TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
BD. OF TRUSTEES, CAL. STATE UNIV. FOR SAN DIEGO STATE UNIV. Doing Business As: BD. OF TRUSTEES, CAL. STATE UNIV. FOR SAN DIEGO STATE UNIV.	Leon Messenie 5200 CAMPANILE DRIVE SAN DIEGO, CA 92182 United States	+1 (619) 594-1515	lmessenie@kpbs.org	Government Entity

Applicant

Address

Phone

Applicant Type

BD. OF TRUSTEES, CAL. STATE UNIV. FOR SAN DIEGO STATE UNIV.

Doing Business As: BD. OF TRUSTEES, CAL. STATE UNIV. FOR SAN DIEGO STATE UNIV.

Leon Messenie

5200 CAMPANILE DRIVE

SAN DIEGO, CA 92182

United States

+1 (619) 594-1515

lmessenie@kpbs.org

Government Entity

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 Attachment - "KPBS Repack Project Plan ver2"

Transmitters

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

Primary Transmitter

Add Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Retune Existing
	Use	Primary (Main)
	Ownership	Owned
	Owner	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	ROHDE AND SCHWARZ
	Model	NV8620V
	Year	2010
	Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	20 kW

Primary Transmitter

Retuning Transmitter Costs

Section	Question	Response
New IOT Tubes	Number of Tubes (including accessories) needed	N/A
New Mask Filter
	Power	30 kW
	Other Power	N/A
New Exciter	Is a new exciter needed?	No

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	N/A

Primary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Inside RF System - Interconnection	Inside RF System interconnection components to connect transmitter to mask filter I/O, power monitor, and 4 port switch. Includes 4 port switch with switch controller.
Proof of Performance - Two Exciters	Transmitter Manufacturer to perform a Proof of Performance on the primary transmitter with two exciters operation on CH-19.
Site Layout, Construction drawings, as-builds	Site construction drawings and as builds for the changes needed to the inside of the KPBS transmission facility

Auxiliary Transmitter

Add Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Retune Existing
	Use	Auxiliary (Backup)
	Ownership	Owned
	Owner	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	ROHDE AND SCHWARZ
	Model	NV8610V
	Year	2010
	Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	10 kW

Auxiliary Transmitter

Retuning Transmitter Costs

Section	Question	Response
New IOT Tubes	Number of Tubes (including accessories) needed	N/A
New Mask Filter
	Power	30 kW
	Other Power	N/A
New Exciter	Is a new exciter needed?	No

Auxiliary 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	N/A

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Inside RF System - Interconnection	Inside RF System interconnection components to connect transmitter to mask filter I/O, RF Power Monitor, to 4 port switch.
Proof Of Performance - One Exciter	Transmitter Manufacturer to perform a Proof of Performance on the auxiliary transmitter with one exciter operating on CH-19.

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?	Yes
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:	350.0 kW
	Manufacturer
	Model	TFU-18GTH-R C170SP CH30
	Year	2001

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?	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	Top 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:	285.0 kW
	Manufacturer
	Model	TFU18GTH/VP-R C170SP CH19
	Year	2019
	Justification for New Antenna	The current DTV Antenna cannot be re-tuned from CH30 to CH19. Note: KPBS will be invoiced separately for the vertical component of the antenna. The FCC will not be charged for the vertical component of the new antenna.

Primary Antenna

Other Antenna Costs

Section	Question	Response
Combiner for Shared Antenna	Do you need a Combiner for a Shared Antenna?	No
	Type
	Number of channels supported	N/A
	Frequencies of channels supported	N/A
	Frequency	N/A
	Do you need a combiner output splitter/switcher for dual feed lines?	N/A
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	Yes
	Broadband or Single Channel?	Broadband
	Feed Line Size	3 1/8 inches inches
Side Mount Brackets	Do you require the separate purchase of side mount brackets for a high power antenna?	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

