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:
166331
Service:
DTV
Call Sign:
KVSN-DT
Channel:
27 (UHF)
File Number:
0000028340
FRN:
0001529627
Date Submitted:
09/23/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

ENTRAVISION HOLDINGS, LLC

Doing Business As: ENTRAVISION HOLDINGS, LLC

Mark Boelke

SUITE 6000 WEST

2425 OLYMPIC BOULEVARD

SANTA MONICA, CA 90404

United States

+1 (310) 447-3870 mboelke@entravision.com Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Samuel Hariton

Widelity

4031 University Dr

Suite 100

Fairfax, VA 22030

United States

+1 (339) 222-8107 sam.hariton@widelity.com

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan The plan is for KVSN to replace the existing Channel 48 system with a new Channel 25 antenna, new 6-1/8" line, and a new transmitter.

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 Visionary-DT
Year 2007
Type Inductive Output Tube
IOT Power Type Single
Power Capacity 15 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-24
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 16.1 kW
Justification for New Transmitter New transmitter is necessary because the existing transmitter is not capable of being retuned as the manufacturer is out of business and parts are no longer available. Capacity adjusted for high altitude

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) Yes
Power 150 kVA
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service Yes
Description The new main transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, KVSN-DT estimated the electrical work cost.
HVAC Service Does the replacement transmitter require HVAC Service? Yes
Type Heating and Cooling
Size 10 tons
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? 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

Information not provided.

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 UAX1kW
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1 kW
Justification for New Transmitter Because KVSN is intending to install the new antenna at the same height and on the same side of the tower as the existing antenna is installed, KVSN will need to install an interim antenna/line/transmitter on a less-optimal side of the tower temporarily

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) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service Yes
Description The new interim transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, K50LZ estimated the electrical work cost.
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? Yes
Size 128.0 square feet
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A
Inside RF System Is an additional interior RF system required to support this interim transmitter? No

Interim Transmitter

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Other Transmitter Cost Not Listed

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 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 ATW25H4-HTC170-48H
Year 2007

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting 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: 232.0 kW
Manufacturer
Model TFU-16ETT/VP-R C170
Year 2017
Justification for New Antenna A new antenna is necessary because the existing antenna cannot be retuned to the new channel and is not capable of broadcasting on channel 25.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 4 1/16 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

Information not provided.

Interim Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Interim
Description of Use N/A
Change Type Purchase New
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Type Class Class A
Mounting Side 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: 222.0 kW
Manufacturer
Model TFU-8WB-1-R C160
Year 2017
Justification for New Antenna Because KVSN is intending to install the new antenna at the same height and on the same side of the tower as the existing antenna is installed, KVSN will need to install an interim antenna/line/transmitter on a less-optimal side of the tower temporarily.

Interim Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Broadband or Single Channel? N/A
Feed Line Size N/A
Side Mount Brackets Do you require the separate purchase of side mount brackets for an antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? No

Interim Antenna

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Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Owned
Owner N/A
Site N/A
Is the existing transmission line shared with another station or stations? No
Is Transmission Line in operating condition? Yes
Existing Transmission Line Manufacturer and Type Manufacturer
Type 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 312 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Rigid
Diameter 4 1/16 inches
Other Diameter N/A
Segment Length 19 1/2 inches
Other Segment Length N/A
Number of parallel runs 1
Length 312 feet per run
Justification for New Transmission Line KVSN's previous transmission line is not capable of operating on the new channel as the segment lengths are the wrong size. A new transmission line will need to be installed in order to support the new channel.

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Interim
Description of Use N/A
Change Type Purchase New
Type Flexible Air
Diameter 1 5/8 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 312 feet per run
Justification for New Transmission Line Because KVSN is intending to install the new antenna at the same height and on the same side of the tower as the existing antenna is installed, KVSN will need to install an interim antenna/line/transmitter on a less-optimal side of the tower temporarily

Interim Transmission Line

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Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? Terrain Constrained
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? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1257453
Coordinates (NAD83) Latitude (NAD83) 38° 44' 41.9" N-
Longitude (NAD83) 104° 51' 39.4" W-
Overall Structure Height 296.91 feet
Support Structure Height 250.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 9386.04 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner CHEYENNE PROPAGATION
Date Constructed 07/02/2008


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 undocumented/poorly documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: Serious 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

Name Description

Structural Analysis

Broadcast Tower Structural Analysis

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 712
Explanation KVSN-DT does not have sufficient resource capacity and expertise inhouse to handle all of the reimbursement filing by the construction deadline for Phase 8 on March 13, 2020. KVSN-DT will hire an outside firm to ensure a timely and well managed transition
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review Yes
Environmental Assessment Yes
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements Yes
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change No
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? No
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

