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:
56830
Service:
LPD
Call Sign:
KSDY-LD
Channel:
31 (UHF)
File Number:
0000088508
FRN:
0007013568
Eligibility Status:
Eligible
Date Submitted:
06/29/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

International Communications Network, Inc.

Maxwell Agha

160 Thorn Street

San Diego, CA 92103

United States

+1 (619) 230-0330 maxwell.agha@bhlflaw.com Corporation

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Tony zumMallen

QCommunications, LLC

705B SE Melody LN #314

Lee's Summit, MO 64063

United States

+1 (816) 729-1177 tony@qcomm.tv

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan Transition to new assigned channel with reasonable and customary engineering and business practices.

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)
Ownership Owned
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model ARK1
Year 2010
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 2 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model TRN-U-2000-FA
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 2.2 kW
Justification for New Transmitter New transmitter required in order to transition to new channel.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Other Transmitter Costs
Does the transmitter installation require a Transmitter Building Site Survey/Installation? Yes
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Rigid Conduit and Wiring No
Other Electrical Service No
HVAC Service Does the replacement transmitter require HVAC Service? No
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Shipping

Shipping cost

Site Prep

Site preparation for installation of new transmitter

Transmitter Shipping fee

Shipping fees for transmitter

Transmitter Decommissioning

Harvesting and removal of old 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)
Ownership Owned
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
Mounting Top Mount
Antenna position in stack Top
Polarization Horizontal
Type Slotted Coaxial
ERP: 15.0 kW
Manufacturer
Model PSILP16AWR
Year 2001

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? Yes
New Antenna Manufacturer and Types
Mounting Top Mount
Antenna position in stack Top
Polarization Horizontal
Type Other
Other Antenna Type Broadband
ERP: 5.0 kW
Manufacturer
Model UTVC-01/X BB
Year 2020
Justification for New Antenna New antenna required for new channel.

Primary Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 1 5/8 inches inches
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Antenna Shipping fee

Shipping fees for new antenna

Antenna Sales Tax

Sales tax for new antenna

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? Yes
Number of Hours 350
Explanation Required to assist in the turnkey management of the channel relocation project in order that the existing internal personal can maintain and operate the stations daily operational requirements and plans.
Outside RF consulting Engineering Services Perform engineering study for displacement application 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
Prepare Form 601 Yes
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
Negotiation of Lease and other Matter for Shared Locations Yes
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 Yes
RF exposure measurements No
Additional Field Engineering Service No

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Engineering - General services

General engineering services related to the repack transition

Attorney - General services

General attorney services related to the repack transition

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 Yes
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
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

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 $222,300.00 $211,050.00 N/A $82,650.00 N/A
Total for all systems $460,415.00 $481,452.50 N/A $189,856.65 N/A
Primary Transmitter TRN-U-2000-FA $222,300.00 $211,050.00 $82,650.00
Transmitter Decommissioning $7,000.00 $7,000.00 Estimated costs of harvesting and removal of old transmitter from site. Revised upon Site Survey. N/A N/A
Site Prep $8,000.00 $8,000.00 4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. N/A N/A
Shipping $3,500.00 $3,500.00 Cost of shipping transmitter. Determined from Anywave invoice $3,500.00 N/A
Transmitter Building Site Survey/Installation $10,000.00 $30,000.00 4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. N/A N/A
Transmitter Shipping fee $3,500.00 $3,500.00 Estimated shipping costs for transmitter. Actual costs to be determined. 4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. 4/8/20- Shipped cost determined from Anywave transmitter quote uploaded on 4/1/20 $0.00 N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $84,000.00 $79,150.00 Cost determined from Anywave invoice $79,150.00 N/A
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW $106,300.00 $79,900.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***Cost determined by transmitter quote from Anywave $0.00 N/A

Components

Actual Information Description File Name
Transmitter Decommissioning Information not provided.
Site Prep Information not provided.
Shipping

Component Description:
Shipping Cost
Amount:
$3,500.00
Transmitter Building Site Survey/Installation Information not provided.
Transmitter Shipping fee

Component Description:
Shipping Fee
Amount:
$3,500.00
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
Cost for transmitter for LPTV
Amount:
$79,150.00
UHF - Air Cooled Solid State Transmitter 2.501 - 3.999 kW

Component Description:
Transmitter UHF
Amount:
$79,900.00

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $59,690.00 $59,690.00 N/A $44,060.00 N/A
Total for all systems $460,415.00 $481,452.50 N/A $189,856.65 N/A
Primary Antenna UTVC-01/X BB $59,690.00 $59,690.00 $44,060.00
Antenna Sales Tax $3,000.00 $3,000.00 Estimated sales tax for new antenna. Actual costs to be determined. N/A N/A
Antenna Shipping fee $2,000.00 $2,000.00 Estimated shipping for new antenna. Actual costs to be determined. $2,000.00 N/A
Elbow complex, single channel, 1 5/8” input (if needed) $6,900.00 $6,900.00 N/A N/A N/A
UHF-Low Power, Top Mount, Other, 5.0kW input, Horizontal $22,030.00 $22,030.00 Cost determined from invoice. $22,030.00 N/A
Sweep test of transmission line and antenna $5,730.00 $5,730.00 4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. N/A N/A
UHF-Low Power, Top Mount, Slotted Coaxial, 15.0kW input, Horizontal $20,030.00 $20,030.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. $20,030.00 N/A

Components

Actual Information Description File Name
Antenna Sales Tax Information not provided.
Antenna Shipping fee

Component Description:
Shipping fee for antenna
Amount:
$2,000.00
Elbow complex, single channel, 1 5/8” input (if needed) Information not provided.
UHF-Low Power, Top Mount, Other, 5.0kW input, Horizontal