Other Antenna Cost Not Listed

Name	Description
Adapter plate to match tower top	Adapter plate need to mount new antenna to top of tower

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	Purchase New
	Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing transmission line shared with another station or stations?	No
	Is Transmission Line in operating condition?	Yes
Existing Transmission Line Manufacturer and Type	Manufacturer
	Type	Rigid
	Diameter	3 1/8 inches
	Other Diameter	N/A
	Segment Length	19 1/2 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	185 feet per run

Primary Transmission Line

New Transmission Line

Section	Question	Response
New Transmission Line Costs	Use	Primary (Main)
	Description of Use	N/A
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Type	Rigid
	Diameter	3 1/8 inches
	Other Diameter	N/A
	Segment Length	20 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	185 feet per run
	Justification for New Transmission Line	The current transmission line at 19'6" for CH30 is not recommended for use at CH19. 20 foot lengths is recommended

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Name	Description
Dehydrator System	Dehydrator needed to keep transmission line dry current system is limited in capacity and will not be able to keep new line pressurized.

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	Owned
	Is this tower consider Complex?	Candelabra
	Is this tower currently shared with any other stations?	No
	One or more FM, AM or TV radio broadcaster(s)	N/A
	Others Types of Users	N/A
	Is tower documented for structural analysis?	No
	Is tower compliant with Rev G?	Unknown
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1213483
Coordinates (NAD83)	Latitude (NAD83)	32° 41' 52.7" N-
	Longitude (NAD83)	116° 56' 06.3" W-
	Overall Structure Height	214.00 feet
	Support Structure Height	150.00 feet
	Ground Elevation Above Mean Sea Level (AMSL)	2495.00 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	KPBS
	Date Constructed	07/17/2001

Primary Tower

Tower Modification Costs

Section	Question	Response
Engineering Study	Please what type of engineering study is required, if any:	Study needed for tower with candelabra
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	Candelabra
Helicopter Services Required	Are helicopter services required?	No

Primary Tower

Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	260
	Explanation	See Attachment " KPBS Further Justification for Form 399"
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	No
	Quantity	N/A
	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	No
	Quantity	N/A
	NEPA Section 106 environmental review	No
	Environmental Assessment	No
	ASR Modification	Yes
	FAA Consultation (including preparation of FAA Form 7460)	Yes
	Negotiation of Lease and other Matter for Shared Locations	No
	Prepare or Review FCC Form 399 for Reimbursement	Yes
	Address transition timing and coordination issues w/ other stations and wireless providers	Yes
RF Field Engineering Services	Comprehensive coverage verification via field study	Yes
	RF exposure measurements	Yes
	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
Construction Project Management	General Contractor Project Management (moved to Other Expenses by Leon Messenie)
Additional Legal Expenses	Additional legal expenses for University-license public TV station
Quarterly Progress Reports	FCC-required Quarterly Progress Reports
California Inspector	Site Inspection for compliance with California Building Code regulations (see attachment OConnor Proposal FCC399 Outside Professional Services - California Inspector
Project Management Consulting	SDSU Representative to interface between the University and General Contractor. see attachment Barrie Company Proposal FCC399 Outside Professional Services - Project Management Consulting

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	No
	BLM or NFS Coordination	No
	FCC Construction Permit Minor Change	No
	FCC License to Cover Application	No
	FCC Special Temporary Authority Application	No
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

Name	Description
General Contractor Expenses	DRP Construction General Contractor Costs. See attachment July 28_2018 General Contractor Justification and Proposal.
California Sales Tax	California Sales Tax at 7.75 percent on all tangible items
California State University System Charge	Required California State University Fee for Financial fund administration. see July 28_2018 California State University System Charge
Shipping Freight	Shipping Antenna, Mask Filters, and other RF Componets to the WIS Storage Yard

