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:
187708
Service:
LPD
Call Sign:
KGRQ-LD
Channel:
21 (UHF)
File Number:
0000089902
FRN:
0004052791
Eligibility Status:
Eligible
Date Submitted:
03/04/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

GILA RIVER TELECOMMUNICATIONS, INC.

Doing Business As: GILA RIVER TELECOMMUNICATIONS, INC.

James Meyers

BOX 5015, 7065 W. ALLISON RD.

CHANDLER, AZ 85226

United States

+1 (520) 796-8885 jmeyers@gilarivertel.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. No
Briefly describe transition plan Displaced by KTAZ-TV ch. 29 Phoenix 11/30/18. Moved KGRQ-LD to higher elevation 11/29/18 to serve region on channel 21 once served by both KGRY-LD ch. 21 and KGRQ-LD ch. 29. Reusing transmitter, but new mask filter, antenna, and tower reinforcement.

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 Retune Existing
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 Anywave
Model ACT-9XU-1000-AC
Year 2014
Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 1.2 kW

Primary Transmitter

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Retuning Transmitter Costs

Section Question Response
New Mask Filter Does the transmitter require a new mask filter? Yes
Mask Filter Type Full Service
Power 1.1-2kW
New Exciter Is a new exciter needed? No

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 Yes
Size 0.75 inches
Length 20.0 feet
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

Information not provided.

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? No
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 Slotted Coaxial
ERP: 2.0 kW
Manufacturer
Model DLP-10B-21
Year 2014

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 Broadband Panel
Number of Stations Supported 1
Number of Panels/Bays 12
Lower Limit 470.00 MHz
Upper Limit 608.00 MHz
Design power capacity in use 14.0 %
ERP: 15.0 kW
Manufacturer
Model 75010210
Year 2020
Justification for New Antenna New location. Must protect KWBA 21 Sierra Vista with directional antenna.

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? Yes
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
Power Dividers Does the panel antenna require power dividers? Yes
Number of Power Dividers 5
Cable Harness Does the panel antenna require cable harness? Yes
Number of Cable Harnesses 9

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Temporary Antenna Array

Installed 3 UHF broadband antennas and splitter temporarily due to light capacity of tower.

Transmission Line

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

Primary Transmission Line

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Existing Transmission Line

Section Question Response
Existing Transmission Line Description Type of change Purchase New
Use Primary (Main)
Ownership Owned
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 Flexible Foam
Diameter 7/8 inches
Number of parallel runs 1
Length 150 feet per run

Primary Transmission Line

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New Transmission Line

Section Question Response
New Transmission Line Costs Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Type Flexible Foam
Diameter 7/8 inches
Number of parallel runs 1
Length 150 feet per run
Justification for New Transmission Line New tower site. Old transmission cable is not reusable.
Interior RF Systems Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? No

Primary Transmission Line

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Other Transmission Line Expenses Not Listed

Name Description

Mounting Brackets

Heliax tower mounting brackets

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 Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? No
Coordinates (NAD83) Latitude (NAD83) 33° 01' 49.3" N-
Longitude (NAD83) 111° 34' 31.5" W-
Overall Structure Height 120.00 feet
Support Structure Height 120.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 1378.00 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner Gila River Telecommunications Inc
Date Constructed 10/01/2015


Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study need for guyed or free-standing tower
Tower Reinforcements Please select whether tower reinforcements are needed: Minor 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

Name Description

Reinforce Tower

Structural engineering analysis showed existing tower at new site can handle only 3 panel antennas of 12 required. Need steel reinforcement pieces.

Install Temporary Antennas

Installed 3 temporary UHF Broadband Antennas and Splitter, 11/28/2018

Install Final Antennas

After tower reinforcement, we need to install 12 permanent UHF broadband panel antennas and splitters

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 200
Explanation Time for site survey and report, tower antenna installation oversight, electrician oversight, transmitter move, structural analysis correspondence, FCC interface, FCC engineer interface, vendor specification, tower reinforcement, and rigger oversight.
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 2
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 3
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 No

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Transmitter Relocation Assistance

Transmitter relocation assistance, one day plus travel

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 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? 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 $25,950.00 $8,534.26 N/A $8,534.26 N/A
Total for all systems $257,017.67 $99,439.93 N/A $95,074.78 N/A
Primary Transmitter ACT-9XU-1000-AC $25,950.00 $8,534.26 $8,534.26
Retune - UHF and VHF - minor re-channel issues $11,000.00 $0.00 No tuning necessary--same UHF channel. $0.00 N/A
Transmitter Building Site Survey/Installation $10,000.00 $3,795.41 Site survey and report with travel, transmitter move. $3,795.41 N/A
0.75" Rigid Conduit and Wiring $900.00 $900.00 Electrician installation of 3/4" conduit, circuit breaker, and 30A outlet. $900.00 N/A
1.1-2kW w mask filter Full Service $4,050.00 $3,838.85 Actual cost of filter and freight. $3,838.85 N/A

