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:
68889
Service:
DTV
Call Sign:
KTVX
Channel:
30 (UHF)
File Number:
0000028267
FRN:
0009961889
Date Submitted:
08/10/2018

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

NEXSTAR BROADCASTING, INC.

Elizabeth Ryder

545 E. JOHN CARPENTER FREEWAY

SUITE 700

IRVING, TX 75062

United States

+1 (972) 373-8800 eryder@nexstar.tv 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

Elizabeth Ryder

General Counsel

Nexstar Broadcasting, Inc.

Elizabeth Ryder

545 E. John Carpenter Freeway

Suite 700

Irving, TX 75062

United States

+1 (972) 373-8800 eryder@nexstar.tv

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. Yes
Briefly describe transition plan DTV Utah is a complex site with 8 stations sharing a two main antennas as well as aux antenna, combiner system and building. Replacement antenna panels, combiner and transmitters will be required. DTVU is still working on its transition plans.

Transmitters

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

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model SigmaCD2
Year 1999
Type Inductive Output Tube
IOT Power Type Single
Power Capacity 20 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? Yes
Manufacturer
Model ULXTE-40
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 25 kW
Justification for New Transmitter Existing transmitter is obsolete and can not be retuned to new channel. See attached quotes. Upgrading to a SS at one power step up from the required TPO. Single tube IOT is the max reimbursement, but Gates quote is lower.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring Yes
Size 3 inches
Length 200.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Cooling Only
Size 30 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Remote Control Wiring

Wire Up Existing Remote Control to New Transmitter

Removal of Existing Equipment

Remove Existing Equipment from Farnsworth Peak

Plan Transmitter Layout and Develop Installation Drawings

Develop Installation Layout. Develop Installation Drawings

Interim Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Interim
Description of Use N/A
Change Type Purchase
Manufacturer
Model ULTXE-20
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 12.9 kW
Justification for New Transmitter DTV Utah Stations will operate on an interim transmitter one at a time in rotating fashion as their existing transmitter is removed and replaced. This is for the KTVX allocated costs for one interim transmitter for the site.

Interim Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring Yes
Size 2 inches
Length 800.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 50 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A
Inside RF System Is an additional interior RF system required to support this interim transmitter? Yes

Interim Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Leased
Owner DTV Utah
Site N/A
Is the existing antenna shared with another station or stations? Yes
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Top Mount
Antenna position in stack Top
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 8
Number of Panels 48
Design power capacity in use 100.0 %
Lower Limit 602.00 MHz
Upper Limit 700.00 MHz
Other Antenna Type N/A
ERP: 475.0 kW
Manufacturer
Model 773 928
Year 1999

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

Facility ID Call Sign
36607 KJZZ-TV
1136 KUCW
35823 KUTV
6359 KSL-TV
6823 KBYU-TV
69396 KUED
69582 KUEN

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? Yes
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Bottom
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 8
Number of Panels/Bays 48
Lower Limit 482.00 MHz
Upper Limit 608.00 MHz
Design power capacity in use 50.0 %
Other Antenna Type N/A
ERP: 2000.0 kW
Manufacturer
Model 759 25063
Year 2017
Justification for New Antenna The current panel antenna is finely tuned to a specific band, but cannot be retuned to the new band.

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? Yes
Type New
Number of channels supported 8
Frequencies of channels supported Upper and lower frequency
Frequency 488.0 MHz - 608.0 MHz
Do you need a combiner output splitter/switcher for dual feed lines? Yes
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Broadband
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? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Antenna Installation

Costs for antenna install.

Transmission Line

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Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? No

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 1062408
Coordinates (NAD83) Latitude (NAD83) 40° 39' 33.0" N-
Longitude (NAD83) 112° 12' 10.0" W-
Overall Structure Height 308.40 feet
Support Structure Height 308.40 feet
Ground Elevation Above Mean Sea Level (AMSL) 9035.32 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner DTV UTAH, LC
Date Constructed 10/28/1999

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
69582 KUEN DTV
36607 KJZZ-TV DTV
35823 KUTV DTV
69396 KUED DTV
6823 KBYU-TV DTV
1136 KUCW DTV
6359 KSL-TV 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: Major 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 800
Explanation KTVX Allocated Costs: DTV Utah will provide project management on site. Additionally, station will retain RF Engineers to review site construction as needed.
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 2
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 2
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 Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements Yes
Additional Field Engineering Service Yes
Number of Days 30
Justification On site RF Engineering to inspect and supervise construction on behalf of station

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Allocation Consulting

RF Consultant analysis of channel allocations, Interference issues, and spectrum issues

Building Structural Engineering

Structural Engineer review and analysis of building and 2nd Floor Combiner Weight Issues

Prepare and File FCC Progress Reports

Prepare and File FCC Quarterly Progress Reports

RF Consultant

RF Consultant for antenna and combiner designs

Reimbursement Reviews

Reimbursement Reviews with FCC, E&Y, and Cavell.

