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:
48836
Service:
DCA
Call Sign:
KXLK-CD
Channel:
14 (UHF)
File Number:
0000027623
FRN:
0020907150
Date Submitted:
02/27/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

UNIVISION LOCAL MEDIA, INC.

Doing Business As: UNIVISION LOCAL MEDIA, INC.

CHRISTOPHER G. WOOD

5999 CENTER DRIVE

LOS ANGELES, CA 90045

United States

+1 (310) 348-3600 cwood@univision.net Corporation

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Theodore Stoner

VP Distribution Technology Strategy

Univision Management Company

Theodore Stoner

9405 NW 41st Street

Miami, FL 33178

United States

+1 (513) 608-0308 tstoner@univision.net

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 Relocate transmission site, order a new transmitter, filter, antenna and transmission line. When the equipment is received, we will proceed to install the new equipment, and remove old. See attachment for details.

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 NV7640V
Year 2008
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power Capacity 6.4 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 THU9-4 Evo
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 6.5 kW
Justification for New Transmitter Old Rohde and Schwarz NV7640V transmitter is not supported for repackaging and they will not support the transmitter for retuning.

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 No
Size N/A
Length N/A
Other Electrical Service Yes
Description Primary AC wiring to transmitter cabinet, and power/control wiring to ancillary components
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

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Other Transmitter Cost Not Listed

Name Description

Channel 14 Mask Filter

Channel 14 Mask Filter

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? No
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 Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Circular
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: 15.0 kW
Manufacturer
Model AL12-23-PLC
Year 2008

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Purchase New
Is this a request for upgraded equipment? No
Ownership Owned
Owner N/A
Is antenna shared? 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 Class A
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels/Bays 9
Lower Limit 470.00 MHz
Upper Limit 860.00 MHz
Design power capacity in use 15.0 %
Other Antenna Type N/A
ERP: 15.0 kW
Manufacturer
Model TUA-C3-03/9M-SM
Year 2018
Justification for New Antenna The existing AL12-23-PLC is not broadband enough to move to CH14. The VSWR would increase and the beam tilt would change. It is circularly polarized: the vertical component would increase potential interference to LMRs.

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?
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? 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 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? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Side Mount Brackets

Side Mount Brackets

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 3 1/8 inches
Other Diameter N/A
Segment Length 20 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1190 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 Flexible Air
Diameter 3 inches
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 1000 feet per run
Justification for New Transmission Line New line required for new location.

Primary 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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Add 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? Candelabra
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1050398
Coordinates (NAD83) Latitude (NAD83) 30° 19' 34.0" N-
Longitude (NAD83) 097° 47' 59.0" W-
Overall Structure Height 1197.49 feet
Support Structure Height 1079.38 feet
Ground Elevation Above Mean Sea Level (AMSL) 849.73 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner LIN Television of Texas, L.P.
Date Constructed 09/22/1965

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
35920 KXAN-TV DTV
35918 KBVO-CD DTV
35882 KTFO-CD DTV
144 KNVA DTV

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: No reinforcements needed

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

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 Leased
Is this tower consider Complex? Candelabra
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users No
Is tower documented for structural analysis? Unknown
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1013180
Coordinates (NAD83) Latitude (NAD83) 30° 19' 23.8" N-
Longitude (NAD83) 097° 47' 59.5" W-
Overall Structure Height 1228.99 feet
Support Structure Height 1151.89 feet
Ground Elevation Above Mean Sea Level (AMSL) 817.90 feet
Structure Type GTOWER - Guyed Structure Used for Communication Purposes
Tower Owner American Towers, LLC
Date Constructed 10/08/1997

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
3222 KFMK FM
66489 KKMJ-FM FM
35849 KASE-FM FM
8685 KMFA FM
19223 KVLR FM
48651 KAMX FM
62048 KVET-FM FM

Primary Tower

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Tower Rigging Costs

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

Primary Tower

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Other Tower Expenses Not Listed

Name Description

Tower Mapping

Per ATC Cost Estimatation: Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

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 Please see attached quote from Widelity.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 1
NEPA Section 106 environmental review No
Environmental Assessment No
ASR Modification No
FAA Consultation (including preparation of FAA Form 7460) No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers No
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 3
Justification Oversee installation of antennas, filter, and transmitter. Configure encoder for new channel.

