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:
33745
Service:
DTV
Call Sign:
KNVN
Channel:
20 (UHF)
File Number:
0000027908
FRN:
0024763385
Date Submitted:
10/09/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

MAXAIR MEDIA, LLC

Doing Business As: MAXAIR MEDIA, LLC

101 LAUREN LANE

CLINTON, MS 39056

United States

+1 (601) 918-1434 jgersh@ActionNewsNow.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

Ken Rice

Chief Engineer

California TV, LLC

Ken Rice

3460 Silverbell Rd

Chico, CA 95973

United States

+1 (503) 893-6543 krice@actionnewsnow.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. No
Briefly describe transition plan Install new primary transmitter and interim side-mount antenna/line for temporary operation on repack channel 20 while install new primary side-mount antenna/line for permanent repack channel 20 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 NV7340 E
Year 2005
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power Capacity 4.0 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 ULXTE 12
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) Yes
Power 150 kVA
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service Yes
Description Circuit Breaker and equipment to connect to transmitter
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

Primary Transmitter - Remote Control

Primary Transmitter - Remote Control

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 Elliptical
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: 321.0 kW
Manufacturer
Model ATW32H4-HSC-245
Year 1998

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 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: 380.9 kW
Manufacturer
Model ATW30H4-ESPX-20H
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?
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 3 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 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: 150.0 kW
Manufacturer
Model ALP24M3-ESPX-20
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? 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? 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 Waveguide
Diameter N/A
Other Diameter N/A
Segment Length N/A
Other Segment Length N/A
Number of parallel runs 1
Length 1060 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 19 3/4 inches
Other Segment Length N/A
Number of parallel runs 1
Length 1106 feet per run
Justification for New Transmission Line New transmission line is required for installation of primary antenna. Repack channel necessitates a change in transmission line segment length.

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 1000 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 No
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 1049183
Coordinates (NAD83) Latitude (NAD83) 40° 15' 30.6" N-
Longitude (NAD83) 122° 05' 24.4" W-
Overall Structure Height 996.71 feet
Support Structure Height 996.71 feet
Ground Elevation Above Mean Sea Level (AMSL) 1762.12 feet
Structure Type LTOWER - Lattice Tower
Tower Owner California TV, LLC
Date Constructed 01/01/1985

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
82891 KTOR FM

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 reimbursement filing, expense tracking, vendor coordination, progress reporting, budget creation, budget review, budget tracking, daisy-chain monitoring and all other activities
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 Yes
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility Yes
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 Yes
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 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

Name Description

Attorney - Other Services

Outside Professional Services - Attorney - Other Services

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)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

Auxiliary Construction Permit Processing Fee

Auxiliary Construction Permit Processing Fee

Other Expenses - Landscape

Site Preparation - Road cleaning to facilitate crew access

Road Repairs

Road repairs required for semi/crew accessibility

Equipment Rental

Equipment Rental

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 $526,827.51 $391,633.39 N/A $391,429.63 N/A
Total for all systems $1,673,974.38 $1,560,772.26 N/A $1,322,192.00 N/A
Primary Transmitter ULXTE 12 $526,827.51 $391,633.39 $391,429.63
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW $494,500.00 $381,936.67 see Estimated Cost Justification KNVN-110-1st Primary Transmitter - UHF Liquid Cooled Solid State, 8.2-13 kW v0 $381,732.96 N/A
Transformer 3 phase/480v - 150 KVA $25,550.00 $2,919.21 see Estimated Cost Justification KNVN-110-1st Primary Transmitter - Transformer v0 $2,919.21 N/A
Other Electrical Service: Circuit Breaker and equipment to connect to transmitter $3,538.51 $3,538.51 see Estimated Cost Justification KNVN-110-1st Primary Transmitter - Other Electrical v1 $3,538.46 N/A
Primary Transmitter - Remote Control $3,239.00 $3,239.00 Please see NFB Consulting quote 2110 $3,239.00 N/A

Components

Actual Information Description File Name
UHF - Liquid Cooled Solid State Transmitter 8.2 - 13 kW

Component Description:
FREIGHT COST
Amount:
$2,001.08

Component Description:
Device Connections with added SLS Annual Support
Amount:
$1,800.00

Component Description:
Transmitter, ULXTE-12
Amount:
$105,252.65

Component Description:
Transmitter, ULXTE-12, Transmitter, ULXTE-12
Amount:
$106,157.85

