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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:
168148
Service:
LPT
Call Sign:
K26NF-D
Channel:
26 (UHF)
File Number:
0000086826
FRN:
0014471106
Eligibility Status:
Eligible
Date Submitted:
10/18/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

KITTITAS COUNTY TV IMPROVEMENT DISTRICT # 1

Doing Business As: KITTITAS COUNTY TV IMPROVEMENT DISTRICT # 1

205 West 5th Ave., Suite 105

ELLENSBURG, WA 98926

United States

+1 (509) 899-3982 kctvdistrict@hotmail.com Government Entity

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 K38KL was displaced to Channel 26 - K26NF

Question Response
Sharee Station Facility ID 168150
Call Sign K20JL-D
Type
Licensee Name KITTITAS COUNTY TV IMPROVEMENT DISTRICT # 1
Status LICENSED
DTS No
Community of License ELLENSBURG, ETC., WA
Pre-auction RF Channel 20
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 168149
Call Sign K23NE-D
Type
Licensee Name KITTITAS COUNTY TV IMPROVEMENT DISTRICT # 1
Status LICENSED
DTS No
Community of License ELLENSBURG, WA
Pre-auction RF Channel 23
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 168147
Call Sign K32IG-D
Type
Licensee Name KITTITAS COUNTY TV IMPROVEMENT DISTRICT # 1
Status LICENSED
DTS No
Community of License ELLENSBURG, ETC., WA
Pre-auction RF Channel 32
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? No

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)
Ownership Owned
Is the existing antenna shared with another station or stations? Yes
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
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 2
Number of Panels 2
Design power capacity in use 100.0 %
Lower Limit 470.00 MHz
Upper Limit 800.00 MHz
ERP: 0.045 kW
Manufacturer
Model K72314
Year 2009

Facility ID's and Call Signs of all stations with whom the antenna is shared.

Facility ID Call Sign
168149 K23NE-D

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Change Type Purchase New
Ownership Owned
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
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Other
Other Antenna Type TUA-C2
ERP: 1.53 kW
Manufacturer
Model TUA-C2
Year 2017
Justification for New Antenna New Channel has a different pattern

Primary Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
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? No

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? No

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? No

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? No
Outside RF consulting Engineering Services Perform engineering study for displacement application No
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
Prepare Form 601 No
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application No
Prepare and file Form FCC License to Cover Application No
Prepare request for Special Temporary Authority No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Form 399 assistance or other program management costs Yes
RF Field Engineering Services Comprehensive coverage verification via field study No
RF exposure measurements No
Additional Field Engineering Service No

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Permit and Filing Costs FCC Construction Permit Major Change No
FCC Construction Permit Minor Change No
FCC License to Cover Application No
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)? No
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? No
Does this relocation require Equipment Storage? No
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System No
New Point to Point Microwave System No

Other Expenses

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Other Expenses Not Listed

Name Description

Equipment Survey

Travel to site, determine equipment required

Receive antenna

Off air input changed channel from 41 to 29 - replace stinger for RX antenna

Retune remove install antenna retune xmtr

Remove / install antennas, retune K38KL to Ch 26 minor parts

Cost Information

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Transmitters

Information not provided.

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $9,381.15 $9,381.15 N/A $9,381.15 N/A
Total for all systems $19,084.35 $16,289.35 N/A $16,289.35 N/A
Primary Antenna TUA-C2 $9,381.15 $9,381.15 $9,381.15
UHF-Low Power, Side Mount, Other, 1.53kW input, Horizontal $9,381.15 $9,381.15 Dielectric antenna, multiple invoices RS Technology $9,381.15 N/A

Components

Actual Information Description File Name
UHF-Low Power, Side Mount, Other, 1.53kW input, Horizontal

Component Description:
Sales Tax
Amount:
$452.48

Component Description:
Dielectric antenna charge
Amount:
$4,482.00

Component Description:
K26NF antenna $1800 plus 1953.77 plus 437.90 totals $4191.67
Amount:
$4,191.67

Component Description:
Cost to assemble antenna
Amount:
$255.00

Cost Information

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Transmission Line

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Information not provided.

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $5,865.00 $3,070.00 N/A $3,070.00 N/A
Total for all systems $19,084.35 $16,289.35 N/A $16,289.35 N/A
Outside Professional Services $5,865.00 $3,070.00 $3,070.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $60.00 See BWS Invoice 6189 $60.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $300.00 N/A $300.00 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $1,710.00 N/A $1,710.00 N/A
Form 399 assistance or other Program Management costs $1,000.00 $1,000.00 Complete Turnkey Project Management 399 Eligibility and 1876 Filing. $1,000.00 N/A

Components

Actual Information Description File Name
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Prepare License to Cover Construction K26NF-D
Amount:
$60.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Engineering Cost for Displacement Application K38KL FI 168148
Amount:
$300.00
Prepare/ Review 399 reimbursement form

Component Description:
Complete Turnkey 399 Reimbursement Project Management
Amount:
$1,710.00
Form 399 assistance or other Program Management costs

Component Description:
399 Eligibility and 1876 Turnkey Project Management
Amount:
$1,000.00

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 $3,838.20 $3,838.20 N/A $3,838.20 N/A
Total for all systems $19,084.35 $16,289.35 N/A $16,289.35 N/A
Other Expenses $3,838.20 $3,838.20 $3,838.20
Retune remove install antenna retune xmtr $2,839.20 $2,839.20 Retune transmitter, remove and install antennas. $2,839.20 N/A
Equipment Survey $175.00 $175.00 1/2 Cost of trip cost to survey equipment needs RS Technology Invoice 3755 $175.00 N/A
Receive antenna $824.00 $824.00 K38KL (26) used to receive Ch 41 as off air input, it was changed to Ch 29 so receive antenna needed some parts changed to accommodate Ch 29 as an input. $824.00 N/A

Components

Actual Information Description File Name
Retune remove install antenna retune xmtr

Component Description:
Trip charge to retune transmitter, remove and install antennas.
Amount:
$350.00

Component Description:
Remove old antennas install new antenna retune K38KL to oCh 26 minor parts $1720 plus $540 plus $229.20 totals $2489.20
Amount:
$2,489.20
Equipment Survey

Component Description:
1/2 trip charge to survey equipment
Amount:
$175.00
Receive antenna

Component Description:
Receive input changed from 41 to 29 stinger $409 & Filter $415 totals $824
Amount:
$824.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $19,084.35 $16,289.35 $16,289.35

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.

Susan Hansen

Consultant


10/18/2019

Certification

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Section Question Response
Submission of Actual Cost Documentation Statements

WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733).

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

  2. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct.

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

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

  5. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) .

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

  7. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.

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

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

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

Joel Underhill

Board Chairman


10/18/2019

Certification

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Section Question Response
Submission of Final Allocation or Accounting Information Statements

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

  1. The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

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

  3. The above-named entity certifies that all costs identified as "actual costs" herein accurately represent the costs actually paid by the above-named entity, including any discounts, refunds, or rebates.

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

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

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

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

Joel Underhill

Board Chairman


10/18/2019

Attachments

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