution. Access to the site is challenging and expenses exceed a typical site due to tourists on the island.	$447,192.10	N/A

Components

Actual Information Description	File Name
Structural engineering tower load study for well documented tower	Component Description: Please refer to line 2 of the invoice for details Amount: $4,480.00 Component Description: KVOS Primary tower structural engineering final payment Amount: $2,250.00 Component Description: Please see line 4 of the invoice - Structural engineering tower load study for well documented tower. re-run for antenna spec change. Amount: $1,680.00
Interim Installation	Information not provided.
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	Component Description: KVOS Primary tower complex tower downpayment Amount: $268,645.49 Component Description: KVOS Primary tower complex tower downpayment Amount: $178,546.61

Cost Information

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	$75,480.00	$6,845.40	N/A	$6,845.40	N/A
Total for all systems	$1,893,497.52	$1,432,055.92	N/A	$1,432,055.92	N/A
Outside Professional Services	$75,480.00	$6,845.40		$6,845.40
Attorney Fees - Prepare and File request for Special Temporary Authorization	$3,680.00	$118.50	N/A	$118.50	N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,520.00	Fees were higher than the estimated amount due to channel 14 procedural requirements	$2,520.00	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$619.20	N/A	$619.20	N/A
Prepare request for Special Temporary Authorization	$2,050.00	$750.00	N/A	$750.00	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$0.00	N/A	$0.00	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$0.00	N/A	$0.00	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$2,025.00	N/A	$2,025.00	N/A
Prepare and or review reimbursement form	$2,630.00	$812.70	N/A	$812.70	The original estimate was only for the consulting engineer and did not include attorney's fees.
Project management of the transition	$47,400.00	$0.00	N/A	$0.00	N/A
Site Survey	$0.00	$0.00	N/A	$0.00	N/A

Components

Actual Information Description	File Name
Attorney Fees - Prepare and File request for Special Temporary Authorization	Component Description: KVOS Attorney Fees, STA Amount: $118.50
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Component Description: KVOS Attorney fees, license to cover Amount: $2,268.00 Component Description: KVOS Attorney fees, license to cover Amount: $252.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: Please refer to lines 3,4 and 5 of the attached invoice $688. Less the 10% discount received the amount due is $619.20. Please note the hours and rates are provided at the bottom of the invoice. Amount: $619.20
Prepare request for Special Temporary Authorization	Component Description: KVOS Engineering fees, STA Amount: $750.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Component Description: KVOS Engineering fees, license to cover Amount: $750.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: Please see line 1 of the invoice - Prepare engineering section of FCC form 2100, construction permit application Amount: $2,250.00
Perform engineering study for new channel assignment and antenna development	Component Description: Please refer to line 1 of the invoice for details Amount: $1,637.50 Component Description: Please refer to line 2 of the invoice for details Amount: $437.50 Component Description: Please refer to line 1 of the invoice for details Amount: $1,317.56 Component Description: Please refer to line one of the invoice - KVOS-DT Perform engineering study for new channel assignment and antenna development Amount: $2,025.00
Prepare and or review reimbursement form	Component Description: Please refer to lines 1,2,6 and 7 of the attached invoice $903. Less the 10% discount received the amount due is $812.70. Please note the hours and rates are provided at the bottom of the invoice. Amount: $812.70 Component Description: Please see line 2 of the invoice - Prepare and or review reimbursement form. Amount: $2,500.00
Project management of the transition	Component Description: Please refer to line 1 of the invoice for details Amount: $37.50
Site Survey	Component Description: Please refer to line 1 of the invoice for details Amount: $1,403.54