Other Expenses

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

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Other Expenses Not Listed

Name Description

Raod Maintenance

Snowplowing Grating and repairs to existing road to remote mountain top.

Accounting

DTV Utah Accounting and Allocation of costs to stations

DTV Utah Operating Agreement Equity Equalization

Per 1988 Operating Agreement. See Exhibit M attached.

KSTU Mask Filter

Adjacent Channel Mask Filter for KSTU. See Exhibit N attached.

Remove and Disposal of Equipment

Common Equipment Removal and Disposal. Rigging, road access, packing materials

Site Access and Transportation

Snow Cat access; helicopter site access; Road opening (snow plowing) etc.

Temporary Sanitation

Required for work on the mountaintop.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $2,104,700.00 $1,069,439.00 N/A $179,292.48 N/A
Total for all systems $4,155,491.00 $2,140,095.00 N/A $181,466.48 N/A
Interim Transmitter ULTXE-20 $1,003,800.00 $130,909.00 $0.00
UHF inside RF system including switching $147,500.00 $17,500.00 1/8 Shared Cost N/A N/A
50 Ton system $266,000.00 $31,625.00 1/8 Shared Cost N/A N/A
Switchgear - industrial 800 amp $38,200.00 $4,375.00 1/8 Shared Cost N/A N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $494,500.00 $70,534.00 1/8 Shared Cost N/A N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $4,375.00 1/8 Shared Cost N/A N/A
2" Rigid Conduit and Wiring (Cost per foot) $20,800.00 $2,500.00 1/8 Shared Cost N/A N/A
Primary Transmitter ULXTE-40 $1,100,900.00 $938,530.00 $179,292.48
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $788,930.00 N/A $179,292.48 N/A
Plan Transmitter Layout and Develop Installation Drawings $15,000.00 $15,000.00 KTVX Allocated Costs for Transmitter Installation layout and installation drawings N/A N/A
Removal of Existing Equipment $25,000.00 $25,000.00 Removal of existing KTVX Transmitter cabinets, Beam Supplies (2); Heat Exchangers (2); and other equipment. Rigging, All Terrain Vehicles; forklifts; oil and glycol issues. N/A N/A
Remote Control Wiring $3,500.00 $3,500.00 Wire up existing remote control to new transmitter. N/A N/A
3" Rigid Conduit and Wiring (Cost per foot) $10,400.00 $9,800.00 Catalog N/A N/A
Transformer 3 phase/480v - 300 KVA $36,800.00 $35,000.00 Catalog N/A N/A
Other -- HVAC Service Type: C Size:30 (Other) $25,000.00 $25,000.00 KTVX Allocated costs for modification of HVAC systems. N/A N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 Catalog N/A N/A

Components

Actual Information Description File Name
UHF inside RF system including switching Information not provided.
50 Ton system Information not provided.
Switchgear - industrial 800 amp Information not provided.
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW Information not provided.
Transformer 3 phase/480v - 300 KVA Information not provided.
2" Rigid Conduit and Wiring (Cost per foot) Information not provided.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
25% down payment Transmitter System; Original estimate is for a Gates Air system. Actual product purchased is a Rohde & Schwarz system (quote attached).
Amount:
$179,292.48
Plan Transmitter Layout and Develop Installation Drawings Information not provided.
Removal of Existing Equipment Information not provided.
Remote Control Wiring Information not provided.
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
Transformer 3 phase/480v - 300 KVA Information not provided.
Other -- HVAC Service Type: C Size:30 (Other) Information not provided.
Switchgear - industrial 800 amp Information not provided.

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $436,593.00 $394,713.00 N/A $0.00 N/A
Total for all systems $4,155,491.00 $2,140,095.00 N/A $181,466.48 N/A
Primary Antenna 759 25063 $436,593.00 $394,713.00 $0.00
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed) $13,700.00 $1,625.00 1/8 Shared Cost N/A N/A
New combiner, cost per channel (without antenna) $84,200.00 $185,000.00 1/8 Shared Cost N/A N/A
Sweep test of existing antenna $6,730.00 $2,125.00 1/8 Shared Cost N/A N/A
UHF - High Power Top Mount Eight Station broadband panel antenna horizontally polarized $168,286.00 $168,286.00 1/8 Shared Cost N/A N/A
Antenna Installation $37,677.00 $37,677.00 1/8 Shared Cost N/A N/A
Combiner output splitting/switching for dual feed lines, if applicable $126,000.00 $0.00 Included in combiner costs N/A N/A

Components

Information not provided.