Component Description:
Transmitter
Amount:
$111,971.84

Component Description:
ULXTE-12
Amount:
$54,549.54
Transformer 3 phase/480v - 150 KVA

Component Description:
KNVN-110-1st Primary Transmitter - Transformer
Amount:
$905.18

Component Description:
KNVN-110-1st Primary Transmitter - Transformer
Amount:
$2,014.03
Other Electrical Service: Circuit Breaker and equipment to connect to transmitter

Component Description:
TP-Link TL-SG1024
Amount:
$96.51

Component Description:
CU1/0THHN
Amount:
$360.70

Component Description:
50 Amp 3 Pole Breaker
Amount:
$282.35

Component Description:
2 1/2 Female Adpt.
Amount:
$260.22

Component Description:
3/4" SS EMT Couplings
Amount:
$162.53

Component Description:
2" Set Screw Coupling
Amount:
$61.41

Component Description:
Home Depot #6609
Amount:
$136.96

Component Description:
600VAC 250VDC 3PHASE 150 AMP
Amount:
$750.75

Component Description:
CU#1 THHN Wire, # 6 CU THHN BLACK
Amount:
$850.03

Component Description:
3-Phase Main Breaker, Plywood for offloading trucks, Lighting
Amount:
$565.43

Component Description:
2 1/2"PVC
Amount:
$11.57
Primary Transmitter - Remote Control

Component Description:
KNVN Transmitter Site
Amount:
$3,239.00

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 $407,980.00 $394,475.00 N/A $291,019.26 N/A
Total for all systems $1,673,974.38 $1,560,772.26 N/A $1,322,192.00 N/A
Interim Antenna ALP24M3-ESPX-20 $138,240.00 $131,400.00 $72,701.76
Sweep test of existing antenna $6,730.00 $6,400.00 N/A N/A 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 N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 N/A N/A N/A
UHF - Lower Power Side Mount, One Station antenna . medium power (50-200 kW), elliptically or circularly polarized $103,100.00 $98,000.00 Please see ERI Proposal ERI proposal 20171030-148 REV B $72,701.76 N/A
Primary Antenna ATW30H4-ESPX-20H $269,740.00 $263,075.00 $218,317.50
Elbow complex, single channel, at antenna input, per 3 1/8. feedline (if needed) $7,600.00 $7,400.00 N/A N/A N/A
UHF - Lower Power Side Mount, One station antenna -- 200-500 kW, elliptically or circularly polarized $227,000.00 $222,275.00 Per ERI Quote 20171024-056 Rev B $200,047.50 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 N/A N/A
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $22,000.00 N/A $12,645.00 N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $5,625.00 N/A

Components

Actual Information Description File Name
Sweep test of existing antenna Information not provided.
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
UHF - Lower Power Side Mount, One Station antenna . medium power (50-200 kW), elliptically or circularly polarized

Component Description:
Aux Antenna; ALP24M3-ESPX-20; Transmission Line System
Amount:
$18,927.63

Component Description:
Aux Antenna
Amount:
$18,927.63

Component Description:
AUX ANTENNA-ALP24M3-ESPX-20, TRANSMISSION LINE SYSTEM
Amount:
$15,918.87

Component Description:
AUX ANTENNA
Amount:
$18,927.63
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 -- 200-500 kW, elliptically or circularly polarized

Component Description:
MAIN ANTENNA
Amount:
$66,682.50

Component Description:
MAIN ANTENNA ATW30H4-ESPX-20H & BRACKETS
Amount:
$66,682.50

Component Description:
MAIN ANTENNA ATW30H4-ESPX-20H & BRACKETS
Amount:
$66,682.50
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) Information not provided.
Side mount brackets for high power antennas (if not included in antenna base cost)

Component Description:
KNVN-210-Primary Antenna - Side Mount Brackets
Amount:
$4,215.00

Component Description:
KNVN Primary Antenna-Side Mount Brackets
Amount:
$4,215.00

Component Description:
KNVN-210-Primary Antenna - Side Mount Brackets
Amount:
$4,215.00
Sweep test of existing antenna