Cost Information

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	$18,031.15	$8,591.15	N/A	$8,591.15	N/A
Total for all systems	$1,893,497.52	$1,432,055.92	N/A	$1,432,055.92	N/A
Other Expenses	$18,031.15	$8,591.15		$8,591.15
MVPD Notification of Channel Change	$0.00	$0.00	N/A	N/A	N/A
Develop and air announcement of upcoming channel change	$0.00	$0.00	N/A	N/A	N/A
Equipment Storage	$0.00	$0.00	N/A	N/A	N/A
Non-zoning permits	$0.00	$0.00	N/A	N/A	N/A
FCC Filing Fees - Special Temporary Authorization request	$195.00	$0.00	N/A	$0.00	N/A
FCC Filing Fees - Form 2100 license to cover application	$335.00	$0.00	N/A	$0.00	N/A
FCC Filing Fees - Form 2100 minor change CP application	$1,110.00	$0.00	N/A	N/A	N/A
DTV Medical Facility Notification	$11,550.00	$3,750.00	N/A	$3,750.00	N/A
Equipment Delivery and Handling Charges	$4,841.15	$4,841.15	Freight for transportation and logistics between the mainland (Seattle) and Orcas Island, WA as well as the handling or large or heavy component delivery to the top of Mt Constitution.	$4,841.15	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$0.00	$0.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
MVPD Notification of Channel Change	Information not provided.
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Storage	Information not provided.
Non-zoning permits	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.
FCC Filing Fees - Form 2100 minor change CP application	Information not provided.
DTV Medical Facility Notification	Component Description: KVOS DTV Medical facility notification invoice Amount: $3,750.00 Component Description: KVOS DTV Medical Facility Notification Invoice Amount: $3,750.00
Equipment Delivery and Handling Charges	Component Description: KVOS Interim Antenna Shipping and Logistics Invoice Amount: $371.76 Component Description: KVOS Ch 14 RF Shipping and Logistics invoice Amount: $1,157.05 Component Description: KVOS Ch 14 RF Filter Line Interconnect Kit Shipping and Logistics Invoice Amount: $300.00 Component Description: KVOS Spinner Load Shipping and Logistics Invoice Amount: $274.86 Component Description: KVOS Primary Antenna Shipping and Logistics Invoice Amount: $2,737.48
Disposal Costs (for equipment and other waste, net of any salvage value)	Information not provided.

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$1,893,497.52	$1,432,055.92	$1,432,055.92

Reimbursement Status

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

Certification

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.
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. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. 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). 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. 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. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. 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.	Kyle Walker VP, Technology 03/26/2022

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.

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.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
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).
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.
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.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
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.

Kyle Walker

VP, Technology

03/26/2022

Certification

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).
The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. 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) . 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. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. 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.	Kyle Walker VP, Technology 03/26/2022

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).

The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.
The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
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) .
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.
The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
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.

Kyle Walker

VP, Technology

03/26/2022

Certification

Section	Question	Response
Submission of Final Allocation or Accounting Information Statements	WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates. 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. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. 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.	Kyle Walker VP, Technology 03/26/2022

Section

Question

Response

Submission of Final Allocation or Accounting Information Statements

The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.
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.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
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.

Kyle Walker

VP, Technology

03/26/2022

(REFERENCE COPY - Not for submission) FCC Form 399: Reimbursement Request

Applicant Information

Applicant Name, Type, and Contact Information

Reimbursement Contact Information

Reimbursement Contact Name and Information

Preparer Contact Information

Preparer Contact Name and Information

Broadcaster Information and Transition Plan

Transmitters

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Antennas

Primary Antenna

Existing Antenna Information

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Interim Antenna

New Antenna Costs

Interim Antenna

Other Antenna Costs

Interim Antenna

Other Antenna Cost Not Listed

Transmission Line

Primary Transmission Line

Existing Transmission Line

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Interim Transmission Line

New Transmission Line

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Tower Equipment And Rigging Costs

Primary Tower

Existing Tower

FM, AM or TV radio broadcasters. Facility ID's, Call Signs and Services of other broadcast stations with whom the tower is shared

Primary Tower

Tower Modification Costs

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Components

Cost Information

Tower Equipment and Rigging Costs

Components

Cost Information

Outside Professional Services

Components

Cost Information

Other Expenses

Components