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $1,164,626.05 $745,016.89 N/A $255,576.05 N/A
Total for all systems $3,456,070.00 $2,642,042.82 N/A $720,624.25 N/A
Interim Transmitter UAX1kW $135,500.00 $129,500.00 $0.00
Other -- Building Addition Size: 128.0 $6,000.00 $6,000.00 N/A N/A N/A
Other Electrical Service: The new interim transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, K50LZ estimated the electrical work cost. $3,500.00 $3,500.00 See quote from Encore Electric N/A N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $126,000.00 $120,000.00 N/A N/A N/A
Primary Transmitter ULXTE-24 $1,029,126.05 $615,516.89 $255,576.05
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW $684,000.00 $293,859.77 Remainder of transmitter budget (minus superseded category) per GatesAir Quote Q-74089 and GatesAir Change Order Q-78728 + tax (includes $3322.47 reimbursed under this category for the transformer) $0.00 N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $5,081.07 Please see GatesAir Quote Q-74089 and GatesAir Change Order Q-78728 (includes tax and freight) Decreased by $3,322.47 previously reimbursed under the superseded transmitter category. N/A N/A
Other Electrical Service: The new main transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, KVSN-DT estimated the electrical work cost. $3,500.00 $3,500.00 See quote from Encore Electric N/A N/A
10 Ton system $60,500.00 $57,500.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 15.6 kW $255,576.05 $255,576.05 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $255,576.05 N/A

Components

Actual Information Description File Name
Other -- Building Addition Size: 128.0 Information not provided.
Other Electrical Service: The new interim transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, K50LZ estimated the electrical work cost. Information not provided.
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW Information not provided.
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW Information not provided.
Transformer 3 phase/480v - 150 KVA Information not provided.
Other Electrical Service: The new main transmitter will require reconfiguration of the electrical service on site. Based on verbal guidance from local electrical contractors, KVSN-DT estimated the electrical work cost. Information not provided.
10 Ton system Information not provided.
UHF - Air Cooled Solid State Transmitter 15.6 kW

Component Description:
New 1st Primary Transmitter
Amount:
$255,576.05

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 $485,800.00 $394,871.24 N/A $166,401.34 N/A
Total for all systems $3,456,070.00 $2,642,042.82 N/A $720,624.25 N/A
Interim Antenna TFU-8WB-1-R C160 $180,000.00 $180,000.00 $0.00
UHF - Lower Power, Side Mount, Class A, basic slot antenna, 222 kW input, directional,, horizontally polarized $180,000.00 $180,000.00 N/A N/A N/A
Primary Antenna TFU-16ETT/VP-R C170 $305,800.00 $214,871.24 $166,401.34
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $196,816.24 Please see Estimated Cost Justification KVSN-210-New Primary Antenna v0 $159,151.84 N/A
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed) $9,570.00 $8,055.00 N/A $7,249.50 N/A
Sweep test of existing antenna $6,730.00 $10,000.00 See quote from Chuck Britt N/A N/A

Components

Actual Information Description File Name
UHF - Lower Power, Side Mount, Class A, basic slot antenna, 222 kW input, directional,, horizontally polarized Information not provided.
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
KVSN-210-New Primary Antenna
Amount:
$10,972.24

Component Description:
UHF - High/Medium Power Top Mount; Other VPOL components; Other wedding cake adapter for top mount antenna; Other elbow complex kit; Rigid transmission line - copper; Rigid transmission line; etc.
Amount:
$74,089.80

Component Description:
UHF - High/ Medium Power Top
Amount:
$74,089.80
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)

Component Description:
Primary Antenna Elbow Complex
Amount:
$3,624.75

Component Description:
KVSN Elbow Complex New Primary Antenna
Amount:
$3,624.75
Sweep test of existing antenna Information not provided.

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $54,600.00 $55,467.86 N/A $41,490.58 N/A
Total for all systems $3,456,070.00 $2,642,042.82 N/A $720,624.25 N/A
Interim Transmission Line $10,296.00 $9,672.00 $0.00
Flexible Air Transmission Line - dielectric, 1 5/8" $10,296.00 $9,672.00 N/A N/A N/A
Primary Transmission Line $44,304.00 $45,795.86 $41,490.58
Rigid Transmission Line - copper, 4 1/16" $44,304.00 $45,795.86 Please see Estimated Cost Justification KVSN-310-New Primary Transmission Line v0 $41,490.58 N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 1 5/8" Information not provided.
Rigid Transmission Line - copper, 4 1/16"

Component Description:
Primary Transmission Line
Amount:
$19,373.76

Component Description:
KVSN-310-New Primary Transmission Line
Amount:
$2,743.06

Component Description:
KVSN Primary Transmission Line
Amount:
$19,373.76

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 $1,501,207.95 $1,207,371.83 N/A $189,021.83 N/A
Total for all systems $3,456,070.00 $2,642,042.82 N/A $720,624.25 N/A
Primary Tower TOWER $1,501,207.95 $1,207,371.83 $189,021.83
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $400,000.00 N/A $89,075.00 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $10,463.88 see Estimated Cost Justification KVSN-410-Tower Mapping Existing Primary Tower v0 $10,463.88 .
Serious tower reinforcement/modifications $1,052,000.00 $795,000.00 N/A $87,575.00 N/A
Structural Analysis $1,907.95 $1,907.95 Broadcast Tower Structural Analysis $1,907.95 N/A

