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:
24508
Service:
DTV
Call Sign:
KHSL-TV
Channel:
36 (UHF)
File Number:
0000027715
FRN:
0024763286
Date Submitted:
10/10/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

CALIFORNIA TV LICENSE COMPANY, LLC

3282 NORTHSIDE PARKWAY

SUITE 275

ATLANTA, GA 30327

United States

+1 (470) 355-1944 jburgett@wileyrein.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

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan Install new primary transmitter and interim side-mount antenna/line for temporary operation on repack channel 36 while install new primary side-mount antenna/line for permanent repack channel 36 operations. Maintain interim antenna as backup.

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 NV7500E
Year 2005
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power Capacity 6.5 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model ULXTE12
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 8.5 kW
Justification for New Transmitter Current transmitter cannot be re-channeled to meet repack channel assignment and is no longer supported by manufacturer.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 3 inches
Length 60.0 feet
Other Electrical Service Yes
Description Installation of electrical services
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 120.0 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

Primary 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 Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 235.0 kW
Manufacturer
Model JA/MS-16SHBP
Year 2005

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? Yes
Ownership Owned
Owner N/A
Is antenna shared? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 205.0 kW
Manufacturer
Model ATW16H4-ESPX-36H
Year 2017
Justification for New Antenna Current antenna cannot be re-tuned for use on repack channel.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 6 1/8 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? Yes
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

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? No
New Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 120.0 kW
Manufacturer
Model ALP16L4-HSPX-36
Year 2017
Justification for New Antenna Interim antenna and transmission line needed to maintain on-air service while new primary antenna and transmission line installed.

Interim Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? S
Feed Line Size 3 1/8 inches
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? Yes
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

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 480 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 6 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 520 feet per run
Justification for New Transmission Line New transmission line required for installation of new primary antenna.

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 3 inches
Segment Length N/A
Other Segment Length
Number of parallel runs 1
Length 400 feet per run
Justification for New Transmission Line Interim antenna and transmission line needed to maintain on-air service while new primary antenna and transmission line installed.

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 Move Equipment
Tower Use Primary (Main)
Description of Use N/A
Ownership Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users Yes
Is tower documented for structural analysis? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1258123
Coordinates (NAD83) Latitude (NAD83) 39° 57' 28.6" N-
Longitude (NAD83) 121° 42' 52.9" W-
Overall Structure Height 499.99 feet
Support Structure Height 497.04 feet
Ground Elevation Above Mean Sea Level (AMSL) 3495.04 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner California TV, LLC
Date Constructed 06/18/2008

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

Facility ID Call Sign Service
22974 KHSL-FM FM

Other Types of Users

Users
Paging Service
K18IS-D

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower N/A
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 595
Explanation KHSL does not have sufficient resource capacity and expertise in house to handle all of the reimbursement filing by the construction deadline for Phase 1. KHSL 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 2
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations 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 No
RF exposure measurements No
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 No
Non-zoning permits No
BLM or NFS Coordination No
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? No
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

Attorney Fees and Other Matters

Attorney Fees and Other Matters

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 $502,420.00 $477,740.00 N/A $318,829.72 N/A
Total for all systems $1,766,483.75 $1,407,963.69 N/A $1,052,777.03 N/A
Primary Transmitter ULXTE12 $502,420.00 $477,740.00 $318,829.72
3" Rigid Conduit and Wiring (Cost per foot) $3,120.00 $2,940.00 3"x20' metal conduit, 4 x Long metal sweeps, and 180' #4 Wire. N/A N/A
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $494,500.00 $470,000.00 N/A $318,473.55 N/A
Other -- Building Addition Size: 120.0 $1,800.00 $1,800.00 10'x12' Concrete pad for Transmitter Heat exchanger and transformers. N/A N/A
Other Electrical Service: Installation of electrical services $3,000.00 $3,000.00 Installation of electrical services $356.17 N/A

Components

Actual Information Description File Name
3" Rigid Conduit and Wiring (Cost per foot) Information not provided.
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW

Component Description:
KHSL Primary Transmitter. Request does not include estimated costs for shipping and taxes which will be requested with a separate invoice when these expenses are incurred.
Amount:
$318,473.55
Other -- Building Addition Size: 120.0 Information not provided.
Other Electrical Service: Installation of electrical services

Component Description:
3 hole corner plate
Amount:
$16.95

Component Description:
CU 8 ea THHN White, Red, Black, Blue
Amount:
$70.45

Component Description:
1-3/4" Holesaw w advance edge conduit size 1-1/4" internal
Amount:
$146.25

