TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
GRAY TELEVISION LICENSEE, LLC Doing Business As: KSLA	4370 PEACHTREE ROAD, NE ATLANTA, GA 30319 United States	+1 (404) 504-9828	allfcclms@gray.tv	Limited Liability Company

Applicant

Address

Phone

Applicant Type

GRAY TELEVISION LICENSEE, LLC

Doing Business As: KSLA

4370 PEACHTREE ROAD, NE

ATLANTA, GA 30319

United States

+1 (404) 504-9828

allfcclms@gray.tv

Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant	Address	Phone	Email
[Confidential]

Preparer Contact Information

Preparer Contact Name and Information

Applicant	Address	Phone	Email
Samuel Hariton Widelity	4031 University Dr Suite 100 Fairfax, VA 22030 United States	+1 (339) 222-8107	sam.hariton@widelity.com

Applicant

Address

Phone

Samuel Hariton

Widelity

4031 University Dr

Suite 100

Fairfax, VA 22030

United States

+1 (339) 222-8107

sam.hariton@widelity.com

Broadcaster Information and Transition Plan

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	Use existing side mount antenna and line as interim Remove and replace existing top mount antenna. Install new main and backup transmitters

Transmitters

Section	Question	Response
Transmitter Related Expenses	Do you have transmitter related expenses?	Yes

Auxiliary Transmitter

Add Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Retune Existing
	Use	Auxiliary (Backup)
	Ownership	Owned
	Owner	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	GatesAir
	Model	UAXT-1000
	Year	2010
	Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power capacity	1.4 kW

Auxiliary Transmitter

Retuning Transmitter Costs

Section	Question	Response
New IOT Tubes	Number of Tubes (including accessories) needed	N/A
New Mask Filter
	Power	3 kW
	Other Power	N/A
New Exciter	Is a new exciter needed?	No

Auxiliary Transmitter

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	No
	Description	N/A
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

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Information not provided.

Primary Transmitter

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	DCX
	Year	2003
	Type	Inductive Output Tube
	IOT Power Type	Single
	Power Capacity	20 kW

Primary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Primary (Main)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Manufacturer
	Model	ULXTE-50
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	31.7 kW
	Justification for New Transmitter	IOT to Solid State upgrade Existing transmitter can not be retuned. Cost of a new IOT exceeds solid state cost

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	Yes
	Transformer (480V)	Yes
	Power	300 kVA
	Rigid Conduit and Wiring	No
	Size	N/A
	Length	N/A
	Other Electrical Service	No
	Description	N/A
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

Other Transmitter Cost Not Listed

Name	Description
Primary Transmitter - De-install	Primary Transmitter - De-install
Primary Transmitter - Installation	Primary Transmitter - Installation

Antennas

Section	Question	Response
Antenna Related Expenses	Do you have antenna related expenses?	Yes

Primary Antenna

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?	No
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:	175.0 kW
	Manufacturer
	Model	TFU-16DSB-A(C)
	Year	2003

Primary Antenna

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?	No
New Antenna Manufacturer and Types	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Not in Stack
	Polarization	Elliptical
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels/Bays	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Design power capacity in use	N/A
	Other Antenna Type	N/A
	ERP:	181.0 kW
	Manufacturer
	Model	TFU-18GTH/VP-R 04
	Year	2019
	Justification for New Antenna	Existing antenna can not be retuned but can be used as interim E-Pol premium not reimbursable Top mount is less expensive than new side mount and interim antenna.

Primary Antenna

Other Antenna Costs

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

Primary Antenna

Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Primary Transmission Line

Existing Transmission Line

Section	Question	Response
Existing Transmission Line Description	Type of change	Purchase New
	Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing transmission line shared with another station or stations?	No
	Is Transmission Line in operating condition?	Yes
Existing Transmission Line Manufacturer and Type	Manufacturer
	Type	Rigid
	Diameter	6 1/8 inches
	Other Diameter	N/A
	Segment Length	19 1/2 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	1850 feet per run

Primary Transmission Line

New Transmission Line

Section	Question	Response
New Transmission Line Costs	Use	Primary (Main)
	Description of Use	N/A
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Type	Rigid
	Diameter	6 1/8 inches
	Other Diameter	N/A
	Segment Length	20 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	1850 feet per run
	Justification for New Transmission Line	Existing line section lengths do not work on new channel