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

RF Engineer LMR Interference

LMR ch 14 Interference Study & Engineer Fees

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? No
Does this relocation require Equipment Storage? No
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? No

Other Expenses

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Other Expenses Not Listed

Name Description

Notification Management

LMR ch14 Notification Management

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 $236,790.00 $236,790.00 N/A $146,763.50 N/A
Total for all systems $1,432,173.00 $770,715.00 N/A $270,010.03 N/A
Primary Transmitter THU9-4 Evo $236,790.00 $236,790.00 $146,763.50
Other Electrical Service: Primary AC wiring to transmitter cabinet, and power/control wiring to ancillary components $6,000.00 $6,000.00 N/A N/A N/A
UHF - Air Cooled Solid State Transmitter 6.5 kW $178,810.00 $178,810.00 Please see R&S Quote 127742.2 $146,763.50 N/A
Channel 14 Mask Filter $51,980.00 $51,980.00 R&S Quote 127742.2 PO 56022 N/A N/A

Components

Actual Information Description File Name
Other Electrical Service: Primary AC wiring to transmitter cabinet, and power/control wiring to ancillary components Information not provided.
UHF - Air Cooled Solid State Transmitter 6.5 kW

Component Description:
DP Forecast deposit: $1,000 per transmitter
Amount:
$67,737.00

Component Description:
35% Due upon FAT PO# Line 1 THU9-4EVO DUAL Drive
Amount:
$79,026.50
Channel 14 Mask Filter Information not provided.

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $54,178.00 $60,192.00 N/A $0.00 N/A
Total for all systems $1,432,173.00 $770,715.00 N/A $270,010.03 N/A
Primary Antenna TUA-C3-03/9M-SM $54,178.00 $60,192.00 $0.00
UHF - Lower Power Side Mount, Class A One Station antenna -- basic $26,300.00 $0.00 Phantom Antenna N/A N/A
UHF - Lower Power Side Mount, Class A broadband panel (cost per panel) $11,340.00 $43,984.00 Dielectric quote 700493CMZ-5 PO 56499 $0.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A N/A
Side Mount Brackets $9,808.00 $9,808.00 Dielectric quote 700493CMZ-5 PO 56499 N/A N/A

Components

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 $59,000.00 $27,998.00 N/A $0.00 N/A
Total for all systems $1,432,173.00 $770,715.00 N/A $270,010.03 N/A
Primary Transmission Line $59,000.00 $27,998.00 $0.00
Flexible Air Transmission Line - dielectric, 3" $59,000.00 $27,998.00 RFS Quote 20084566 N/A N/A

Components

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $875,200.00 $244,500.00 N/A $44,700.00 N/A
Total for all systems $1,432,173.00 $770,715.00 N/A $270,010.03 N/A
Primary Tower GTOWER $441,600.00 $210,600.00 $20,600.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $190,000.00 Rigging Costs $0.00 N/A
Tower Mapping $20,600.00 $20,600.00 Please see American Tower Customer Project Cost Estimation III. B 1 Transmitters for the estimate and KXLK Email from Station Engineer for an explanation why they are paying for a tower mapping. $20,600.00 N/A
Primary Tower TOWER $433,600.00 $33,900.00 $24,100.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $24,100.00 N/A $24,100.00 N/A
Structural engineering tower load study for well documented tower $12,600.00 $9,800.00 MEI proposals dated 02/04/2019, 04/02/2019 & 04/24/2019 PO59549 N/A N/A

Components

Actual Information Description File Name
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) Information not provided.
Tower Mapping