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	$461,307.00	$451,413.00	N/A	$230,523.00	N/A
Total for all systems	$2,029,311.61	$1,748,477.46	N/A	$977,295.58	N/A
Primary Transmitter NV8620V	$264,389.00	$259,442.00		$141,852.00
Site Layout, Construction drawings, as-builds	$8,500.00	$8,500.00	See attached reimbursement packet cover letter. file: 2019MAY04 KPBS Reimbursement Request 011.pdf	$8,200.00	N/A
Inside RF System - Interconnection	$109,489.00	$109,489.00	see attachment 2019MAY04 KPBS Reimbursement Request 011.pdf. Item 3 under "Justification for additional Funds" in cover letter	$99,799.00	N/A
UHF and VHF - minor banding issues	$105,200.00	$99,000.00	N/A	$0.00	N/A
Proof of Performance - Two Exciters	$8,600.00	$8,600.00	N/A	N/A	N/A
30 kW mask filter	$32,600.00	$33,853.00	Adjusted August 15, 2018. See attachment "August 15_2018 WIS-KPBS Repack turnkey proposal with KPBS Breakdown.pdf" for details. Leon Messenie	$33,853.00	N/A
Auxiliary Transmitter NV8610V	$196,918.00	$191,971.00		$88,671.00
Proof Of Performance - One Exciter	$4,300.00	$4,300.00	N/A	N/A	N/A
Inside RF System - Interconnection	$54,818.00	$54,818.00	Adjusted August 15, 2018. See attachment "August 15_2018 WIS-KPBS Repack turnkey proposal with KPBS Breakdown.pdf" for details. $6,368 Dielectric RF Components $48,450 Labor per WIS Proposal (1/2 of the estimated $96,900 labor cost per WIS proposal)	$54,818.00	N/A
30 kW mask filter	$32,600.00	$33,853.00	Adjusted August 15, 2018. See attachment "August 15_2018 WIS-KPBS Repack turnkey proposal with KPBS Breakdown.pdf" for details. Leon Messenie	$33,853.00	N/A
UHF and VHF - minor banding issues	$105,200.00	$99,000.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Site Layout, Construction drawings, as-builds	Component Description: see attached file 2019MAY14 KPBS Reimbursement Request 011.pdf, Item 10 under cover letter "Detail Breakdown" and Item 1 under "Justification for additional funds" Amount: $8,200.00
Inside RF System - Interconnection	Component Description: see attached, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 1 Amount: $20,638.90 Component Description: Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 3, 5, 6, and 1/2 of Line 7. Amount: $54,744.50 Component Description: Ties to DPR Invoice DPRB008964-2 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124BS rev 2. Line 3, 5, and 6. Amount: $24,415.60
UHF and VHF - minor banding issues	Component Description: N/A Amount: N/A
Proof of Performance - Two Exciters	Information not provided.
30 kW mask filter	Component Description: see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" Item 2 Amount: $3,385.30 Component Description: Ties to DPR Invoice DPRB008964-2 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124BS rev 2. Line 1. Amount: $13,541.20 Component Description: Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 1. Amount: $16,926.50
Proof Of Performance - One Exciter	Information not provided.
Inside RF System - Interconnection	Component Description: see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section item 4 Amount: $24,861.80 Component Description: Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 4, and 1/2 of Line 7. Amount: $27,409.00 Component Description: Ties to DPR Invoice DPRB008964-2 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124BS rev 2. Line 4. Amount: $2,547.20 Component Description: N/A Amount: N/A Component Description: N/A Amount: N/A
30 kW mask filter	Component Description: Ties to DPR Invoice DPRB008964-2 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124BS rev 2. Line 2. Amount: $13,541.20 Component Description: see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 3. Amount: $3,385.30 Component Description: Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 2. Amount: $16,926.50
UHF and VHF - minor banding issues	Information not provided.