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

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

Primary Tower

Existing Tower

Section	Question	Response
Existing Tower Description	Type of change	Modify Existing
	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?	No
	One or more FM, AM or TV radio broadcaster(s)	N/A
	Others Types of Users	N/A
	Is tower documented for structural analysis?	Yes
	Is tower compliant with Rev G?	No
Existing Tower Structure Registration	Do you have a tower registration number?	No
Existing Tower Structure Registration	ASR Number
Coordinates (NAD83)	Latitude (NAD83)	32° 40' 28.3" N-
	Longitude (NAD83)	093° 55' 59.1" W-
	Overall Structure Height	1790.99 feet
	Support Structure Height	1706.67 feet
	Ground Elevation Above Mean Sea Level (AMSL)	254.92 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	KSLA LLC
	Date Constructed	12/12/1978

Primary Tower

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:	Minor Reinforcements needed

Primary Tower

Tower Rigging Costs

Section	Question	Response
Tower Rigging Costs	Complex Tower	N/A
Helicopter Services Required	Are helicopter services required?	Yes

Primary Tower

Other Tower Expenses Not Listed

Name	Description
Existing Primary Tower - Ice Bridge	Existing Primary Tower - Ice Bridge

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	895
	Explanation	Pattern analysis Antenna Spec Transmitter Spec Building drawings Installation Supervision Accounting Internal Legal Strategic 399 Support
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	No
	Quantity	N/A
	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	No
RF Field Engineering Services	Comprehensive coverage verification via field study	Yes
	RF exposure measurements	No
	Additional Field Engineering Service	No
	Number of Days	N/A
	Justification	N/A

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

Section	Question	Response
AM Pattern Disturbance	Is an Impact Study needed?	No
AM Pattern Disturbance	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	No
	FCC License to Cover Application	Yes
	FCC Special Temporary Authority Application	No
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

Other Expenses Not Listed

Name	Description
Equipment Rental	Equipment rental required for repack work

Cost Information

Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$1,958,669.19	$1,130,116.54	N/A	$963,691.55	N/A
Total for all systems	$3,436,064.50	$2,391,254.22	N/A	$1,939,373.45	N/A
Primary Transmitter ULXTE-50	$1,849,314.19	$1,117,905.94		$960,906.15
Primary Transmitter - Installation	$3,350.00	$3,350.00	Please see KSLA Primary Transmitter - Installation Budget Revision Justification Letter	$3,350.00	N/A
Primary Transmitter - De-install	$15,500.00	$15,500.00	Please see THTV quote 1013	$15,500.00	N/A
Switchgear - industrial 800 amp	$38,200.00	$36,300.00	N/A	N/A	N/A
UHF - Liquid Cooled Solid State Transmitter 31.7 kW	$808,464.19	$808,464.19	Per GatesAir GA-00021483 includes tax and shipping costs (decreased by $219,291.75 previously forwarded for payment on superseded equipment) Like for Like transmitter ULXTE-40	$722,764.40	N/A
Transformer 3 phase/480v - 300 KVA	$36,800.00	$35,000.00	N/A	N/A	N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	$947,000.00	$219,291.75	*System Notice: Estimate adjusted and locked because line has been superseded.*Gates Air Quote attached Headroom analysis attached	$219,291.75	N/A
Auxiliary Transmitter UAXT-1000	$109,355.00	$12,210.60		$2,785.40
3 kW mask filter	$4,155.00	$0.00	retune mask filter	N/A	N/A
UHF and VHF - minor banding issues	$105,200.00	$12,210.60	Quote attached (GA-00021677)	$2,785.40	N/A

Components

Actual Information Description	File Name
Primary Transmitter - Installation	Component Description: Worked with Chief Engineer to prepare site for transition. Amount: $3,350.00
Primary Transmitter - De-install	Component Description: Transmitter System de-Install Amount: $15,500.00
Switchgear - industrial 800 amp	Information not provided.
UHF - Liquid Cooled Solid State Transmitter 31.7 kW	Component Description: Transmitter Amount: $424,586.89 Component Description: Transmitter Amount: $76,798.72 Component Description: Transmitter Amount: $221,378.79
Transformer 3 phase/480v - 300 KVA	Information not provided.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW	Component Description: ULXTE-40 transmitter per Quote Q-69739 Amount: $131,575.05 Component Description: ULXTE-40 per Quote Q-69739 Amount: $87,716.70
3 kW mask filter	Information not provided.
UHF and VHF - minor banding issues	Component Description: Channel change UAX-1000AT Amount: $1,114.16 Component Description: Channel change UAX-1000AT Amount: $1,671.24

