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:
128831
Service:
LPD
Call Sign:
KQHD-LD
Channel:
33 (UHF)
File Number:
0000089806
FRN:
0021122429
Eligibility Status:
Eligible
Date Submitted:
10/14/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

Steward

Doing Business As: DAWN STEWART

310 NORTH CENTER AVE

HARDIN, MT 59034

United States

+1 (406) 665-1832 Montana@Digitaldevelopment.net Individual

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. No
Briefly describe transition plan To migrate the transmission from Ch 43 to Ch 33 as efficiently and with as little downtime as possible in order to preserve customer satisfaction and meet the FCC requirements for reimbursement and licensing

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 MXi 100
Year 2005
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 100 W

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-200-FA
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 280 W
Justification for New Transmitter EXISTING TRANSMITTER NOT CAPABLE OF OPERATING ON NEW CHANNEL ASSIGNMENT

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? No
Electrical Service Service Entrance (3 phases 800A 208V) Yes
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

SITE PREPARATION

PREPARE SITE FOR NEW SYSTEM INTEGRATION

DECOMMISSIONING

DECOMMISSION AND REMOVE EXISTING EQUIPMENT

SHIPPING AND HANDLING

EXPECTED SHIPPING AND HANDLING OF NEW EQUIPMENT

SALES TAX

EXPECTED SALES TAX FOR EQUIPMENT

Antennas

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Section Question Response
Antenna Related Expenses Do you have antenna related expenses? No

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 75
Explanation Required to assist in the turnkey management of the channel relocation project in order that the existing internal personnel 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 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 Yes
RF exposure measurements No
Additional Field Engineering Service Yes
Number of Days 3
Justification Estimated field engineering services during transition activities. Actual costs to be determined.

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 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? 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

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 $51,200.00 $42,785.00 N/A $23,385.00 N/A
Total for all systems $140,910.40 $124,417.40 N/A $30,230.40 N/A
Primary Transmitter TRN-U-200-FA $51,200.00 $42,785.00 $23,385.00
DECOMMISSIONING $3,500.00 $3,500.00 Estimated costs to de-install, disconnect and decommission old transmitter. N/A N/A
SALES TAX $3,000.00 $3,000.00 N/A N/A N/A
SITE PREPARATION $5,000.00 $5,000.00 Estimated costs to prepare site for installation. Includes receiving and inventory of transmitter and its components; pre-assembly of cabinets and subassemblies; ensuring site has materials required by installation crew. N/A N/A
Service entrance 3 phase/800 amp/208 volt $14,400.00 $7,200.00 3/30/2020- Working to obtain quote which may be delayed due to coronavirus pandemic N/A N/A
UHF - Air Cooled Solid State Transmitter 160 - 300 Watts $24,300.00 $23,085.00 Cost determined from Anywave Invoice (with attached proposal) submitted on 4/10/20 $23,085.00 N/A
SHIPPING AND HANDLING $1,000.00 $1,000.00 N/A $300.00 N/A

Components

Actual Information Description File Name
DECOMMISSIONING Information not provided.
SALES TAX Information not provided.
SITE PREPARATION Information not provided.
Service entrance 3 phase/800 amp/208 volt Information not provided.
UHF - Air Cooled Solid State Transmitter 160 - 300 Watts

Component Description:
Cost of 280W transmitter; the lowest power transmitter that Anywave offers.
Amount:
$23,085.00
SHIPPING AND HANDLING

Component Description:
Cost of shipping and handling of transmitter.
Amount:
$300.00

Cost Information

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Antennas

Information not provided.

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 $87,375.40 $79,297.40 N/A $6,675.40 N/A
Total for all systems $140,910.40 $124,417.40 N/A $30,230.40 N/A
Outside Professional Services $87,375.40 $79,297.40 $6,675.40
Form 399 assistance or other Program Management costs $3,825.40 $3,825.40 399 Actual Program Assistance costs. $3,825.40 Applicant incurred additional cost for assistance with completing 399 Form from another consultant.
Additional Field Engineering Service, 3 Days $7,500.00 $7,500.00 3 DAYS OF FIELD ENGINEERING TO AFFET THE TRANSITION AT 2,500 DAY N/A N/A
Comprehensive coverage verification via field study, if needed $52,600.00 $43,732.00 Per-attached quote number 721-R for Coverage Verification N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $2,235.00 $2,235.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 N/A N/A N/A
Prepare Form 601 $755.00 $755.00 3/30/2020- Working to obtain quote which may be delayed due to coronavirus pandemic N/A N/A
Project management of the transition $7,912.50 $7,912.50 N/A N/A N/A
Prepare/ Review 399 reimbursement form $1,710.00 $2,500.00 PER ATTACHED ANYWAVE QUOTE $2,500.00 N/A
Perform engineering study for displacement application $1,800.00 $1,800.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $1,280.00 $1,280.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,102.50 N/A $275.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $1,052.50 N/A $75.00 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

Components

Actual Information Description File Name
Form 399 assistance or other Program Management costs

Component Description:
Form 399 Assistance
Amount:
$500.00

Component Description:
399 Paperwork PM
Amount:
$600.60

Component Description:
399 Paperwork PM
Amount:
$1,047.20

Component Description:
399 Assistance to complete
Amount:
$1,000.00

Component Description:
399 Paperwork PM
Amount:
$677.60
Additional Field Engineering Service, 3 Days Information not provided.
Comprehensive coverage verification via field study, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare Form 601 Information not provided.
Project management of the transition Information not provided.
Prepare/ Review 399 reimbursement form

Component Description:
Prepare and/review reimbursement form.
Amount:
$2,500.00
Perform engineering study for displacement application Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepare Displacement Application
Amount:
$275.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Prep and file license to cover
Amount:
$75.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application 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 $2,335.00 $2,335.00 N/A $170.00 N/A
Total for all systems $140,910.40 $124,417.40 N/A $30,230.40 N/A
Other Expenses $2,335.00 $2,335.00 $170.00
Disposal Costs (for equipment and other waste, net of any salvage value) $2,000.00 $2,000.00 3/30/2020- Working to obtain quote which may be delayed due to coronavirus pandemic N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A $170.00 N/A

Components

Actual Information Description File Name
Disposal Costs (for equipment and other waste, net of any salvage value) Information not provided.
FCC Filing Fees - Form 2100 license to cover application

Component Description:
FCC Filing Fee for License to Cover CP
Amount:
$170.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $140,910.40 $124,417.40 $30,230.40

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 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.

DAWN STEWART

APPLICANT


10/14/2020

Attachments

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