Component Description:
Broadcast Tower Mapping
Amount:
$20,600.00
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
"BROADCAST STRUCTURAL - AUSTIN - A / 7000 / 7000 / 12058127 / 12634110 / FID: 48836 / ASRN :1013180 / KXLK-CD Channel 14 / BROADCAST REPACK"
Amount:
$19,000.00

Component Description:
BROADCAST STRUCTURAL
Amount:
$5,100.00
Structural engineering tower load study for well documented tower Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $184,315.00 $188,150.00 N/A $76,256.53 N/A
Total for all systems $1,432,173.00 $770,715.00 N/A $270,010.03 N/A
Outside Professional Services $184,315.00 $188,150.00 $76,256.53
RF Engineer LMR Interference $59,725.00 $59,725.00 PROPOSAL_WALLACE_REV3_030 419 PO 60139 N/A N/A
Additional Field Engineering Service, 3 Days $2,500.00 $2,500.00 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 -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 N/A N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $3,037.50 N/A
Project management of the transition $94,010.00 $99,675.00 Please see attached quote from Widelity. $73,219.03 N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 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 N/A N/A

Components

Actual Information Description File Name
RF Engineer LMR Interference Information not provided.
Additional Field Engineering Service, 3 Days Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization 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 Information not provided.
Perform engineering study for new channel assignment and antenna development

Component Description:
KXLK-CD-530-RF Eng - Engineering Study for New Channel Assignment
Amount:
$750.00

Component Description:
Network analysis of KXLK transmission line and antenna. Work performed by Peter Eckmann
Amount:
$1,750.00

Component Description:
Antenna aperture planning, Alternative antenna evaluation
Amount:
$162.50

Component Description:
prepare implementation plan, aperture & alternative antenna evaluations
Amount:
$375.00
Project management of the transition

Component Description:
Project Management
Amount:
$2,231.70

Component Description:
Project Management
Amount:
$1,237.30

Component Description:
Project Management
Amount:
$1,829.40

Component Description:
Project Management
Amount:
$3,646.70

Component Description:
Project management Services
Amount:
$331.25

Component Description:
K. Lahm - Alternate site population & structural analysis review - 3/10/2019
Amount:
$375.00

Component Description:
K. Lahm - Alternative tower structural analysis
Amount:
$75.00

Component Description:
Project management Services
Amount:
$480.00

Component Description:
Project Management Services
Amount:
$217.50

Component Description:
Project Management Services
Amount:
$590.00

Component Description:
Project management Services
Amount:
$243.75

Component Description:
Project Management Services
Amount:
$206.25

Component Description:
Project management Services
Amount:
$283.40

Component Description:
Project management Services
Amount:
$173.55

Component Description:
Cost Reconciliation
Amount:
$3,315.20

Component Description:
K. Lahm - Alternative antenna & site/tower analysis
Amount:
$750.00

Component Description:
Project Management
Amount:
$3,589.30

Component Description:
Project Management
Amount:
$2,772.50

Component Description:
Project management Services
Amount:
$219.70

Component Description:
Project management Services
Amount:
$256.75

Component Description:
Project Management
Amount:
$2,608.40

Component Description:
Project management Services
Amount:
$395.00

Component Description:
Project management Services
Amount:
$138.75

Component Description:
Project Management Services
Amount:
$223.60

Component Description:
Project management Services
Amount:
$367.25

Component Description:
Project Management
Amount:
$247.50

Component Description:
Project Management Services
Amount:
$444.86

Component Description:
Project management Services
Amount:
$272.50

Component Description:
Project management Services
Amount:
$436.25

Component Description:
Project management Services
Amount:
$478.75

Component Description:
Project management Services
Amount:
$337.35

Component Description:
Project Management Services
Amount:
$236.25

Component Description:
Project management Services
Amount:
$323.75

Component Description:
Project management Services
Amount:
$281.25

Component Description:
Project management Services
Amount:
$428.34

Component Description:
Project Management
Amount:
$4,361.20

Component Description:
Project Management Services
Amount:
$308.10

Component Description:
Project Management Services,
Amount:
$484.98

Component Description:
Project Management Services
Amount:
$299.00

Component Description:
Invoice revisions to meet FCC submittal requirements
Amount:
$45.00