Cost Information

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	$296,230.00	$165,727.91	N/A	$165,727.91	N/A
Total for all systems	$3,436,064.50	$2,391,254.22	N/A	$1,939,373.45	N/A
Primary Antenna TFU-18GTH/VP-R 04	$296,230.00	$165,727.91		$165,727.91
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$6,400.00	N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	$289,500.00	$159,327.91	Quote attached V-Pol premium not included in cost Please see Estimated Cost Justification KSLA-210-Primary Antenna - UHF High Power Top Mount, E-POL v0	$159,327.91	N/A

Components

Actual Information Description	File Name
Sweep test of existing antenna	Component Description: KSLA-210-Primary Antenna - Sweep Test Amount: $3,200.00 Component Description: KSLA-210-Primary Antenna - Sweep Test Amount: $1,600.00 Component Description: KSLA-210-Primary Antenna - Sweep Test Amount: $640.00 Component Description: INCLUDES ONE FIELD ENGINEER ON-SITE Amount: $960.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	Component Description: Elbow Complex Amount: $987.75 Component Description: UHF - HIGH POWER TOP MOUNT (200 - 1,000 KW) Amount: $79,663.95 Component Description: RIGID TRANSMISSION LINE - COPPER Amount: $22,911.44 Component Description: UHF - high power top mount (200-1,000 KW) antenna Amount: $15,932.79 Component Description: UHF-High power top mount Amount: $39,831.98

Cost Information

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	$373,700.00	$160,358.30	N/A	$160,358.30	N/A
Total for all systems	$3,436,064.50	$2,391,254.22	N/A	$1,939,373.45	N/A
Primary Transmission Line	$373,700.00	$160,358.30		$160,358.30
Rigid Transmission Line - copper, 6 1/8"	$373,700.00	$160,358.30	Quote attached Please see Estimated Cost Justification KSLA-310-Primary Transmission Line - Rigid Copper, 6 1:8" v0	$160,358.30	N/A

Components

Actual Information Description	File Name
Rigid Transmission Line - copper, 6 1/8"	Component Description: KSLA-310-Primary Transmission Line - Rigid, Copper, 6 1/8": $4,002.30 Amount: $4,002.30 Component Description: KSLA-310-Primary Transmission Line - Rigid, Copper, 6 1/8" Amount: $5,440.00 Component Description: KSLA-310-Primary Transmission Line - Rigid, Copper, 6 1/8" Amount: $15,466.50 Component Description: KSLA-310-Primary Transmission Line - Rigid, Copper, 6 1/8": $18,540.75 Amount: $18,540.75 Component Description: KSLA-310-Primary Transmission Line - Rigid, Copper, 6 1/8" Amount: $77,332.50 Component Description: KSLA-310-Primary Transmission Line - Rigid, Copper, 6 1/8" Amount: $38,666.25 Component Description: TRANSMISSION LINE RIGID - COPPER Amount: $910.00

Actual Information Description

File Name

Rigid Transmission Line - copper, 6 1/8"

Component Description:: KSLA-310-Primary Transmission Line - Rigid, Copper, 6 1/8": $4,002.30
Amount:: $4,002.30

Component Description:: KSLA-310-Primary Transmission Line - Rigid, Copper, 6 1/8"
Amount:: $5,440.00

Component Description:: KSLA-310-Primary Transmission Line - Rigid, Copper, 6 1/8"
Amount:: $15,466.50

Component Description:: KSLA-310-Primary Transmission Line - Rigid, Copper, 6 1/8": $18,540.75
Amount:: $18,540.75

Component Description:: KSLA-310-Primary Transmission Line - Rigid, Copper, 6 1/8"
Amount:: $77,332.50

Component Description:: KSLA-310-Primary Transmission Line - Rigid, Copper, 6 1/8"
Amount:: $38,666.25

