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:
49264
Service:
DTV
Call Sign:
KFFV
Channel:
16 (UHF)
File Number:
0000027893
FRN:
0027496066
Date Submitted:
12/26/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

KFFV-TV LLC

Doing Business As: KFFV-TV LLC

Norman H. Shapiro

26 NORTH HALSTED STREET

CHICAGO, IL 20190

United States

+1 (312) 705-2600 nshapiro@wciu.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. Yes
Briefly describe transition plan See attached Transition Plan Narrative.

Question Response
Sharee Station Facility ID 23428
Call Sign KSTW
Type Commercial
Licensee Name THE CW TELEVISION STATIONS INC
Status LICENSED
DTS No
Community of License TACOMA, WA
Pre-auction RF Channel 11
Post-auction RF Channel 11
Neilsen DMA Seattle-Tacoma
Network Affiliation
Question Response
Sharee Station Facility ID 67956
Call Sign KRUM-LD
Type
Licensee Name CENTRO FAMILIAR CRISTIANO
Status LICENSED AND SILENT
DTS No
Community of License SEATTLE, WA
Pre-auction RF Channel 24
Post-auction RF Channel
Neilsen DMA
Network Affiliation

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 DHD20P1
Year 2006
Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power Capacity 5.5 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? Yes
Manufacturer
Model THU9evo-10
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 15.5 kW
Justification for New Transmitter Please see attached Transition Plan Narrative.

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 Provide electrical distribution to new 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 Installation

Installation costs related to the Primary transmitter

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: 169.0 kW
Manufacturer
Model B16UG
Year 1989

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: 578.0 kW
Manufacturer
Model TFU-12DSB/VP-R BP290 (C)
Year 2019
Justification for New Antenna Existing CH44 antenna is fixed frequency and not re-tunable. Comparable antenna is horizontally polarized only. Station requests to upgrade to an elliptically polarized antenna.

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? 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.

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 Utilize Existing
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 Dielectric (Hitachi)
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 600 feet per run

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Dehydrator

New dehydrator for existing 3" transmission line

Extension Jumper

Jumper required to extend the existing 3" transmission line to connect to the new Primary antenna

Gas Stop

A new gas stop that was required due to a bad gas stop that was discovered on the existing Primary transmission line during the system sweep of the KFFV Primary antenna

Tower Equipment And Rigging Costs

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

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex?
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? Yes
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1033248
Coordinates (NAD83) Latitude (NAD83) 47° 36' 55.0" N-
Longitude (NAD83) 122° 18' 33.0" W-
Overall Structure Height 636.80 feet
Support Structure Height 559.70 feet
Ground Elevation Above Mean Sea Level (AMSL) 411.74 feet
Structure Type LTOWER - Lattice Tower
Tower Owner American Tower, LLC
Date Constructed 05/02/1979

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
23428 KSTW DTV

Other Types of Users

Users
KRUM-LD CH24

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for undocumented/poorly documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: Minor Reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower Other
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 250
Explanation Please see attached Transition Plan Narrative.
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 Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements 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

Site Survey

Required to specify the final equipment needs and installation planning.

Site Coordination Meeting

Site coordination meetings with all broadcasters, contractors and vendors involved with the site project to jointly define a site action plan and cutover approach to allow for construction activities in alignment with stations constraints (e.g. ratings).

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits 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

Information not provided.

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $759,330.47 $203,007.94 N/A $203,007.94 N/A
Total for all systems $1,680,935.25 $699,917.47 N/A $537,570.47 N/A
Primary Transmitter THU9evo-10 $759,330.47 $203,007.94 $203,007.94
Primary Transmitter Installation $30,000.00 $30,000.00 This is the installation of the KFFV Primary transmitter $30,000.00 N/A
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW $684,000.00 $127,677.47 N/A $127,677.47 N/A
Other Electrical Service: Provide electrical distribution to new transmitter. $45,330.47 $45,330.47 The KFFV required electrical modifications to the existing panels and the building required union labor. Electrical project management required for tenant coordination. $45,330.47 N/A

Components

Actual Information Description File Name
Primary Transmitter Installation

Component Description:
KFFV Primary transmitter installation final payment
Amount:
$30,000.00
UHF - Liquid Cooled Solid State Transmitter 14.2 - 20 kW

Component Description:
KFFV Primary transmitter shipping final payment
Amount:
$8,808.00

Component Description:
KFFV Primary Transmitter Downpayment
Amount:
$26,991.25

Component Description:
KFFV Primary Transmitter Final Payment
Amount:
$91,878.22
Other Electrical Service: Provide electrical distribution to new transmitter.