Components

Actual Information Description File Name
Retune - UHF and VHF - minor re-channel issues Information not provided.
Transmitter Building Site Survey/Installation

Component Description:
KGRQ-LD Sacaton Peak, AZ new transmitter site survey and management strategy meeting
Amount:
$2,015.50

Component Description:
Refund for labor overcharge. See letter of explanation with submission.
Amount:
($570.00)

Component Description:
Channel 21 transmitter move from KGRY-LD to KGRQ-LD new site, including labor, travel, and an electrical cable assembly.
Amount:
$1,903.84

Component Description:
Refund for labor overcharge. See letter of explanation with submission.
Amount:
($615.29)

Component Description:
Mask Filter installation portion of invoice.
Amount:
$1,061.36
0.75" Rigid Conduit and Wiring

Component Description:
Install two electrical outlets for existing transmitter moved to this site on Sacaton Peak, AZ.
Amount:
$900.00
1.1-2kW w mask filter Full Service

Component Description:
Transmitter 1.4kW Full Service Mask Filter including shipping
Amount:
$3,838.85

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 $48,104.95 $32,040.78 N/A $32,040.78 N/A
Total for all systems $257,017.67 $99,439.93 N/A $95,074.78 N/A
Primary Antenna 75010210 $48,104.95 $32,040.78 $32,040.78
Temporary Antenna Array $6,979.95 $6,979.95 3 Used Kathrein K723147 UHF Panel Antennas with 3 Heliax link cables, mounting bolts. Plus new Kathrein power splitter and splitter mounting brackets. $6,979.95 N/A
Side Mount antenna brackets $4,625.00 $0.00 Included in antenna system quote N/A N/A
UHF Broadband panel antenna (per panel), horizontally-polarized $21,000.00 $25,060.83 Permanent horizontally-polarized 12-panel UHF antenna array. $25,060.83 Permanent 12-panel UHF horizontally-polarized antenna array.
Cable harness (each, for panel antenna system, if not included in antenna cost) $9,000.00 $0.00 Included in antenna system quote N/A N/A
Power Dividers (each, for panel antenna system, if not included in antenna cost) $6,500.00 $0.00 Included in antenna system quote N/A N/A

Components

Actual Information Description File Name
Temporary Antenna Array

Component Description:
Temporary, used UHF transmit antenna--no labor. Qty 3 Scala K723147 plus mounting and interconnecting cables
Amount:
$2,614.97

Component Description:
Refund for labor overcharge. See letter of explanation with submission.
Amount:
($1,782.66)

Component Description:
Temporary UHF Transmit Antenna, new power splitter and mounting brackets only
Amount:
$627.74

Component Description:
Temporary UHF Transmit Antenna, engineering and supervision labor portion only
Amount:
$5,519.90
Side Mount antenna brackets Information not provided.
UHF Broadband panel antenna (per panel), horizontally-polarized

Component Description:
Permanent 12-panel horizontally-polarized UHF antenna array with mounts, splitters, and interconnecting cables, and freight.
Amount:
$25,060.83
Cable harness (each, for panel antenna system, if not included in antenna cost) Information not provided.
Power Dividers (each, for panel antenna system, if not included in antenna cost) Information not provided.

Cost Information

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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 $1,650.00 $1,255.08 N/A $1,255.08 N/A
Total for all systems $257,017.67 $99,439.93 N/A $95,074.78 N/A
Primary Transmission Line $1,650.00 $1,255.08 $1,255.08
Flexible Foam Transmission Line - dielectric, 7/8" $1,650.00 $1,255.08 Includes tower mounting brackets and connectors $1,255.08 N/A
Mounting Brackets $0.00 $0.00 Included in cost of transmission line N/A N/A

Components

Actual Information Description File Name
Flexible Foam Transmission Line - dielectric, 7/8"

Component Description:
Transmission Line for permanent use. Includes hangers, connectors, grounding kits, and shipping.
Amount:
$1,255.08
Mounting Brackets 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 $79,942.00 $25,052.00 N/A $23,552.00 N/A
Total for all systems $257,017.67 $99,439.93 N/A $95,074.78 N/A
Primary Tower TOWER $79,942.00 $25,052.00 $23,552.00
Install Temporary Antennas $2,950.00 $2,950.00 N/A $2,950.00 N/A
Study needed for guyed or free-standing tower $8,700.00 $7,000.00 Actual cost for tower structural analyses, one for temporary antenna and one for permanent antenna array. $7,000.00 N/A
Reinforce Tower $0.00 $0.00 N/A $0.00 N/A
Install Final Antennas $9,350.00 $9,350.00 N/A $9,350.00 Includes minor tower reinforcement.
Minor tower reinforcement/modifications $2,752.00 $2,752.00 Additional steel elements required to modify tower to hold final configuration of the permanent 12-bay antenna needed to serve the same areas as before the repack. Materials and shipping only. Installation included in tower rigger charges. $2,752.00 N/A
Tower Rigging Short Tower (less than 500') $56,190.00 $3,000.00 No additional costs. $1,500.00 Tower rigger removal of antennas associated with this displacement. Does not include disposal or installation of permanent antenna, listed under other categories.