Component Description:: TRANSMISSION LINE RIGID - COPPER
Amount:: $910.00

Cost Information

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	$462,406.00	$609,900.00	N/A	$473,277.51	N/A
Total for all systems	$3,436,064.50	$2,391,254.22	N/A	$1,939,373.45	N/A
Primary Tower TOWER	$462,406.00	$609,900.00		$473,277.51
Structural engineering tower load study for well documented tower	$12,600.00	$22,900.00	Please see Estimated Cost Justification KSLA-410-Existing Primary Tower - Structural Engineering Tower Load Study v0	$22,900.00	N/A
Tall Tower (greater than 500')	$210,500.00	$355,694.00	per Tower King II Proposal C-20-014	$355,694.00	N/A
Minor tower reinforcement/modifications	$158,000.00	$150,000.00	N/A	$13,377.51	N/A
Tower Helicopter Lift	$79,506.00	$79,506.00	Please see Tower King II Proposal C-20-014	$79,506.00	N/A
Existing Primary Tower - Ice Bridge	$1,800.00	$1,800.00	Please see KSLA Existing Primary Tower - Ice Bridge Budget Revision Justification Letter	$1,800.00	N/A

Components

Actual Information Description	File Name
Structural engineering tower load study for well documented tower	Component Description: Broadcast tower structural analysis Amount: $4,400.00 Component Description: Professional Services - Broadcast Tower Structural Analysis Amount: $2,200.00 Component Description: Professional Services-TIA Inspection Amount: $10,800.00 Component Description: Structural Analysis Amount: $2,750.00 Component Description: Engineering Amount: $2,750.00
Tall Tower (greater than 500')	Component Description: Down Payment and Mobilization for KSLA-TV Repack Amount: $200,000.00 Component Description: Final Payment for KSLA-TV Repack Antenna Project Amount: $155,694.00
Minor tower reinforcement/modifications	Component Description: Broadcast Tower Modification Design Amount: $4,800.00 Component Description: copper strap Amount: $231.00 Component Description: copper strap, platform Amount: $8,346.51
Tower Helicopter Lift	Component Description: KSLA-410-Existing Primary Tower - Helicopter Lift Amount: $79,506.00
Existing Primary Tower - Ice Bridge	Component Description: Build ice bridge Amount: $1,800.00