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	$575,750.00	$581,362.80	N/A	$322,858.00	N/A
Total for all systems	$2,029,311.61	$1,748,477.46	N/A	$977,295.58	N/A
Primary Antenna TFU18GTH/VP-R C170SP CH19	$575,750.00	$581,362.80		$322,858.00
UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized	$247,000.00	$256,186.80	*System Notice: Estimate adjusted and locked because line has been superseded.*Adjusted 6/6/2018 by L. Messenie as a result of the Wireless Infrastructure Service Budgetary Proposal and Wireless Infrastructure Service Invoice 6124AS	$256,186.80	N/A
Adapter plate to match tower top	$23,180.00	$23,180.00	Adjusted 6/6/2018 by L. Messenie as a result of the Wireless Infrastructure Service Budgetary Proposal and Wireless Infrastructure Service Invoice 6124AS	$20,862.00	N/A
Sweep test of existing antenna	$6,730.00	$7,360.00	Adjusted 6/6/2018 by L. Messenie as a result of the Wireless Infrastructure Service Budgetary Proposal and Wireless Infrastructure Service Invoice 6124AS	$7,360.00	N/A
Elbow complex, broadband, at antenna input, per 3 1/8. feedline (if needed)	$9,340.00	$9,984.00	Adjusted August 15, 2018. See attachment "August 15_2018 WIS-KPBS Repack turnkey proposal with KPBS Breakdown.pdf" for details. Leon Messenie	$9,984.00	N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	$289,500.00	$284,652.00	Added by L. Messenie per FCC to show Horizontal and Vertical Polarity. See attachment 2019May14 KPBS Reimbursement Request #011.pdf Exhibit C Detailed Breakdown Line 1 justification. NOTE: KPBS will pay vertical polarity cost separately.	$28,465.20	N/A

Components

Actual Information Description	File Name
UHF - High Power Top Mount (200-1000 kW), One station antenna, horizontally polarized	Component Description: This item was changed by FCC request. The new antenna is Elliptical Polarization. Thus the change to this category in the 399. Amount: N/A Component Description: Ties to DPR Invoice DPRB008964-2 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124BS rev 2. Line 7. Amount: $113,860.80 Component Description: Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 8. Amount: $142,326.00
Adapter plate to match tower top	Component Description: Ties to DPR Invoice DPRB008964-2 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124BS rev 2. Line 9. Amount: $9,272.00 Component Description: Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 11. Amount: $11,590.00
Sweep test of existing antenna	Component Description: see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section item 6 Amount: $3,680.00 Component Description: Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 9. Amount: $3,680.00
Elbow complex, broadband, at antenna input, per 3 1/8. feedline (if needed)	Component Description: see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section item 5 Amount: $998.40 Component Description: Ties to DPR Invoice DPRB008964-2 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124BS rev 2. Line 8. Amount: $3,993.60 Component Description: Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 10. Amount: $4,992.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	Component Description: see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 7 Amount: $28,465.20

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	$24,690.00	$46,005.00	N/A	$28,271.00	N/A
Total for all systems	$2,029,311.61	$1,748,477.46	N/A	$977,295.58	N/A
Primary Transmission Line	$24,690.00	$46,005.00		$28,271.00
Rigid Transmission Line - copper, 3 1/8"	$19,240.00	$40,555.00	Adjusted August 15, 2018. See attachment "August 15_2018 WIS-KPBS Repack turnkey proposal with KPBS Breakdown.pdf" for details. Leon Messenie	$28,271.00	N/A
Dehydrator System	$5,450.00	$5,450.00	Adjusted August 15, 2018. See attachment "August 15_2018 WIS-KPBS Repack turnkey proposal with KPBS Breakdown.pdf" for details. Leon Messenie	N/A	N/A

Components

Actual Information Description	File Name
Rigid Transmission Line - copper, 3 1/8"	Component Description: see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 8 Amount: $2,827.10 Component Description: Ties to DPR Invoice DPRB008964-2 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124BS rev 2. Line 10. Amount: $11,308.40 Component Description: Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 12. Amount: $14,135.50
Dehydrator System	Information not provided.