Component Description:
KNVN-210-Primary Antenna - Sweep Test
Amount:
$1,875.00

Component Description:
KNVN Primary Antenna-Sweep Test
Amount:
$1,875.00

Component Description:
KNVN-210-Primary Antenna - Sweep Test
Amount:
$1,875.00

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 $282,412.00 $236,848.00 N/A $180,783.26 N/A
Total for all systems $1,673,974.38 $1,560,772.26 N/A $1,322,192.00 N/A
Interim Transmission Line $59,000.00 $56,000.00 $34,559.54
Flexible Air Transmission Line - dielectric, 3" $59,000.00 $56,000.00 N/A $34,559.54 N/A
Primary Transmission Line $223,412.00 $180,848.00 $146,223.72
Rigid Transmission Line - copper, 6 1/8" $223,412.00 $180,848.00 Per ERI Proposal Number: 20171024-056 Rev B (uploaded to LMS) $146,223.72 N/A

Components

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

Component Description:
KNVN Interim Transmission Line
Amount:
$8,602.33

Component Description:
KNVN-380-Interim Transmission Line - Flexible Air, 3"
Amount:
$8,752.55

Component Description:
KNVN-380-Interim Transmission Line - Flexible Air, 3"
Amount:
$8,602.33

Component Description:
KNVN-380-Interim Transmission Line - Flexible Air, 3"
Amount:
$8,602.33
Rigid Transmission Line - copper, 6 1/8"

Component Description:
KNVN-310-Primary Transmission Line - Rigid Copper, 6 1/8"
Amount:
$48,741.24

Component Description:
KNVN Primary Transmission Line
Amount:
$48,741.24

Component Description:
KNVN -Primary Transmission Line
Amount:
$48,741.24

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 $210,500.00 $286,166.00 N/A $275,115.93 N/A
Total for all systems $1,673,974.38 $1,560,772.26 N/A $1,322,192.00 N/A
Primary Tower LTOWER $210,500.00 $286,166.00 $275,115.93
Tall Tower (greater than 500') $210,500.00 $286,166.00 see Estimated Cost Justification KNVN-410-Existing Primary Tower - Tower Rigging, Complex Tower v0 $275,115.93 N/A

Components

Actual Information Description File Name
Tall Tower (greater than 500')

Component Description:
ADDITIONAL MATERIALS
Amount:
$2,397.03

Component Description:
Potty Service
Amount:
$85.00

Component Description:
Potty Service
Amount:
$85.00

Component Description:
Weather Days- Additional Costs SWE Engineering Services
Amount:
$8,450.00

Component Description:
KNVN-410-Existing Primary Tower - Tower Rigging, Complex Tower
Amount:
$79,521.30

Component Description:
Potty Service
Amount:
$105.00

Component Description:
KNVN Existing Primary Tower-Tower Rigging
Amount:
$79,521.30

Component Description:
Potty Service
Amount:
$85.00

Component Description:
KNVN-410-Existing Primary Tower - Tower Rigging, Complex Tower
Amount:
$79,521.30

Component Description:
Potty Service
Amount:
$85.00

Component Description:
Weather Days
Amount:
$20,800.00

Component Description:
Potty Service
Amount:
$85.00

Component Description:
Potty Service
Amount:
$85.00

Component Description:
Potty Service
Amount:
$105.00

Component Description:
Remobilization
Amount:
$4,100.00

Component Description:
Potty Service
Amount:
$85.00

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 $137,365.00 $143,030.00 N/A $100,664.85 N/A
Total for all systems $1,673,974.38 $1,560,772.26 N/A $1,322,192.00 N/A
Outside Professional Services $137,365.00 $143,030.00 $100,664.85
Attorney - Other Services $6,855.00 $6,855.00 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $6,855.00 Invoices received
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $3,500.00 N/A $3,250.00 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
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application $2,105.00 $1,625.00 Please see KNVN Attorney fees construction permit (aux) Justification Cover Letter $1,625.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $5,000.00 N/A $0.00 N/A
Prepare request for Special Temporary Authorization $2,050.00 $1,500.00 N/A N/A N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application $1,580.00 $200.00 Please see KNVN License to Cover Aux Budget Justification Letter $200.00 N/A
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application $2,105.00 $925.00 Please see KNVN CP Aux Budget Justification Letter $925.00 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 $809.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $1,025.00 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
Prepare and or review reimbursement form $2,630.00 $7,500.00 The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time. $7,500.00 Please see submitted invoices.
Project management of the transition $94,010.00 $99,675.00 Per Widelity Strategic Quote $78,475.85 N/A