Component Description:
Project Management Services
Amount:
$102.00

Component Description:
Project management Services
Amount:
$560.95

Component Description:
Project Management
Amount:
$2,356.85

Component Description:
Project management services
Amount:
$403.50

Component Description:
Project Management
Amount:
$1,483.60

Component Description:
Project Management
Amount:
$2,242.50

Component Description:
Project management Services
Amount:
$247.50

Component Description:
Project Management
Amount:
$75.00

Component Description:
Project management Services
Amount:
$307.50

Component Description:
Project management Services
Amount:
$413.75

Component Description:
Project Management Services
Amount:
$94.50

Component Description:
Project management services
Amount:
$75.00

Component Description:
Project management Services
Amount:
$275.00

Component Description:
Project management services
Amount:
$49.50

Component Description:
Project Management Services
Amount:
$85.50

Component Description:
Project Management Services
Amount:
$21.00

Component Description:
Project Management Services
Amount:
$91.50

Component Description:
Project Management
Amount:
$5,149.65

Component Description:
Project Management
Amount:
$2,112.00

Component Description:
Project management Services
Amount:
$278.75

Component Description:
Project management Services
Amount:
$219.70

Component Description:
Project management Services
Amount:
$337.35

Component Description:
Project management services
Amount:
$88.50

Component Description:
Project Management Services
Amount:
$102.00

Component Description:
Project management services
Amount:
$283.40

Component Description:
Project management
Amount:
$2,617.55

Component Description:
Project Management
Amount:
$2,727.80

Component Description:
Project Management Services
Amount:
$507.00

Component Description:
Project Management Services
Amount:
$228.00

Component Description:
Project management Services
Amount:
$254.80

Component Description:
Project Management Services
Amount:
$442.50

Component Description:
Project management Services
Amount:
$223.60

Component Description:
Project Management Services
Amount:
$429.00

Component Description:
Project Management Services
Amount:
$458.75

Component Description:
Project Management
Amount:
$4,410.75

Component Description:
Project management services
Amount:
$397.50

Component Description:
Project management Services
Amount:
$367.25

Component Description:
Project management services
Amount:
$21.00

Component Description:
Project Management
Amount:
$3,138.30

Component Description:
Project Management
Amount:
$33.00

Component Description:
Project Management
Amount:
$4,124.60

Component Description:
Project Management Services
Amount:
$138.00

Component Description:
Project Management Services
Amount:
$117.00

Component Description:
Project management services
Amount:
$147.00

Component Description:
Project Management
Amount:
$4,099.15

Component Description:
Project management Services
Amount:
$306.25

Component Description:
Project Management Services
Amount:
$167.70
Prepare and or review reimbursement form Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application 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 $22,690.00 $13,085.00 N/A $290.00 N/A
Total for all systems $1,432,173.00 $770,715.00 N/A $270,010.03 N/A
Other Expenses $22,690.00 $13,085.00 $290.00
Notification Management $9,400.00 $9,400.00 RF Notifications Quote #LS11292018 $290.00 N/A
Develop and air announcement of upcoming channel change $100.00 $100.00 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
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
DTV Medical Facility Notification $11,550.00 $2,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Notification Management

Component Description:
Legal Services
Amount:
$290.00
Develop and air announcement of upcoming channel change Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
DTV Medical Facility Notification

Component Description:
Medical Notification Mailing
Amount:
$2,000.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,432,173.00 $770,715.00 $270,010.03

Reimbursement Status

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

Certification

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Section Question Response
Submission of Estimated Expenses Statements

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.

  1. The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.

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

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

  4. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).

  5. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.

  6. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.

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

  8. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

JOSE E FRANCHI , FRANCHI .

VP FINANCE


02/27/2020

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.

JOSE E FRANCHI , FRANCHI .

VP FINANCE


02/27/2020

Attachments

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