Actual Information Description

File Name

Rigid Transmission Line - copper, 3 1/8"

Component Description:: see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 8
Amount:: $2,827.10

Component Description:: Ties to DPR Invoice DPRB008964-2 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124BS rev 2. Line 10.
Amount:: $11,308.40

Component Description:: Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 12.
Amount:: $14,135.50

Dehydrator System

Information not provided.

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	$441,000.00	$151,300.00	N/A	$127,820.00	N/A
Total for all systems	$2,029,311.61	$1,748,477.46	N/A	$977,295.58	N/A
Primary Tower TOWER	$441,000.00	$151,300.00		$127,820.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	$421,000.00	$132,300.00	Adjusted 6/6/2018 by L. Messenie as a result of the Wireless Infrastructure Service Budgetary Proposal and Wireless Infrastructure Service Invoice 6124AS	$120,820.00	N/A
Structural engineering tower load study for a documented tower with candelabra	$20,000.00	$19,000.00	N/A	$7,000.00	N/A

Components

Actual Information Description	File Name
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	Component Description: see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 9 Amount: $54,670.00 Component Description: Ties to DPR Invoice DPRB008964-1 Line 9. Back up documentation is from sub-contractor WIS Invoice 6124AS rev 2. Line 13. Amount: $66,150.00
Structural engineering tower load study for a documented tower with candelabra	Component Description: Line 2 Tower Mapping & Line 3 Structural Analysis Amount: $7,000.00

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	$216,420.00	$208,802.05	N/A	$67,891.83	N/A
Total for all systems	$2,029,311.61	$1,748,477.46	N/A	$977,295.58	N/A
Outside Professional Services	$216,420.00	$208,802.05		$67,891.83
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	$2,365.00	$2,250.00	N/A	$895.31	N/A
Additional Legal Expenses	$17,000.00	$17,000.00	12-3-2018 (See attachment "KPBS Additional Legal Fee Justification" for explanation to overage and adjustment request for estimate increase.)	$14,595.59	(See attachment "KPBS Additional Legal Fee Justification" for explanation to overage and adjustment request for estimate increase.)
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	$500.00	N/A
Project Management Consulting	$13,500.00	$13,500.00	Project Management consulting services to interface between San Diego State University and the project General Contractor. Also looks out for SDSU interests during construction projects	$8,775.00	N/A
California Inspector	$5,400.00	$5,400.00	Required by the California State University system to ensure compliance with California Building codes	N/A	N/A
Quarterly Progress Reports	$5,000.00	$5,000.00	Prepare and file FCC-required progress reports for repacked station throughout transition.	$1,167.88	N/A
Construction Project Management	$0.00	$0.00	N/A	N/A	N/A
RF Exposure Measurements	$21,050.00	$20,000.00	N/A	N/A	N/A
Comprehensive coverage verification via field study, if needed	$84,200.00	$80,000.00	N/A	N/A	N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	$2,105.00	$2,000.00	N/A	N/A	N/A
ASR modification (prepare FCC Form 854)	$2,105.00	$2,000.00	N/A	$750.00	N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	$5,260.00	$5,000.00	N/A	$1,169.82	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$1,687.50	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	$1,037.50	N/A
Address transition timing and coordination issues w/ other stations and wireless	$2,630.00	$3,652.05	See attachment 2019APR22 Additional Cost Justification.pdf	$3,652.05	N/A
Prepare and or review reimbursement form	$2,630.00	$2,500.00	N/A	$1,667.43	N/A
Project management of the transition	$41,080.00	$39,000.00	N/A	$31,993.75	N/A