Component Description:
1" SS EMT Coupling, 1" Pull ELL
Amount:
$122.52

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 $874,980.00 $398,411.01 N/A $322,437.76 N/A
Total for all systems $1,766,483.75 $1,407,963.69 N/A $1,052,777.03 N/A
Interim Antenna ALP16L4-HSPX-36 $221,540.00 $107,555.00 $56,741.75
Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed) $7,600.00 $7,400.00 N/A $0.00 N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized $89,400.00 $49,732.47 Total cost of Interim Antenna ALP16L-HSPX-36 is $66,755.00 (per ERI proposal 20171011-935 Rev A). $17,022.53 has already been forwarded for payment on the superseded Interim Antenna Cost Category, which leaves a remainder of $49,732.47. $39,719.22 Per Proposal #20171011-935 for KHSL-003
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 N/A $0.00 N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 N/A $0.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $0.00 N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized $89,400.00 $17,022.53 ***System Notice: Estimate adjusted and locked because line has been superseded.*** $17,022.53 12/12/18 DO NOT UPLOAD INVOICES TO THIS COMPONENT. PLEASE USE NEW ANTENNA SECTION. Total cost of Interim Antenna ALP16L-HSPX-36 is $56,741.75. Form 399 system has split estimate into two separate line items, which when combined equal $56,741.75.
Primary Antenna ATW16H4-ESPX-36H $653,440.00 $290,856.01 $265,696.01
UHF - Lower Power Side Mount, One station antenna -- 200-500 kW, elliptically or circularly polarized $227,000.00 $129,506.01 See ERI quote 20171013-965. Partial reimbursement has already occurred for this antenna. Estimated cost deducts prior reimbursement of $116,250 and adds taxes + freight per ERI invoice KHSL-003 $129,146.01 x
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,250.00 N/A
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) $12,300.00 $11,700.00 N/A $0.00 N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 N/A $14,050.00 N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $5,000.00 N/A $0.00 N/A
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized $189,500.00 $58,125.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***Estimated Cost includes tax and freight expenses totaling $51,646.01 for primary and auxiliary antennas. See Attachment "KHSL - ERI Invoice KHSL-003, Cover Letter, Explanation of Variance and Quotes (submitted 10.16.18).pdf." $58,125.00 12/12/18 DO NOT UPLOAD INVOICES TO THIS COMPONENT. PLEASE USE NEW ANTENNA SECTION. Invoice KHSL-003 includes total sales tax and freight charges for all equipment provided by ERI and identified on invoice.
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized $189,500.00 $58,125.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***See attached "Invoice - KHSL-001 (revised 2.28.18), Cover Letter and Explanation of Variance." Also see attachment "KHSL - ERI Primary Antenna Quote #20171013-965." $58,125.00 12/12/18 PLEASE DO NOT UPLOAD NEW INVOICES HERE.

Components

Actual Information Description File Name
Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed) Information not provided.
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized

Component Description:
Antenna Equipment and Installation Services
Amount:
$17,022.52

Component Description:
10% of total for Interim Antenna, Primary Antenna, Installation Services - Primary and Interim
Amount:
$5,674.17

Component Description:
Interim Antenna (ALP16L4-HSPX-36). Initial 30% payment.
Amount:
$17,022.53
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Sweep test of existing antenna

Component Description:
Sweep test - primary antenna
Amount:
$1,875.00

Component Description:
Sweep test for interim antenna not included on invoice.
Amount:
N/A
UHF - Lower Power Side Mount, One station antenna - medium power (50-200 kW), horizontally polarized

Component Description:
PLEASE MARK THIS INVOICE AS DENIED // Interim Antenna (ALP16L4-HSPX-36). Third 30% payment.
Amount:
N/A

Component Description:
Interim Antenna (ALP16L4-HSPX-36). Second 30% payment.
Amount:
$17,022.53
UHF - Lower Power Side Mount, One station antenna -- 200-500 kW, elliptically or circularly polarized

Component Description:
UHF Lower Power Side Mount, E-POL
Amount:
$109,771.01

Component Description:
1st Primary Antenna - UHF Lower Power Side Mount, E-POL
Amount:
$19,375.00
Sweep test of existing antenna

Component Description:
Primary Antenna - System Sweep test. Third 30% payment.
Amount:
$1,875.00

Component Description:
1st Primary Antenna - Sweep Test
Amount:
$625.00

Component Description:
Primary Antenna - System Sweep test. Initial 30% payment.
Amount:
$1,875.00

Component Description:
Primary Antenna - System Sweep test. Second 30% payment.
Amount:
$1,875.00
Elbow complex, single channel, at antenna input, per 6 1/8. feedline (if needed) Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
Primary Antenna - Side Mount Brackets. Third 30% payment.
Amount:
$4,215.00

Component Description:
1st Primary Antenna - Side Mount Brackets
Amount:
$1,405.00