Cost Information

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Transmission Line

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $854,600.00 $101,500.00 N/A $0.00 N/A
Total for all systems $4,155,491.00 $2,140,095.00 N/A $181,466.48 N/A
Primary Tower TOWER $854,600.00 $101,500.00 $0.00
Major tower reinforcement/modifications $421,000.00 $50,000.00 1/8 Shared Cost N/A N/A
Structural engineering tower load study for well documented tower $12,600.00 $1,500.00 1/8 Shared Cost N/A N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $50,000.00 1/8 Shared Cost N/A N/A

Components

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 $396,900.00 $212,350.00 N/A $2,174.00 N/A
Total for all systems $4,155,491.00 $2,140,095.00 N/A $181,466.48 N/A
Outside Professional Services $396,900.00 $212,350.00 $2,174.00
Project management of the transition $126,400.00 $37,500.00 Catalog $2,174.00 N/A
Reimbursement Reviews $10,600.00 $10,600.00 Reimbursement Reviews with FCC, E&Y, Cavell. N/A N/A
RF Consultant $16,000.00 $16,000.00 KTVX Allocation of Costs. RF Consulting Engineer for Antenna and Combiner overall system design. Vendor specs and system range testing. N/A N/A
Prepare and File FCC Progress Reports $18,000.00 $18,000.00 Prepare and file FCC Progress Reports N/A N/A
Building Structural Engineering $20,000.00 $20,000.00 KTVX specific and allocation of costs related to building structural and weight analysis. N/A N/A
Allocation Consulting $15,000.00 $15,000.00 KTVX Allocation of costs. RF Engineering Consultant to review channel allocations, interference, alternative channels, support can not construct filing. N/A N/A
Additional Field Engineering Service, 30 Days $45,000.00 $45,000.00 RF Engineer on site to supervise installation and construction of KTVX Equipment. N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 Catalog N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 Catalog N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 Catalog N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 Catalog N/A N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 Catalog N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 Catalog N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 Catalog N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 Catalog N/A N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 Catalog N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 Catalog N/A N/A
RF Exposure Measurements $21,050.00 $2,500.00 1/8 Shared Cost N/A N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $10,000.00 1/8 Shared Cost N/A N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Project Management for Structural Analysis and Tower Modifications including consultants Kessler and Gehman Associates for preparation of Form 387 progress report. Services from May 26, 2018 through June 29, 2018.
Amount:
$450.00

Component Description:
Project Management for Structural Analysis and Tower Modifications including consultants Kessler and Gehman Associates. Services from March 31, 2018 through April 27, 2018.
Amount:
$674.00

Component Description:
Project Management for Structural Analysis and Tower Modifications. Services from October 27, 2017 through December 31, 2017.
Amount:
$600.00

Component Description:
Project Management for Structural Analysis and Tower Modifications. Services from January 1, 2018 through January 26, 2018.
Amount:
$450.00
Reimbursement Reviews Information not provided.
RF Consultant Information not provided.
Prepare and File FCC Progress Reports Information not provided.
Building Structural Engineering Information not provided.
Allocation Consulting Information not provided.
Additional Field Engineering Service, 30 Days Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Perform engineering study for new channel assignment and antenna development Information not provided.
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form Information not provided.
RF Exposure Measurements Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $362,698.00 $362,093.00 N/A $0.00 N/A
Total for all systems $4,155,491.00 $2,140,095.00 N/A $181,466.48 N/A
Other Expenses $362,698.00 $362,093.00 $0.00
Temporary Sanitation $3,000.00 $3,000.00 1/8 Shared Cost N/A N/A
Site Access and Transportation $25,000.00 $25,000.00 Cost Allocation to KTVX for site transportation and site access including snow cats, helicopter services, road clearing, snow plowing etc. N/A N/A
Remove and Disposal of Equipment $5,000.00 $5,000.00 Removal and disposal of KTVX Equipment down the mountain. N/A N/A
KSTU Mask Filter $6,725.00 $6,725.00 1/8 Shared Cost N/A N/A
DTV Utah Operating Agreement Equity Equalization $223,083.00 $223,083.00 See Exhibit M. N/A N/A
Accounting $5,800.00 $5,800.00 DTV Utah estimate of KTVX allocation of costs for accounting services for project. N/A N/A
Raod Maintenance $10,000.00 $10,000.00 1/8 Shared Cost N/A N/A
Develop and air announcement of upcoming channel change $3,500.00 $3,500.00 Production costs to develop and air channel change announcement. N/A N/A
Equipment Storage $4,000.00 $4,000.00 DTV Utah estimate of allocated costs to KTVX for equipment storage on site and logistics at base of mountain. etc. N/A N/A
Equipment Delivery and Handling Charges $25,000.00 $25,000.00 Estimate of KTVX specific and Allocation of Costs for delivery of equipment up mountain. N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $27,500.00 $27,500.00 DTV Utah estimate of allocated costs for KTVX - Combiner and other common equipment removal and rigging down mountain. N/A N/A
Non-zoning permits $5,900.00 $5,900.00 KTVX Estimate of Cost Allocation. N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 Catalog N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 Catalog N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 Catalog N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 Catalog N/A N/A
MVPD Notification of Channel Change $5,000.00 $5,000.00 N/A N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $4,155,491.00 $2,140,095.00 $181,466.48

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.

Elizabeth Ryder

General Counsel


08/10/2018

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.

Elizabeth Ryder

General Counsel


08/10/2018

Attachments

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