Components

Actual Information Description	File Name
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Component Description: see attachment 2019MAY19 Gray Miller Persh LLP Invoice 30316.pdf for breakdown details Amount: $416.13 Component Description: see attachment 2019APR24 GrayMillerPershPLL Invoice 30147.pdf cover letter for breakdown explanation. Amount: $479.18
Additional Legal Expenses	Component Description: Invoice Lines 1-7; Work on Repack Reimbursement issues. (See attachment "KPBS Additional Legal Fee Justification" for explanation to overage and adjustment request for estimate increase.) Amount: $1,440.45 Component Description: Invoice Line 4 and Line 5: Work on KPBS repack regarding documentation of CSU charges and reimbursement delays Amount: $523.80 Component Description: see attachment 2019MAY19 Gray Miller Persh PLL Invoice 30316.pdf for breakdown details Amount: $373.45 Component Description: Line 1 & 3 - Telephone call with Leon Messenie re repack and Review FCC Public Notice on initial allocation of repack funds Amount: $125.13 Component Description: Line 3,4,5,6,8,9,10,11,13,14 - See invoice for details Amount: $1,131.99 Component Description: Line 1 - Prepare for Telephone call with KPBS team to discuss University procedures and amending the FCC Form 399 Amount: $392.85 Component Description: Lines 1,6, and 7 are misc. legal issues. See attachment 2019APR22 Gray Miller Persh PLL Invoice 29999-REV1.pdf. Amount: $635.35 Component Description: Line 1 - Work on Repack Issue regarding status of reimbursement payments Amount: $87.30 Component Description: Line 1 - Email regarding FCC Auction Close Amount: $43.65 Component Description: see attachment 2019APR24 GrayMillerPershPLL Invoice 30147.pdf cover letter for breakdown explanation. Amount: $891.43 Component Description: Lines 1 of invoice. Email regarding government shutdown and how it relates to the FCC Repack Amount: $43.65 Component Description: Line 1 & 2 Emails regarding Repack Amount: $130.95 Component Description: Invoice Line 2, Line 3, and Line 4: Work on KPBS reimbursement issues regarding delays. Emails with C. Cavell (FCC) and with FCC staff regarding same. Prepare for Telephone call with C. Cavell (FCC) and M. Dowell (EY) Amount: $1,658.70 Component Description: Line 1,3,4,5 - See invoice for details Amount: $331.74 Component Description: Line 2 & 4 - Email regarding tower status and Work on Repack cost reimbursement filings Amount: $439.41 Component Description: Line 2,4,5,7,9,10,11 - See invoice for details Amount: $1,827.48 Component Description: Line 1 - Work on KPBS repack issues regarding University procurement processes. Amount: $87.30 Component Description: Legal services regarding reimbursement and amending the FCC 399 Form Amount: $2,531.70 Component Description: Ties to Lines 1 - Line 10 of invoice 29509 for various legal correspondence, analysis, and repack issues involving coordination with other linked stations. Amount: $1,899.26
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Component Description: see attachment 2019MAY19 Cheasapeake RF Consultants LLC Invoice 4982.pdf foe detail breakdown Amount: $500.00
Project Management Consulting	Component Description: Processing General Contractor Agreement and Billings. Review documents for compliance with SDSU agreement. Work performed by S. Lantz of The Barrie Company for the billing period of June 2018 Amount: $1,350.00 Component Description: Processing General Contractor Agreement and Billings. Review documents for compliance with SDSU agreement. Work performed by S. Lantz of The Barrie Company for the billing period of Sept 2018 Amount: $3,780.00 Component Description: Processing General Contractor Agreement and Billing, Review and confirm contract compliance with SDSU agreement Amount: $3,240.00 Component Description: Processing General Contractor Agreement and Billings. Review documents for compliance with SDSU agreement. Work performed by S. Lantz of The Barrie Company for the billing period of October 2018 Amount: $405.00
California Inspector	Information not provided.
Quarterly Progress Reports	Component Description: see attachment 2019APR24 GrayMillerPershPLL Invoice 30147.pdf cover letter for breakdown explanation. Amount: $174.60 Component Description: Line 2 - Work on Quarterly Progress Report for repack and review with Leon Messenie of KPBS Amount: $392.85 Component Description: Line 2 - Email Reminder of Quarterly Transition Progress Report due Jan 10, 2018 Amount: $43.65 Component Description: Invoice Line 1: Reminder about quarterly repack transition report due July 10,2018 Amount: $43.65 Component Description: Line 2 - Analysis and review re repack transition quarterly progress report deadline and submission status for KPBS-TV Amount: $37.83 Component Description: Line 2 of invoice 29322 Email reminder of quarterly progress report due Amount: $43.65 Component Description: Line 1 - Email regarding 2017 Third Quarter Progress Report Amount: $43.65 Component Description: Line 2, 4, 7 of invoice 29817. see invoice for item details Amount: $388.00
Construction Project Management	Information not provided.
RF Exposure Measurements	Information not provided.
Comprehensive coverage verification via field study, if needed	Information not provided.
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase	Information not provided.
ASR modification (prepare FCC Form 854)	Component Description: Line 2 - Prepare and Submit FAA Notification regarding Tower Height Change Amount: $375.00 Component Description: Creation, Review, and filing of FAA 7460-1 ASR form by J. Davis Amount: $375.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Component Description: Line 1,3,6,12 - see invoice for details Amount: $439.41 Component Description: Line 1,2,7,12 - See invoice for details Amount: $453.96 Component Description: Line 1 - Prepare FCC Minor Change application Amount: $189.15 Component Description: see attachment 2019APR24 GrayMillerPershPLL Invoice 30147.pdf cover letter for breakdown explanation. Amount: $87.30
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: Line Item 2 - Develop ERP and parameters for initial CP application Amount: $1,687.50
Perform engineering study for new channel assignment and antenna development	Component Description: Various discussions regarding implementation of repack to ch-19 Amount: $262.50 Component Description: Discussions regarding the amount of BeamTilt on the new CH19 antenna Amount: $250.00 Component Description: Line Item 1 - Channel Assignment Review Amount: $525.00
Address transition timing and coordination issues w/ other stations and wireless	Component Description: Line 3, 5, 6 of invoice 29817. See invoice for item details Amount: $218.25 Component Description: Line 2 - issues regarding timing of notifications to MVPD's Amount: $43.65 Component Description: Line 3, 4, 5 of invoice 29322. Work on KPBS issues regarding coordination of Phase 2 transition dates with other stations Amount: $349.20 Component Description: Ties to Line 1, 2, 3, 4, 5 of invoice 29639. Various work on repack coordination with other stations, consumer education requirements, and some timing issues with MVPD notification Amount: $974.85 Component Description: Lines 2,3,4,5,8. See attachment 2019APR22 Gray Miller Persh PLL Invoice 29999-REV1.pdf. With this submission KPBS is requesting the upwards adjustment of $1152.05 to cover the additional costs. See attachment 2019APR22 Additional Cost Justification.pdf Amount: $2,066.10
Prepare and or review reimbursement form	Component Description: Invoice Line 1 through Line 4: Work on the KPBS repack reimbursement issues regarding submission and processing of payments Amount: $916.65 Component Description: Line 3 - Telephone call re FCC Post auction Repack and 1876 Form Amount: $113.49 Component Description: Line 2 - Review 1876 form and channel assignment Amount: $87.30 Component Description: Line 8 - Review and correspondence re 1876 form Amount: $113.49 Component Description: Invoice Line 2 and Line 3; Work on KPBS repack reimbursement issues, email to FCC staff (P.Gallant) regarding reimbursement issues. Amount: $436.50
Project management of the transition	Component Description: see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 11 Amount: $27,843.75 Component Description: Line 1 Project Management & Engineering Amount: $4,150.00