Cost Information

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	$255,850.00	$244,542.16	N/A	$130,625.65	N/A
Total for all systems	$3,436,064.50	$2,391,254.22	N/A	$1,939,373.45	N/A
Outside Professional Services	$255,850.00	$244,542.16		$130,625.65
Attorney Fees - Prepare and File request for Special Temporary Authorization	$3,680.00	$80.20	The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time.	$80.20	N/A
Project management of the transition	$141,410.00	$144,675.00	Widelity Strategic Support Quote	$125,871.66	N/A
Attorney Fees - Negotiation of lease and other matters for shared locations	$4,210.00	$1,033.62	The estimated cost has been adjusted to include all invoices submitted for reimbursement at this time.	$1,033.62	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
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	$357.66	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	$2,500.00	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	$779.17	N/A
Prepare and or review reimbursement form	$2,630.00	$3.34	Please see KSLA Prepare and/or Review Reimbursement Form Budget Revision Justification Letter	$3.34	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
Comprehensive coverage verification via field study, if needed	$84,200.00	$80,000.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Attorney Fees - Prepare and File request for Special Temporary Authorization	Component Description: KSLA-550-Attorney - Special Temporary Authorization Amount: $26.58 Component Description: KSLA-550-Attorney - Special Temporary Authorization Amount: $53.62
Project management of the transition	Component Description: Project Management Amount: $1,723.15 Component Description: Project Management Amount: $2,292.65 Component Description: Project Management Amount: $192.50 Component Description: Project Management Amount: $2,977.55 Component Description: Project Management Amount: $2,665.25 Component Description: Project Management Amount: $2,212.45 Component Description: Project management Amount: $5,006.60 Component Description: Project Management Amount: $2,897.25 Component Description: Project Management Amount: $1,283.70 Component Description: Project Management Amount: $1,626.25 Component Description: Project Management Amount: $2,755.80 Component Description: Project Management Amount: $2,741.30 Component Description: Project management Amount: $1,245.65 Component Description: Project Management Amount: $231.00 Component Description: Project Management Amount: $3,176.20 Component Description: Project Management Amount: $2,034.20 Component Description: Project management Amount: $8,592.95 Component Description: Project Management Amount: $1,965.90 Component Description: Project Management Amount: $2,918.75 Component Description: Project Management Amount: $1,903.75 Component Description: Project Management Amount: $2,144.65 Component Description: Project Management Amount: $2,792.55 Component Description: Project Management Amount: $5,608.80 Component Description: Project Management Amount: $3,256.95 Component Description: Project Management Amount: $2,873.35 Component Description: Project Management Amount: $102.66 Component Description: Project Management Amount: $1,207.85 Component Description: Project Management Amount: $38.50 Component Description: Project Management Amount: $8,015.10 Component Description: Project Management Amount: $2,383.25 Component Description: Project Management Amount: $223.29 Component Description: Project Management Amount: $33.36 Component Description: Project Management Amount: $2,908.90 Component Description: Project Management Amount: $2,360.55 Component Description: Project Management Amount: $38.50 Component Description: Project Management Amount: $3,020.95 Component Description: Project Management Amount: $2,847.55 Component Description: Project Management Amount: $2,607.00 Component Description: Project Management Amount: $2,568.05 Component Description: Project Management Amount: $2,784.55 Component Description: Project Management Amount: $6,779.35 Component Description: Project Management Amount: $2,068.30 Component Description: Project Management Amount: $4,499.90 Component Description: Project Management Amount: $2,021.60 Component Description: Project Management Amount: $1,544.40 Component Description: Project Management Amount: $2,169.80 Component Description: Project Management Amount: $3,313.15 Component Description: Project Management Amount: $2,568.50 Component Description: Project Management Amount: $2,647.45
Attorney Fees - Negotiation of lease and other matters for shared locations	Component Description: Professional Services Rendered Amount: $51.28 Component Description: Legal Services Amount: $19.93 Component Description: Professional Services Rendered Amount: $10.65 Component Description: Professional Services Rendered Amount: $94.02 Component Description: Professional Services Rendered Amount: $6.64 Component Description: Professional Services Rendered Amount: $49.50 Component Description: Legal Services Amount: $27.86 Component Description: Professional Services Rendered Amount: $70.14 Component Description: Professional Services Rendered Amount: $127.88 Component Description: Professional Services Rendered Amount: $29.90 Component Description: Professional Services Rendered Amount: $203.35 Component Description: Legal Services Amount: $297.53 Component Description: Professional Services Rendered Amount: $44.94
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application	Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Component Description: License application tech box data preparation Amount: $191.66 Component Description: Draft license application. Amount: $166.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Component Description: KSLA FCC Form 2100 Construction permit application Amount: $2,500.00
Perform engineering study for new channel assignment and antenna development	Component Description: Engineering study work for new channel assignment and antenna development Amount: $125.00 Component Description: KSLA-530-RF Eng - Engineering Study for New Channel Assignment Amount: $79.17 Component Description: Engineering study work for new channel assignment and antenna development; Amount: $500.00 Component Description: Project Management Amount: $75.00
Prepare and or review reimbursement form	Component Description: KSLA-550-Attorney - Prepare and or review reimbursement form Amount: $3.34
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application	Information not provided.
Comprehensive coverage verification via field study, if needed	Information not provided.

Cost Information

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	$89,209.31	$80,609.31	N/A	$45,692.53	N/A
Total for all systems	$3,436,064.50	$2,391,254.22	N/A	$1,939,373.45	N/A
Other Expenses	$89,209.31	$80,609.31		$45,692.53
Equipment Rental	$22,712.24	$22,712.24	Please see Estimated Cost Justification KSLA-610-Equipment Rental V4	$22,685.64	N/A
MVPD Notification of Channel Change	$0.00	$0.00	N/A	N/A	N/A
Develop and air announcement of upcoming channel change	$2,850.00	$2,850.00	estimate for on air rescan announcement production. Quote attached	N/A	N/A
Equipment Storage	$30,500.00	$30,500.00	Estimate for Dielectric on site antenna storage Estimate attached	$4,567.33	N/A
Equipment Delivery and Handling Charges	$17,985.07	$17,985.07	Please see Estimated Cost Justification KSLA-610-Equipment Delivery and Handling v0	$15,644.56	N/A
Disposal Costs (for equipment and other waste, net of any salvage value)	$3,277.00	$3,277.00	please see Estimated Cost Justification KSLA-610-Disposal V0	$2,460.00	N/A
FCC Filing Fees - Form 2100 license to cover application	$335.00	$335.00	Please see KSLA FCC Filing Fee - License to Cover Budget Justification Letter	$335.00	N/A
DTV Medical Facility Notification	$11,550.00	$2,950.00	Group quote attached	N/A	N/A