Components

Actual Information Description File Name
Attorney - Other Services

Component Description:
Professional Services Rendered
Amount:
$250.00

Component Description:
Legal Services
Amount:
$1,875.00

Component Description:
KNVN-590-Outside Professional Services - Attorney - Other Services
Amount:
$125.00

Component Description:
Legal Services
Amount:
$750.00

Component Description:
KNVN-590-Outside Professional Services - Attorney - Other Services
Amount:
$250.00

Component Description:
KNVN-590-Outside Professional Services - Attorney - Other Services
Amount:
$375.00

Component Description:
KNVN-590-Outside Professional Services - Attorney - Other Services
Amount:
$125.00

Component Description:
Professional Services
Amount:
$375.00

Component Description:
KNVN-590-Outside Professional Services - Attorney - Other Services
Amount:
$250.00

Component Description:
Legal Services
Amount:
$1,250.00

Component Description:
Legal Services
Amount:
$1,230.00
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
KNVN-550-Attorney - Special Temporary Authorization
Amount:
$500.00

Component Description:
Professional Services
Amount:
$1,000.00

Component Description:
KNVN-550-Attorney - Special Temporary Authorization
Amount:
$1,750.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Aux Antenna, prepare and File Form 2100 Construction Permit or License Application

Component Description:
KNVN-550-Attorney - Construction Permit Application (Aux)
Amount:
$1,625.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
KNVN-550-Attorney - Construction Permit Application (Main)
Amount:
$625.00

Component Description:
Legal Services
Amount:
$306.25
Prepare request for Special Temporary Authorization Information not provided.
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, License to Cover Application

Component Description:
KNVN-530-RF Eng - Prepare License to Cover Application (Aux)
Amount:
$200.00
RF Consulting Engineer Fees- Aux Antenna: Prepare engineering section of FCC Form 2100, Construction Permit Application

Component Description:
"Develop technical parameters for a side-mount auxiliary antenna on repack Ch-20 at 225 kW ERP."
Amount:
$925.00
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:
Conduct channel study for "maximization" of TV repack facility, work with antenna manufacturer to specify alternate directional antenna pattern
Amount:
$809.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Consulting Engineer - J, Davis - Hourly (@ $250/hr)
Amount:
$475.00

Component Description:
KNVN-530-RF Eng - Engineering Study for New Channel Assignment
Amount:
$550.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
KNVN-590-Prepare and/or Review Reimbursement Form
Amount:
$125.00

Component Description:
KNVN-590-Prepare and/or Review Reimbursement Form
Amount:
$500.00

Component Description:
Review, finalize and submit draft Form 399 for KNVN
Amount:
$500.00

Component Description:
Exchange e-mails re response to staff request
Amount:
$250.00

Component Description:
Professional Services
Amount:
$500.00

Component Description:
Review, finalize and submit draft Form 399 for KNVN
Amount:
$625.00

Component Description:
Professional Services Rendered
Amount:
$250.00

Component Description:
Professional Services
Amount:
$625.00

Component Description:
Prepare and send e-mail re FCC quarterly reports
Amount:
$750.00

Component Description:
Professional Services
Amount:
$1,000.00

Component Description:
Legal Services
Amount:
$625.00

Component Description:
Professional Services
Amount:
$875.00

Component Description:
Professional Services Rendered
Amount:
$625.00

Component Description:
Review and file revised form 399
Amount:
$250.00
Project management of the transition