Components

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

Component Description:
Freight for antenna and transmission line components and equipment.
Amount:
$89,075.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
For site survey performed at KVSN on Cheyenne Mt Colorado Springs, Facility #166331 between 3 and 5 Oct 2018.
Amount:
$1,385.38

Component Description:
Tower mapping and prep of documentation necessary for tower load study
Amount:
$9,078.50
Serious tower reinforcement/modifications

Component Description:
Per Proposal#061917JS10, 50% due upon acceptance. Total contract price: $175,150.00
Amount:
$87,575.00
Structural Analysis

Component Description:
Broadcast Tower Structural Analysis
Amount:
$1,907.95

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 $189,506.00 $179,550.00 N/A $68,134.45 N/A
Total for all systems $3,456,070.00 $2,642,042.82 N/A $720,624.25 N/A
Outside Professional Services $189,506.00 $179,550.00 $68,134.45
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $250.00 N/A
RF Exposure Measurements $21,050.00 $20,000.00 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 N/A N/A
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $10,000.00 N/A N/A N/A
NEPA Section 106 environmental review, if needed $6,310.00 $6,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $4,000.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $2,875.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $2,437.50 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A N/A N/A
Project management of the transition $112,496.00 $106,800.00 N/A $62,571.95 N/A

Components

Actual Information Description File Name
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepare technical portion of fCC Form 2100, License to Cover App.
Amount:
$250.00
RF Exposure Measurements 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) Information not provided.
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet Information not provided.
NEPA Section 106 environmental review, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization 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.
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

Component Description:
Preparation of the engineering section of FCC From 2100
Amount:
$2,000.00

Component Description:
Preparation of the engineering section of FCC From 2100
Amount:
$875.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Prep of the engineering section of a 1st Priority Window Application to move from channel 25 to channel 27
Amount:
$2,000.00

Component Description:
Engineering study work for new channel assignment including antenna development
Amount:
$437.50
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form Information not provided.
Project management of the transition

Component Description:
Project Management
Amount:
$1,815.05

Component Description:
Project management
Amount:
$1,610.85

Component Description:
Project Management
Amount:
$2,302.55

Component Description:
Project Management
Amount:
$3,540.40

Component Description:
Project Management
Amount:
$3,780.65

Component Description:
Project Management
Amount:
$2,575.45

Component Description:
Project Management
Amount:
$3,091.65

Component Description:
Project Management
Amount:
$1,763.45

Component Description:
Project Management
Amount:
$3,130.75

Component Description:
Project management
Amount:
$1,053.15

Component Description:
Project Management
Amount:
$1,482.40

Component Description:
Project management
Amount:
$148.20

Component Description:
Project Management
Amount:
$2,231.60

Component Description:
Project management
Amount:
$2,091.70

Component Description:
Project Management
Amount:
$2,734.10

Component Description:
Project Management
Amount:
$1,653.00

Component Description:
Project Management
Amount:
$2,540.60

Component Description:
Project management
Amount:
$778.60

Component Description:
Project managment
Amount:
$1,193.70

Component Description:
Project management
Amount:
$2,286.95

Component Description:
Project Management
Amount:
$1,989.85

Component Description:
Project Management
Amount:
$2,472.95

Component Description:
Project Management
Amount:
$1,836.10

Component Description:
Project Management
Amount:
$1,637.85

Component Description:
Project Management
Amount:
$3,768.75

Component Description:
Project Management
Amount:
$2,190.75

Component Description:
Project Management
Amount:
$2,346.90

Component Description:
Project Management
Amount:
$2,814.90

Component Description:
Project Management
Amount:
$1,709.10

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 $60,330.00 $59,765.00 N/A $0.00 N/A
Total for all systems $3,456,070.00 $2,642,042.82 N/A $720,624.25 N/A
Other Expenses $60,330.00 $59,765.00 $0.00
MVPD Notification of Channel Change $750.00 $750.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $15,000.00 $15,000.00 N/A N/A N/A
Equipment Storage $15,000.00 $15,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $10,000.00 $10,000.00 N/A N/A N/A
Non-zoning permits $2,500.00 $2,500.00 N/A N/A N/A
Local Zoning $5,000.00 $5,000.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 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 $3,456,070.00 $2,642,042.82 $720,624.25

Reimbursement Status

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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. 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.

Manuel Cavazos , III .

EVP - Director of Technology


09/23/2019

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.

Manuel Cavazos , III .

EVP - Director of Technology


09/23/2019

Certification

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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.

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

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

  3. 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.

  4. 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.

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

  6. 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.

Manuel Cavazos , III .

EVP - Director of Engineering


09/23/2019

Attachments

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