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	$310,144.61	$309,594.61	N/A	$199,931.75	N/A
Total for all systems	$2,029,311.61	$1,748,477.46	N/A	$977,295.58	N/A
Other Expenses	$310,144.61	$309,594.61		$199,931.75
Shipping Freight	$16,000.00	$16,000.00	Estimate Freight cost from Dielectric to deliver antenna, mask filters, transmission line and support items to tower rigger storage yard.	N/A	N/A
California State University System Charge	$20,302.83	$20,302.83	California State University required fee for project fund financial administration. (see attachment July 28_2018 California State University System Charge)	N/A	N/A
California Sales Tax	$33,016.78	$33,016.78	N/A	N/A	N/A
General Contractor Expenses	$187,935.00	$187,935.00	General Contractor costs per DPR Construction Executive Summary. Does not include Contingency or RF Sitework. (see attachment July 28, 2018 General Contractor Justification and Proposal)	$168,811.09	N/A
MVPD Notification of Channel Change	$1,845.00	$1,845.00	Cost was more than originally estimated. Price adjusted per FCC email.	$1,845.00	The original estimate cost used for the 399 form was low. This is the current going price for notifying MVPD facilities.
Develop and air announcement of upcoming channel change	$2,545.00	$2,545.00	Please see attached KPBS Rate Card, KPBS Production Estimate, and Calculation Document	N/A	N/A
Equipment Delivery and Handling Charges	$17,450.00	$17,450.00	see attached file, 2019MAY04 KPBS Reimbursement Request 011.pdf. Reference cover letter "Justification for Additional Funds" section Item 2	$17,450.00	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$12,000.00	$12,000.00	N/A	N/A	N/A
DTV Medical Facility Notification	$11,550.00	$11,000.00	N/A	$4,825.66	N/A
Equipment Storage	$7,500.00	$7,500.00	N/A	$7,000.00	N/A

