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:
67007
Service:
LPD
Call Sign:
K34ND-D
Channel:
34 (UHF)
File Number:
0000083936
FRN:
0003716198
Eligibility Status:
Eligible
Date Submitted:
01/14/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

THREE ANGELS BROADCASTING NETWORK, INC.

Doing Business As: THREE ANGELS BROADCASTING NETWORK, INC.

MOSES PRIMO

PO BOX 220

WEST FRANKFORT, IL 62896

United States

+1 (618) 627-4651 TECH@3ABN.ORG Not-for-Profit

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

Samuel Hariton

Widelity

Samuel Hariton

PO Box 220

Ste 100

Fairfax, VA 22030

United States

+1 (339) 222-8107 sam.hariton@widelity.com

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 Replace transmitter and move to new site.

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 TXUP1000LD
Year 2007
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1 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 TMU9evo-3
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.15 kW
Justification for New Transmitter Old transmitter was converted from analog service.

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) 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

Primary Transmitter - Disposal

Primary Transmitter - Disposal

Primary Transmitter- Installation

Primary Transmitter- Installation

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? Yes

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) No
Others Types of Users Yes
Is tower documented for structural analysis? No
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? No
Coordinates (NAD83) Latitude (NAD83) 47° 19' 13.0" N-
Longitude (NAD83) 119° 48' 04.5" W-
Overall Structure Height 33.00 feet
Support Structure Height 33.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 2884.00 feet
Structure Type POLE - Any type of Pole
Tower Owner LocalTel
Date Constructed 01/01/1990


Other Types of Users

Users
DK33EH-D
DK24AI-D
DK21AJ-D

Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: No study needed
Tower Reinforcements Please select whether tower reinforcements are needed: No reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower N/A
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 194
Explanation K34ND-D does not have sufficient resource capacity and expertise in house to handle all activities necessary for completion of the station's build by the construction deadline. K34ND-D will hire an outside firm to facilitate a timely transition.
Outside RF consulting Engineering Services Perform engineering study for displacement application Yes
Prepare engineering section of Form FCC Construction Permit Application No
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 No
Form 399 assistance or other program management costs No
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? Yes
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

Travel to site

Travel to site.

399 Preparation

399 Preparation

Displacement Application

Displacement Application

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 $86,150.00 $41,528.72 N/A $39,378.72 N/A
Total for all systems $175,659.50 $57,407.52 N/A $41,892.52 N/A
Primary Transmitter TMU9evo-3 $86,150.00 $41,528.72 $39,378.72
Primary Transmitter- Installation $591.55 $591.55 Please see Peek Enterprises quote 2020029Q $0.00 N/A
Primary Transmitter - Disposal $1,558.45 $1,558.45 Please see Peek Enterprises quote 2020029Q $0.00 N/A
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $84,000.00 $39,378.72 Please see Estimated Cost Justification K34ND-D-110-Primary Transmitter - UHF Air Cooled Solid State, 1-2.5 kW V0 $39,378.72 N/A

Components

Actual Information Description File Name
Primary Transmitter- Installation

Component Description:
K34ND-D-110-Primary Transmitter - Installation
Amount:
$591.55
Primary Transmitter - Disposal

Component Description:
K34ND-D-110-Primary Transmitter - Disposal
Amount:
$1,558.45
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
TMU9evo-3 Transmitter System
Amount:
$36,461.78

Component Description:
Milestone Payments
Amount:
$2,916.94

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

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 $56,190.00 $3,040.00 N/A $0.00 N/A
Total for all systems $175,659.50 $57,407.52 N/A $41,892.52 N/A
Primary Tower POLE $56,190.00 $3,040.00 $0.00
Tower Rigging Short Tower (less than 500') $56,190.00 $3,040.00 Please see Peek Enterprises quote 2020029Q $0.00 N/A

Components

Actual Information Description File Name
Tower Rigging Short Tower (less than 500')

Component Description:
Deployment
Amount:
$3,040.00

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $23,319.50 $2,838.80 N/A $2,513.80 N/A
Total for all systems $175,659.50 $57,407.52 N/A $41,892.52 N/A
Outside Professional Services $23,319.50 $2,838.80 $2,513.80
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $75.00 Please see Peek Enterprises quote 2020043Q $0.00 N/A
Perform engineering study for displacement application $1,800.00 $250.00 Please see Peek Enterprises quote 2020043Q $0.00 N/A
Project management of the transition $20,467.00 $2,513.80 Please see K34ND-D Project Management Budget Revision Justification Letter $2,513.80 N/A

Components

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

Component Description:
K34ND-D-530- RF Engineering-License to Cover-Main
Amount:
$75.00
Perform engineering study for displacement application

Component Description:
Interference study and application preparation
Amount:
$250.00
Project management of the transition

Component Description:
Project Management
Amount:
$854.80

Component Description:
Project Management
Amount:
$558.55

Component Description:
Project management
Amount:
$652.05

Component Description:
Project Management
Amount:
$448.40

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 $10,000.00 $10,000.00 N/A $0.00 N/A
Total for all systems $175,659.50 $57,407.52 N/A $41,892.52 N/A
Other Expenses $10,000.00 $10,000.00 $0.00
399 Preparation $2,000.00 $2,000.00 N/A $0.00 N/A
Travel to site $5,000.00 $5,000.00 N/A N/A N/A
Equipment Delivery and Handling Charges $1,000.00 $1,000.00 N/A N/A N/A
Displacement Application $2,000.00 $2,000.00 N/A $0.00 N/A

Components

Actual Information Description File Name
399 Preparation

Component Description:
K34ND-D-610-Form 399 Preparation
Amount:
$75.00
Travel to site Information not provided.
Equipment Delivery and Handling Charges Information not provided.
Displacement Application

Component Description:
K34ND-D-610-Displacement Application
Amount:
$350.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $175,659.50 $57,407.52 $41,892.52

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.

Daniel Peek , Peek .

RF Engineer


01/14/2021

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.

Daniel Peek , Peek .

RF Engineer


01/14/2021

Attachments

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