Component Description:
Primary Antenna - Side Mount Brackets. Initial 30% payment.
Amount:
$4,215.00

Component Description:
Primary Antenna - Side Mount Brackets. Second 30% payment.
Amount:
$4,215.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized

Component Description:
Primary Antenna ATW16H4-HSPX-36H (H-pol pricing). Second 30% payment.
Amount:
$58,125.00

Component Description:
12/12/18 Please mark this invoice as DENIED
Amount:
N/A
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized

Component Description:
Primary Antenna ATW16H4-HSPX-36H (H-pol pricing). Initial 30% payment.
Amount:
$58,125.00

Cost Information

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Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $128,640.00 $140,012.86 N/A $127,178.73 N/A
Total for all systems $1,766,483.75 $1,407,963.69 N/A $1,052,777.03 N/A
Interim Transmission Line $23,600.00 $28,293.55 $21,679.39
Flexible Air Transmission Line - dielectric, 3" $23,600.00 $28,293.55 Per ERI proposal 20171011-935 Rev A, 500' of 3" Heliax line with associated connectors and hanging hardware. $21,679.39 N/A
Primary Transmission Line $105,040.00 $111,719.31 $105,499.34
Rigid Transmission Line - copper, 6 1/8" $105,040.00 $111,719.31 see Estimated Cost Justification KHSL-310-Primary Transmission Line - Rigid Copper v0 $105,499.34 N/A

Components

Actual Information Description File Name
Flexible Air Transmission Line - dielectric, 3"

Component Description:
Interim Antenna - Flexible Air Transmission Line. Third 30% payment.
Amount:
$6,423.23

Component Description:
Interim Transmission Line, 3" Flexible Air Dielectric
Amount:
$2,141.07

Component Description:
Interim Antenna - Flexible Air Transmission Line. Initial 30% payment.
Amount:
$6,423.23

Component Description:
Interim Antenna - Flexible Air Transmission Line. Second 30% payment.
Amount:
$6,423.23

Component Description:
Hanger Kit 3" Coaxial
Amount:
$268.63
Rigid Transmission Line - copper, 6 1/8"

Component Description:
Primary Antenna - Rigid Transmission Line (Copper 6-1/8"). Third 30% payment.
Amount:
$28,073.92

Component Description:
Primary Transmission Line - Rigid Copper, 6 1/8"
Amount:
$9,357.97

Component Description:
Primary Antenna - Rigid Transmission Line (Copper 6-1/8"). Second 30% payment.
Amount:
$28,073.92

Component Description:
Primary Antenna - Rigid Transmission Line (Copper 6-1/8"). Initial 30% payment.
Amount:
$28,073.92

Component Description:
MACXLINE 6 1/8 50 OHM CUSTOM SECTION 45.2
Amount:
$11,919.61

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 $84,200.00 $203,032.32 N/A $203,032.32 N/A
Total for all systems $1,766,483.75 $1,407,963.69 N/A $1,052,777.03 N/A
Primary Tower TOWER $84,200.00 $203,032.32 $203,032.32
Short Tower (less than 500') $84,200.00 $203,032.32 ERI proposals 20180718-730 & 20171013-965 and taxes on ERI invoice 11/7/2018. See attachment "Invoice - KHSL-001, Cover Letter, Explanation of Variance and Quotes (submitted 4.25.2018).pdf." $203,032.32 Installation cost is for both Interim and Primary antennas.

Components

Actual Information Description File Name
Short Tower (less than 500')

Component Description:
Primary and Interim Antenna systems installation. Third 30% payment.
Amount:
$51,420.00

Component Description:
Existing Primary Tower - Tower Rigging
Amount:
$17,140.00

Component Description:
Primary and Interim Antenna systems installation. Second 30% payment.
Amount:
$51,420.00

Component Description:
Increased Antenna Installation Cost
Amount:
$14,747.00

Component Description:
50% of total for Increased Antenna Installation Cost, Updated crew wages along with the addition of an ERI engineered rigging plan for KHSL-TV
Amount:
$16,885.32

Component Description:
Primary and Interim Antenna systems installation. Initial 30% payment.
Amount:
$51,420.00

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 $130,450.00 $143,578.75 N/A $62,149.75 N/A
Total for all systems $1,766,483.75 $1,407,963.69 N/A $1,052,777.03 N/A
Outside Professional Services $130,450.00 $143,578.75 $62,149.75
Prepare and or review reimbursement form $2,630.00 $12,653.75 per Estimated Cost Justification KHSL-590-Prepare and_or Review Reimbursement Form v2 $12,427.50 Est equals subtotal
Project management of the transition $94,010.00 $99,675.00 Per Widelity quote KHSL-TV Strategic Support 12/16/18 (uploaded into LMS) $44,322.25 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $1,562.50 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $700.00 N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $452.50 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $2,250.00 N/A $1,435.00 N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $7,000.00 N/A N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $1,250.00 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