Component Description:
Project Management
Amount:
$6,078.70

Component Description:
Project Management
Amount:
$2,988.20

Component Description:
Project Management
Amount:
$9,063.90

Component Description:
Project Management
Amount:
$4,720.45

Component Description:
Project Management
Amount:
$5,166.85

Component Description:
Potty Service
Amount:
$85.00

Component Description:
Project Management
Amount:
$3,512.90

Component Description:
Project Management
Amount:
$4,397.90

Component Description:
Project Management
Amount:
$3,103.95

Component Description:
Project Management
Amount:
$5,598.80

Component Description:
Project Management
Amount:
$2,842.90

Component Description:
Project Management
Amount:
$2,572.85

Component Description:
Project Management
Amount:
$6,503.90

Component Description:
Project Management
Amount:
$2,277.20

Component Description:
Project Management
Amount:
$3,326.05

Component Description:
Project Management
Amount:
$5,914.60

Component Description:
Project Management
Amount:
$4,419.85

Component Description:
Project Management
Amount:
$1,824.75

Component Description:
Project Management
Amount:
$1,993.55

Component Description:
Cost Reconciliation
Amount:
$2,083.55

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 $108,889.87 $108,619.87 N/A $83,179.07 N/A
Total for all systems $1,673,974.38 $1,560,772.26 N/A $1,322,192.00 N/A
Other Expenses $108,889.87 $108,619.87 $83,179.07
Equipment Rental $6,293.80 $6,293.80 Please see KNVN Equipment Rental Budget Revision Justification Letter N/A N/A
Road Repairs $19,425.40 $19,425.40 Please see KNVN Justification New Category Road Repairs (per Walberg Inc Proposal dated 7/3/19 & Invoice 5192) $19,425.40 N/A
Other Expenses - Landscape $536.24 $536.24 Please see the attached invoice from Maxair Media invoice #KR053118 $536.24 N/A
MVPD Notification of Channel Change $5,000.00 $5,000.00 N/A $2,278.00 N/A
Develop and air announcement of upcoming channel change $5,000.00 $5,000.00 N/A $0.00 N/A
Equipment Storage $2,000.00 $2,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $49.17 $49.17 Please see KNVN MaxAir Disposal Costs Budget Justification Letter $49.17 N/A
Equipment Delivery and Handling Charges $56,295.26 $56,295.26 see Estimated Cost Justification KNVN-610-Equipment Delivery and Handling v5 $56,300.26 .
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 $525.00 see Estimated Cost Justification KNVN-610-FCC Filing Fee - Special Temporary Authorization v0 $525.00 N/A
Auxiliary Construction Permit Processing Fee $1,100.00 $1,100.00 Please see KNVN Auxiliary CP Filing Fee Budget Justification Cover Letter $1,100.00 N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $2,965.00 N/A

Components

Actual Information Description File Name
Equipment Rental Information not provided.
Road Repairs

Component Description:
Repair grading on Tuscan Springs Rd
Amount:
$19,425.40
Other Expenses - Landscape

Component Description:
Costco-Genset 2Kw Portable
Amount:
$536.24
MVPD Notification of Channel Change

Component Description:
MVPD Notification Service
Amount:
$2,278.00
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Load of debris to dump
Amount:
$49.17
Equipment Delivery and Handling Charges

Component Description:
Forklift Rental
Amount:
$3,631.52

Component Description:
FORKLIFT VARIABLE REACH
Amount:
$3,146.90

Component Description:
FORKLIFT VARIABLE REACH
Amount:
$3,146.90

Component Description:
FORKLIFT VARIABLE REACH 8000#
Amount:
$3,146.90

Component Description:
Forklift Variable Reach
Amount:
$3,146.90

Component Description:
Forklift Variable Reach
Amount:
$3,146.90

Component Description:
Forklift Variable Reach
Amount:
$3,146.90

Component Description:
CA PERSONAL PROP TAX REIMB CHARGE
Amount:
$3,146.90

Component Description:
2.5 Ton Pallet Jack
Amount:
$217.17

Component Description:
Offload Antenna & Transmission Line
Amount:
$10,410.00

Component Description:
PERSONAL PROP TAX
Amount:
$3,146.90

Component Description:
Forklift Variable Reach
Amount:
$3,146.90

Component Description:
Forklift Variable Reach 8000#
Amount:
$3,146.90

Component Description:
Forklift Variable Reach 8000# 40-49'
Amount:
$3,640.07

Component Description:
Fencing panel, base and clips, Hitch to haul rental supplies
Amount:
$597.90

Component Description:
KNVN-610-Equipment Delivery and Handling: $40.80
Amount:
$40.80

Component Description:
CA PERSONAL PROP TAX REIMB CHARGE
Amount:
$3,146.90

Component Description:
Forklift Variable Reach 8000# 40-49'
Amount:
$3,146.90
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

Component Description:
KNVN-610-FCC Filing Fee - Special Temporary Authorization: $335.00
Amount:
$335.00

Component Description:
Remittance Advice; STA Fee
Amount:
$190.00
Auxiliary Construction Permit Processing Fee

Component Description:
Auxiliary CP Processing Fee, STA FCC Filing FEe
Amount:
$1,100.00
DTV Medical Facility Notification

Component Description:
DTV Notification Service
Amount:
$2,965.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,673,974.38 $1,560,772.26 $1,322,192.00

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. 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.

Dan Modisett

President


10/09/2020

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.

Dan Modisett

President


10/09/2020

Attachments

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