Components

Actual Information Description File Name
Install Temporary Antennas

Component Description:
Temporary UHF Transmit Antenna Array Rigging
Amount:
$2,950.00
Study needed for guyed or free-standing tower

Component Description:
Revised structural analysis with simplified reinforcement recommendations for permanent 12-bay UHF antenna array
Amount:
$1,850.00

Component Description:
Tower structural analysis good only for temporary transmit antenna array
Amount:
$5,000.00

Component Description:
Tower reinforcement research, communications with structural engineer at Sabre Towers.
Amount:
$150.00
Reinforce Tower Information not provided.
Install Final Antennas

Component Description:
Tower rigger installation of minor tower reinforcement and permanent 12-panel antenna array
Amount:
$9,350.00
Minor tower reinforcement/modifications

Component Description:
Tower steel reinforcement materials, including shipping.
Amount:
$2,752.00
Tower Rigging Short Tower (less than 500')

Component Description:
Removal of previous channel 21 site antenna from "Blackwater" tower.
Amount:
$1,500.00

Component Description:
Removal of displaced KGRQ-LD channel 29 antenna from "Stotonic" site.
Amount:
$1,500.00

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 $98,920.72 $31,857.81 N/A $29,342.66 N/A
Total for all systems $257,017.67 $99,439.93 N/A $95,074.78 N/A
Outside Professional Services $98,920.72 $31,857.81 $29,342.66
Transmitter Relocation Assistance $2,658.22 $2,658.22 Two days labor plus travel to Phoenix from San Diego for Paul Redfield (Orbdot, Inc.) assistance with moving and installation of the transmitter from Blackwater, AZ to KGRQ-LD new location at Sacaton Peak, AZ $2,658.22 N/A
Comprehensive coverage verification via field study, if needed $52,600.00 $4,244.59 N/A $4,244.59 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $0.00 N/A N/A N/A
Prepare Form 601 $755.00 $0.00 N/A N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $1,260.00 N/A $1,260.00 N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $225.00 N/A $225.00 N/A
Project management of the transition $21,100.00 $13,000.00 Displacement communications with attorney and engineers, structural engineer communication, vendor product specification, transmitter relocation, rigger supervision, FCC filing of STA extensions and license cancellation $10,484.85 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $625.00 N/A $625.00 N/A
Prepare request for Special Temporary Authorization $2,560.00 $2,300.00 N/A $2,300.00 N/A
Perform engineering study for displacement application $1,800.00 $1,275.00 N/A $1,275.00 N/A
Form 399 assistance or other Program Management costs $1,275.00 $1,275.00 N/A $1,275.00 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $3,600.00 Time required to complete tasks for Form 399 filing, and revisions exceeded the predetermined estimate. $3,600.00 Filing of FCC Form 399 has taken longer than originally estimated.
Attorney Fees - Prepare and File request for Special Temporary Authorization $6,705.00 $1,395.00 N/A $1,395.00 N/A

Components

Actual Information Description File Name
Transmitter Relocation Assistance

Component Description:
Assistance with transmitter move to new KGRQ-LD site at Sacaton Pk, AZ by Paul Redfield of Orbdot, Inc.
Amount:
$2,658.22
Comprehensive coverage verification via field study, if needed

Component Description:
Final, superficial signal survey after installation of permanent antenna system.
Amount:
$1,824.54

Component Description:
Superficial signal strength survey to confirm operation of temporary transmission system after installation of antenna and transmitter at new Sacaton Peak, AZ site.
Amount:
$1,511.02

Component Description:
Superficial signal survey after displacement transmitter move to new site.
Amount:
$1,068.42

Component Description:
Refund for labor overcharge. See letter of explanation with submission.
Amount:
($159.39)
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare Form 601 Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepare and file FCC Form 2100 application for displacement construction permit for KGRQ-LD on channel 21
Amount:
$1,260.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
File FCC License to Cover Application
Amount:
$225.00
Project management of the transition

Component Description:
Form 399 Admin, antenna wiring schematic drawing for riggers, rigger correspondence
Amount:
$1,162.50