Components

Actual Information Description	File Name
Shipping Freight	Information not provided.
California State University System Charge	Information not provided.
California Sales Tax	Information not provided.
General Contractor Expenses	Component Description: Ties to Lines 1, 2, 3, 4, 5, 6, 7, 8, 11 Amount: $55,803.15 Component Description: Ties to DPR Invoice DPRB008964-1 Lines 1, 2, 3, 4, 5, 6, 7, 8, 10 Amount: $15,122.00 Component Description: Ties to DPR Invoice DPRB008964-2 Line 1, 2, 3, 4, 5, 6, 7, 8, 10 Amount: $8,328.00 Component Description: (Corrected to show cents) Ties to DPR Invoice DPRB009919-3 Lines 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 Amount: $89,557.94
MVPD Notification of Channel Change	Component Description: (New Attachment has Invoice and Estimate per FCC Request) MVPD Notification Service for KPBS Amount: $1,845.00
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Delivery and Handling Charges	Component Description: see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 13. Amount: $17,450.00
Disposal Costs (for equipment and other waste, net of any salvage value)	Information not provided.
DTV Medical Facility Notification	Component Description: see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 12 Amount: $4,750.00 Component Description: Invoice Line 1: Analysis, review and respond to correspondence re KPBS Post-incentive auction spectrum repack facility channel change modifications, health care facility notifications, and online inspection file posting requirements. Amount: $75.66
Equipment Storage	Component Description: see attached file, 2019MAY14 KPBS Reimbursement Request 011.pdf. Reference cover letter "Detail Breakdown" section Item 14 Amount: $7,000.00

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$2,029,311.61	$1,748,477.46	$977,295.58

Reimbursement Status

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

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.	Leon Messenie Director of Engineering, KPBS 05/19/2019

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.

Leon Messenie

Director of Engineering, KPBS

05/19/2019

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.	Leon Messenie Director of Engineering, KPBS 05/19/2019

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.

Leon Messenie

Director of Engineering, KPBS

05/19/2019

(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

Add Transmitter Information

Primary Transmitter

Retuning Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Auxiliary Transmitter

Add Transmitter Information

Auxiliary Transmitter

Retuning Transmitter Costs

Auxiliary Transmitter

Other Transmitter Costs

Auxiliary 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

Transmission Line

Primary Transmission Line

Existing Transmission Line

Primary Transmission Line

New Transmission Line

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Tower Equipment And Rigging Costs

Primary Tower

Existing Tower

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