Components

Actual Information Description File Name
Prepare and or review reimbursement form

Component Description:
Review and submit Form 399 reimbursement request
Amount:
$226.25

Component Description:
KHSL-590-Prepare and/or Review Reimbursement Form
Amount:
$1,230.00

Component Description:
Total Professional Services
Amount:
$226.25

Component Description:
Legal services
Amount:
$7,790.00

Component Description:
Prepare Form 399 for submission
Amount:
$226.25

Component Description:
Total Professional Services, Total Disbursements
Amount:
$226.25

Component Description:
Legal services
Amount:
$226.25

Component Description:
KHSL-TV, Chico CA Channel Repack
Amount:
$226.25

Component Description:
Professional legal services
Amount:
$2,050.00
Project management of the transition

Component Description:
Project Management
Amount:
$8,868.20

Component Description:
Project Management
Amount:
$6,006.05

Component Description:
Project Management
Amount:
$1,851.00

Component Description:
Project Management
Amount:
$3,535.60

Component Description:
Project Management
Amount:
$4,082.65

Component Description:
Project Management
Amount:
$3,219.30

Component Description:
Project Management
Amount:
$2,959.70

Component Description:
Project Management
Amount:
$4,859.85

Component Description:
Project Management
Amount:
$2,712.60

Component Description:
Project Management
Amount:
$6,227.30
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Engineer consulting
Amount:
$875.00

Component Description:
Consulting Engineer
Amount:
$687.50
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Consulting Engineer
Amount:
$700.00
Prepare request for Special Temporary Authorization Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Legal Services
Amount:
$452.50
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
KHSL-550-Attorney - License to Cover Application (Main)
Amount:
$1,435.00
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
Consulting Engineer
Amount:
$250.00

Component Description:
Engineer consulting
Amount:
$312.50

Component Description:
RF Eng - Engineering Study for New Channel Assignment
Amount:
$687.50
Address transition timing and coordination issues w/ other stations and wireless Information not provided.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $45,793.75 $45,188.75 N/A $19,148.75 N/A
Total for all systems $1,766,483.75 $1,407,963.69 N/A $1,052,777.03 N/A
Other Expenses $45,793.75 $45,188.75 $19,148.75
Attorney Fees and Other Matters $16,403.75 $16,403.75 see Estimated Cost Justification KHSL-610-Attorney Fees and Other Matters v2 $15,498.75 N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 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
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
Equipment Delivery and Handling Charges $5,000.00 $5,000.00 N/A N/A N/A
Equipment Storage $1,200.00 $1,200.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $5,000.00 $5,000.00 N/A N/A N/A
MVPD Notification of Channel Change $5,000.00 $5,000.00 N/A $3,650.00 N/A

Components

Actual Information Description File Name
Attorney Fees and Other Matters

Component Description:
Legal services
Amount:
$931.25

Component Description:
KHSL-610-Attorney Fees and Other Matters
Amount:
$452.50

Component Description:
Professional legal services
Amount:
$1,230.00

Component Description:
Analyzed and responded to questions and follow-up
Amount:
$1,200.00

Component Description:
General FCC Advice
Amount:
$820.00

Component Description:
Total Professional Services, Total Disbursements
Amount:
$820.00

Component Description:
Prepare Form 399 repack reimbursement request
Amount:
$5,125.00

Component Description:
Total Professional Services
Amount:
$1,640.00

Component Description:
Professional legal services
Amount:
$410.00

Component Description:
Total Professional Services
Amount:
$205.00

Component Description:
Total Professional Services
Amount:
$615.00

Component Description:
Total Professional Services
Amount:
$410.00

Component Description:
Total Professional Services
Amount:
$410.00

Component Description:
Total Professional Services
Amount:
$1,230.00
DTV Medical Facility Notification

Component Description:
DTV Notification Service, Notification of Medical Facilities-Transmitter Medical Facility Notification per proposal.
Amount:
$3,183.00
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
Equipment Delivery and Handling Charges

Component Description:
Forklift Rental Deposit for Repack work on tower
Amount:
$4,535.79
Equipment Storage Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
MVPD Notification of Channel Change

Component Description:
MVPD Notification Services
Amount:
$1,385.00

Component Description:
DTV Notification Service
Amount:
$2,265.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,766,483.75 $1,407,963.69 $1,052,777.03

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.

Robert S. Prather , Jr .

CEO


10/10/2019

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.

Robert S. Prather , Jr .

CEO


10/10/2019

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.

Robert S. Prather , Jr .

CEO


10/10/2019

Attachments

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