Component Description:
KFFV Initial electrical preparations for primary transmitter
Amount:
$721.53

Component Description:
KFFV Electrical preparations for Primary transmitter
Amount:
$1,958.43

Component Description:
KFFV Primary transmitter electrical final payment
Amount:
$42,650.51

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 $213,568.16 $184,828.16 N/A $25,962.56 N/A
Total for all systems $1,680,935.25 $699,917.47 N/A $537,570.47 N/A
Primary Antenna TFU-12DSB/VP-R BP290 (C) $213,568.16 $184,828.16 $25,962.56
UHF - High Power, Side Mount, basic slot antenna, 578 kW input, directional,, elliptically or circularly polarized $178,428.16 $178,428.16 KFFV Primary side mount antenna. The existing side mount antenna was designed for channel 44-45 only. A new antenna was required for channel 16. $19,562.56 Test
Side mount brackets for high power antennas (if not included in antenna base cost) $23,150.00 $0.00 Cost included in the KFFV Primary antenna line item N/A N/A
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $6,400.00 N/A
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) $5,260.00 $0.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF - High Power, Side Mount, basic slot antenna, 578 kW input, directional,, elliptically or circularly polarized

Component Description:
KFFV Primary antenna sales tax
Amount:
$15,349.00

Component Description:
KFFV Primary antenna pre-shipping binder
Amount:
$71,758.30

Component Description:
KFFV Primary antenna shipping sales tax
Amount:
$1,076.16

Component Description:
KFFV Primary antenna shipping
Amount:
$10,655.00

Component Description:
KFFV Primary antenna final payment
Amount:
$7,831.40

Component Description:
KFFV Primary antenna downpayment
Amount:
$71,758.30
Side mount brackets for high power antennas (if not included in antenna base cost) Information not provided.
Sweep test of existing antenna

Component Description:
KFFV Primary antenna system sweep
Amount:
$6,400.00
Pattern scatter analysis for side mount high/med power antennas (if not included in antenna base cost) 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 $9,712.46 $9,712.46 N/A $9,712.46 N/A
Total for all systems $1,680,935.25 $699,917.47 N/A $537,570.47 N/A
Primary Transmission Line $9,712.46 $9,712.46 $9,712.46
Gas Stop $1,831.81 $1,831.81 A new gas stop that was required due to a bad gas stop that was discovered on the existing Primary transmission line during the system sweep of the KFFV Primary antenna $1,831.81 N/A
Extension Jumper $5,315.65 $5,315.65 Jumper required to extend the existing 3" transmission line to connect to the new Primary antenna $5,315.65 N/A
Dehydrator $2,565.00 $2,565.00 New dehydrator for existing 3" transmission line $2,565.00 N/A

Components

Actual Information Description File Name
Gas Stop

Component Description:
KFFV Primary transmission line gas stop
Amount:
$1,382.00

Component Description:
KFFV Primary transmission line gas stop shipping sales tax
Amount:
$28.46

Component Description:
KFFV Primary transmitter line gas stop sales tax
Amount:
$139.58

Component Description:
KFFV Primary transmission line gas stop shipping
Amount:
$281.77
Extension Jumper

Component Description:
KFFV Primary transmission line extension downpayment
Amount:
$1,160.00

Component Description:
KFFV Primary transmission line extension final payment
Amount:
$4,155.65
Dehydrator

Component Description:
KFFV Primary transmission line dehydrator final payment
Amount:
$2,565.00

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 $605,300.00 $270,294.08 N/A $270,294.08 N/A
Total for all systems $1,680,935.25 $699,917.47 N/A $537,570.47 N/A
Primary Tower LTOWER $605,300.00 $270,294.08 $270,294.08
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $16,345.00 N/A $16,345.00 N/A
Minor tower reinforcement/modifications $158,000.00 $49,017.08 The KFFV site is challenging for tower personnel due to several adjacent high power TV and FM antennas and related RF safety coordination. In addition, rigging options are very limited as the tower is located in a residential neighborhood. $49,017.08 N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas) $421,000.00 $204,932.00 N/A $204,932.00 N/A

Components

Actual Information Description File Name
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
KFFV Primary tower, complex tower broadcast tower mapping
Amount:
$16,345.00
Minor tower reinforcement/modifications

Component Description:
KFFV Primary tower minor modification final payment
Amount:
$15,574.20

Component Description:
KFFV Primary tower minor modification decommissioning downpayment
Amount:
$9,633.75

Component Description:
KFFV Primary tower minor modification downpayment
Amount:
$14,175.38

Component Description:
KFFV Primary tower minor modification decommissioning downpayment
Amount:
$9,633.75
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)

Component Description:
KFFV Primary tower, complex tower project management
Amount:
$9,480.00

Component Description:
KFFV Primary tower, complex tower broadcast structural
Amount:
$10,475.00

Component Description:
KFFV Primary tower, complex tower milestone payment 2
Amount:
$80,910.00

Component Description:
KFFV Primary tower, complex tower milestone payment 3
Amount:
$40,455.00