Component Description:
Antenna cost for Repack
Amount:
$22,030.00
Sweep test of transmission line and antenna Information not provided.
UHF-Low Power, Top Mount, Slotted Coaxial, 15.0kW input, Horizontal

Component Description:
Horizontal antenna
Amount:
$20,030.00

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 $169,215.00 $201,502.50 N/A $63,146.65 N/A
Total for all systems $460,415.00 $481,452.50 N/A $189,856.65 N/A
Outside Professional Services $169,215.00 $201,502.50 $63,146.65
Engineering - General services $10,000.00 $10,000.00 Estimated general engineering fees related to the repack transition (MX). Actual costs to be determined. 4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. $5,212.80 N/A
Comprehensive coverage verification via field study, if needed $52,600.00 $52,600.00 4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $2,235.00 $2,235.00 N/A $0.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,052.50 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,025.00 N/A N/A N/A
Prepare Form 601 $755.00 $755.00 4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $7,900.00 Estimate of attorney fees for preparation of License. Actual costs to be determined. N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $3,262.50 $3,262.50 4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. N/A N/A
Prepare/ Review 399 reimbursement form $1,710.00 $2,500.00 Per attached QComm quote. $2,500.00 N/A
Project management of the transition $36,925.00 $53,900.00 Estimated $154/hr x 350 hours. N/A N/A
Perform engineering study for displacement application $1,800.00 $10,000.00 Engineering required for displacement application. $6,700.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,102.50 N/A $950.00 N/A
Form 399 assistance or other Program Management costs $5,890.00 $5,890.00 Per attached QComm quote. $3,195.00 N/A
Attorney - General services $45,000.00 $45,000.00 Estimated general attorney fees related to the repack transition (MX). Actual costs to be determined. $44,338.85 N/A
Prepare request for Special Temporary Authorization $1,280.00 $1,280.00 N/A $250.00 N/A

Components

Actual Information Description File Name
Engineering - General services

Component Description:
Engineer consulting
Amount:
$150.00

Component Description:
Engineering consulting
Amount:
$150.00

Component Description:
Engineer Consulting
Amount:
$375.00

Component Description:
Collection an submission of services rendered to client.
Amount:
$675.00

Component Description:
Retune mask filter from CH 50 to CH 31
Amount:
$708.06

Component Description:
Engineer consulting
Amount:
$150.00

Component Description:
filter retune from CH 51 to CH 31
Amount:
$2,854.74

Component Description:
Engineer consulting
Amount:
$150.00
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare Form 601 Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations Information not provided.
Prepare/ Review 399 reimbursement form

Component Description:
Form 399 Submission
Amount:
$2,500.00
Project management of the transition Information not provided.
Perform engineering study for displacement application

Component Description:
Engineering analysis related to REPACK
Amount:
$850.00

Component Description:
Engineering analysis related to REPACK
Amount:
$3,150.00

Component Description:
Engineering study of channels due to REPACK
Amount:
$1,750.00

Component Description:
Engineering analysis related to REPACK.
Amount:
$950.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Engineering section fees
Amount:
$950.00
Form 399 assistance or other Program Management costs

Component Description:
399 Assistance and PM costs
Amount:
$1,324.40

Component Description:
Prepare and process From 399
Amount:
$500.00

Component Description:
From 399 Project managament
Amount:
$1,370.60
Attorney - General services

Component Description:
Attorney fees for general REPACK work.
Amount:
$381.00

Component Description:
Attorney fees for general REPACK work.
Amount:
$225.00

Component Description:
Attorney fees for general REPACK work.
Amount:
$170.00

Component Description:
Attorney fees for general REPACK work.
Amount:
$5,417.00

Component Description:
Attorney fees for general REPACK work.
Amount:
$8,603.00

Component Description:
Attorney fees for general REPACK work.
Amount:
$2,100.00

Component Description:
Attorney fees for general REPACK work.
Amount:
$2,231.00

Component Description:
Attorney fees for general REPACK work.
Amount:
$2,427.50

Component Description:
Attorney fees for general REPACK work.
Amount:
$7,300.00

Component Description:
Attorney fees for general REPACK work.
Amount:
$150.00

Component Description:
Attorney fees for general REPACK work.
Amount:
$6,773.50

Component Description:
Attorney fees for general REPACK work.
Amount:
$2,692.85

Component Description:
Attorney fees for general REPACK work.
Amount:
$5,868.00
Prepare request for Special Temporary Authorization

Component Description:
Engineering fees for STA
Amount:
$250.00

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 $9,210.00 $9,210.00 N/A $0.00 N/A
Total for all systems $460,415.00 $481,452.50 N/A $189,856.65 N/A
Other Expenses $9,210.00 $9,210.00 $0.00
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,110.00 N/A N/A N/A
FCC Filing Fees - Form 2100 Major change CP application $4,960.00 $4,960.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $305.00 4/1/2020- Working to obtain quote which may be delayed due to coronavirus pandemic. N/A N/A
Equipment Storage $500.00 $500.00 Expecting multiple staggered equipment deliveries from different vendors and need to store and stage new equipment prior to installation date. N/A N/A
Equipment Delivery and Handling Charges $1,000.00 $1,000.00 Transport, forklift rental and handling fees from staging area to transmitter site. Estimated cost. Actuals to be determined. N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $1,000.00 $1,000.00 Estimated 4-6 yard disposal bin on site to capture all waste from on site system integration and tower vendors. Actuals to be submitted N/A N/A

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $460,415.00 $481,452.50 $189,856.65

Reimbursement Status

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

Certification

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Section Question Response
Submission of Estimated Expenses Statements

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

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

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

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

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

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

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

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

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

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

Maxwell Agha

CEO


06/29/2020

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.

Maxwell Agha

CEO


06/29/2020

Attachments

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