Component Description:
Refund for labor overcharge. See letter of explanation with submission.
Amount:
($330.00)

Component Description:
Mutually exclusive application for channel 21 talks with Globe Broadcasting
Amount:
$262.50

Component Description:
Various KGRQ-LD transition project management functions: correspondence with engineers, FCC, and vendors; transport and reconditioning of temporary UHF transmit panel antennas.
Amount:
$825.00

Component Description:
Review FCC filing, create structural engineering specifications, specify tower work with rigger
Amount:
$600.00

Component Description:
Refund for labor overcharge. See letter of explanation with submission.
Amount:
($180.00)

Component Description:
Refund for labor overcharge. See letter of explanation with submission.
Amount:
($285.00)

Component Description:
Project management, Form 399 administration
Amount:
$450.00

Component Description:
Project management portion - permanent antenna installation supervision
Amount:
$3,652.35

Component Description:
KGRQ-LD displacement MX application settlement communications and FCC filings
Amount:
$525.00

Component Description:
Correspondence with tower rigger and KGRQ-LD station management. (Apportioned)
Amount:
$150.00

Component Description:
Initial displacement technical strategy talks and report
Amount:
$450.00

Component Description:
Reimbursement admin, tower specifications and correspondence
Amount:
$2,362.50

Component Description:
File FCC cancellation of KGRY-LD 21 license due to its channel 21 displacement by KGRQ-LD after displacement on channel 29 by KTAZ 29
Amount:
$150.00

Component Description:
Refund for labor overcharge. See letter of explanation with submission.
Amount:
($105.00)

Component Description:
Project management duties - Form 399 management, vendor correspondence, client communications
Amount:
$1,050.00

Component Description:
Refund for labor overcharge. See letter of explanation with submission.
Amount:
($255.00)
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Preparation of engineering portion of Form 2100 displacement construction permit for channel 21
Amount:
$625.00
Prepare request for Special Temporary Authorization

Component Description:
Extension of STA due to need for tower reinforcement.
Amount:
$150.00

Component Description:
File silent STA for KGRY-LD, superseded in move of KGRQ-LD.
Amount:
$750.00

Component Description:
Extension of STA due to pandemic and excessive site heat.
Amount:
$150.00

Component Description:
Preparation of engineering portion of request for KGRQ-LD STA on channel 21.
Amount:
$950.00

Component Description:
File KGRQ-LD STA extension due to tower reinforcement delays (unable to find suitable contractor)
Amount:
$150.00

Component Description:
File KGRQ-LD STA extension due to pandemic
Amount:
$150.00
Perform engineering study for displacement application

Component Description:
Engineering study for Form 2100 displacement construction permit for KGRQ-LD move to channel 21
Amount:
$625.00

Component Description:
FCC Engineer displacement amendment interference study
Amount:
$650.00
Form 399 assistance or other Program Management costs

Component Description:
Form 399 reimbursement administration - submitting, organizing invoices, FCC correspondence.
Amount:
$1,087.50

Component Description:
Form 399 reimbursement administration - filing, clarifications, correspondence, certification
Amount:
$187.50
Prepare/ Review 399 reimbursement form

Component Description:
Initial FCC Form 399 input
Amount:
$3,600.00
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Filing of KGRQ-LD STA and MX settlement
Amount:
$1,395.00

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 $2,450.00 $700.00 N/A $350.00 N/A
Total for all systems $257,017.67 $99,439.93 N/A $95,074.78 N/A
Other Expenses $2,450.00 $700.00 $350.00
Disposal Costs (for equipment and other waste, net of any salvage value) $700.00 $700.00 Disposal of channel 29 slot antenna array plus disposal of previous channel 21 slot antenna array and transmission line. $350.00 N/A
FCC Filing Fees - Special Temporary Authorization request $305.00 $0.00 KGRQ-LD is a tribal governmental agency and should not be subject to FCC filing fees. N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $0.00 KGRQ-LD is a tribal governmental agency and should not be subject to fees. N/A N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $0.00 KGRQ-LD is a tribal governmental agency and should not be subject to FCC filing fees. N/A N/A
Equipment Delivery and Handling Charges $0.00 $0.00 N/A N/A N/A

Components

Actual Information Description File Name
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Disposal of superceded channel 21 transmit antenna.
Amount:
$350.00

Component Description:
Disposal of displaced KGRQ-LD channel 29 antenna
Amount:
$350.00
FCC Filing Fees - Special Temporary Authorization request Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
Equipment Delivery and Handling Charges Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $257,017.67 $99,439.93 $95,074.78

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.

Gary L Stigall

Technical Consultant


03/04/2021

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.

Gary L Stigall

Technical Consultant


03/04/2021

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.

Gary L Stigall

Technical Consultant


03/04/2021

Attachments

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