Component Description:
KFFV Primary tower, complex tower downpayment
Amount:
$40,455.00

Component Description:
KFFV Primary tower, complex tower final payment
Amount:
$23,157.00

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 $74,420.00 $21,515.67 N/A $19,429.27 N/A
Total for all systems $1,680,935.25 $699,917.47 N/A $537,570.47 N/A
Outside Professional Services $74,420.00 $21,515.67 $19,429.27
Site Survey $0.00 $0.00 N/A $0.00 N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $0.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $1,008.00 N/A $1,008.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $348.30 N/A $348.30 N/A
Prepare request for Special Temporary Authorization $2,050.00 $0.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $500.00 N/A $500.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $2,250.00 N/A $2,250.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $2,025.00 N/A $2,025.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $0.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $3,196.60 The original estimate was only for the consulting engineer and did not include attorney's fees.
Project management of the transition $39,500.00 $12,884.37 N/A $10,101.37 N/A
Site Coordination Meeting $0.00 $0.00 This cost is for travel and logistics expenses. N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $3,680.00 $0.00 N/A N/A N/A

Components

Actual Information Description File Name
Site Survey

Component Description:
Please refer to line 3 of the invoice for details
Amount:
$1,338.81
Attorney Fees - Negotiation of lease and other matters for shared locations Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
KFFV Attorney fees, license to cover
Amount:
$1,008.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Please refer to lines 3 and 4 of the attached invoice $387. Less the 10% discount received the amount due is $348.30. Please note the hours and rates are provided at the bottom of the invoice.
Amount:
$348.30
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
KFFV Engineering fees, license to cover
Amount:
$500.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Please see line one of the invoice - Prepare engineering section of FCC form 2100, construction permit application.
Amount:
$2,250.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Please refer to line one of the invoice - KFFV-DT Perform engineering study for new channel assignment and antenna development
Amount:
$2,025.00

Component Description:
Please refer to line 2 of the invoice for details
Amount:
$811.31

Component Description:
Please refer to line 4 of the invoice for details
Amount:
$437.50

Component Description:
Please refer to line 3 of the invoice for details
Amount:
$1,468.75
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Prepare and or review reimbursement form

Component Description:
Please see line 2 of the invoice - Prepare and or review reimbursement form.
Amount:
$2,500.00

Component Description:
Please refer to lines 1,2,5 and 6 of the attached invoice totaling $774. Less the 10% discount received the amount due is $696.60. Please note the hours and rates are provided at the bottom of the invoice.
Amount:
$696.60
Project management of the transition

Component Description:
KFFV Project management of the transition invoice 5
Amount:
$515.38

Component Description:
KFFV Project management of the transition invoice 1
Amount:
$4,741.45

Component Description:
KFFV Project management of the transition invoice 3
Amount:
$2,164.58

Component Description:
KFFV Project management of the transition invoice 2
Amount:
$1,546.13

Component Description:
KFFV Project management of the transition invoice 4
Amount:
$1,133.83

Component Description:
KFFV Project management of the transition invoice 6
Amount:
$2,783.00

Component Description:
Please refer to line 2 of the invoice for details
Amount:
$37.50
Site Coordination Meeting Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization 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 $18,604.16 $10,559.16 N/A $9,164.16 N/A
Total for all systems $1,680,935.25 $699,917.47 N/A $537,570.47 N/A
Other Expenses $18,604.16 $10,559.16 $9,164.16
MVPD Notification of Channel Change $0.00 $0.00 N/A N/A N/A
Develop and air announcement of upcoming channel change $0.00 $0.00 N/A N/A N/A
Equipment Storage $0.00 $0.00 N/A N/A N/A
Equipment Delivery and Handling Charges $3,298.41 $3,298.41 Equipment offloading rental and labor. $3,298.41 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $2,115.75 $2,115.75 Remove and dispose of old transmitter $2,115.75 N/A
Local Zoning $0.00 $0.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $0.00 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 $3,750.00 N/A $3,750.00 N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage Information not provided.
Equipment Delivery and Handling Charges

Component Description:
KFFV Equipment delivery and handling charges, system load and RF system
Amount:
$1,649.20

Component Description:
KFFV Equipment delivery and handling charges, Primary transmitter
Amount:
$721.53

Component Description:
KFFV Equipment delivery and handling charges, coax and transformer
Amount:
$927.68
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
KFFV Disposal costs
Amount:
$2,115.75
Local Zoning 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:
KFFV DTV Medical facility notification
Amount:
$3,750.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $1,680,935.25 $699,917.47 $537,570.47

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.

Kyle Walker

VP, Technology


12/26/2020

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.

Kyle Walker

VP, Technology


12/26/2020

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.

Kyle Walker

VP, Technology


12/26/2020

Attachments

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