Components

Actual Information Description	File Name
Equipment Rental	Component Description: PREMIUM TUNNEL CONTAINER JS25ZZK0018 Amount: $177.34 Component Description: TELEHANDLER 5500LB 16-20FT LIFT ROPS Amount: $2,331.26 Component Description: Equip Rental Amount: $2,340.51 Component Description: TELEHANDLER 10000LB 50-56FT LIFT ROPS Amount: $5,503.82 Component Description: 25' PREMIUM TUNNEL CONTAINER JS25ZZK0018 Amount: $177.34 Component Description: TELEHANDLER 10000LB 50-56FT LIFT ROPS Amount: $5,667.97 Component Description: TRUCK WATER 2000 GALLON DSL Amount: $1,532.84 Component Description: TELEHANDLER 5500LB 16-20FT LIFT Amount: $2,340.51 Component Description: REFUEL SERVICE FEE Amount: $2,614.05
MVPD Notification of Channel Change	Information not provided.
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Storage	Component Description: KSLA-610-Equipment Storage: $1,200.00 Amount: $1,200.00 Component Description: PREMIUM TUNNEL CONTAINER Amount: $177.33 Component Description: KSLA-610-Equipment Storage: $3,190.00 Amount: $3,190.00
Equipment Delivery and Handling Charges	Component Description: FREIGHT AND SHIPPING Amount: $7,175.52 Component Description: Invoice moved to correct budget category. Amount: N/A Component Description: FREIGHT AND SHIPPING Amount: $3,451.35 Component Description: FREIGHT AND SHIPPING Amount: $4,927.50 Component Description: FREIGHT AND SHIPPING Amount: $90.19
Disposal Costs (for equipment and other waste, net of any salvage value)	Component Description: Daily Rent Amount: $155.00 Component Description: Daily Rent Amount: $150.00 Component Description: Remove old tower equipment Amount: $2,000.00 Component Description: Daily Rent Amount: $155.00
FCC Filing Fees - Form 2100 license to cover application	Component Description: For Professional Services Rendered Through August 31, 2020 Amount: $335.00
DTV Medical Facility Notification	Information not provided.

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$3,436,064.50	$2,391,254.22	$1,939,373.45

Reimbursement Status

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.	Yes

Certification

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.
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. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. 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). 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. 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. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Robert Folliard , III . Assistant Secretary 03/17/2022

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.

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.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
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).
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.
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.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

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

Robert Folliard , III .

Assistant Secretary

03/17/2022

Certification

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.
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. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. 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. 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. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Robert Folliard , III . Assistant Secretary 03/17/2022

Section

Question

Response

Submission of Final Allocation or Accounting Information Statements

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.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
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.
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.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

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

Robert Folliard , III .

Assistant Secretary

03/17/2022

(REFERENCE COPY - Not for submission) FCC Form 399: Reimbursement Request

Applicant Information

Applicant Name, Type, and Contact Information

Reimbursement Contact Information

Reimbursement Contact Name and Information

Preparer Contact Information

Preparer Contact Name and Information

Broadcaster Information and Transition Plan

Transmitters

Auxiliary Transmitter

Add Transmitter Information

Auxiliary Transmitter

Retuning Transmitter Costs

Auxiliary Transmitter

Other Transmitter Costs

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Antennas

Primary Antenna

Existing Antenna Information

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Transmission Line

Primary Transmission Line

Existing Transmission Line

Primary Transmission Line

New Transmission Line

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Tower Equipment And Rigging Costs

Primary Tower

Existing Tower

Primary Tower

Tower Modification Costs

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Components

Cost Information

Tower Equipment and Rigging Costs

Components

Cost Information

Outside Professional Services

Components