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:
168353
Service:
LPT
Call Sign:
K19MN-D
Channel:
19 (UHF)
File Number:
0000089503
FRN:
0014920581
Eligibility Status:
Eligible
Date Submitted:
06/08/2021

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

Pikes Peak Television, Inc.

Doing Business As: Pikes Peak Television, Inc.

825 Edmond Street

St. Joseph, MO 64501

United States

+1 (816) 271-8505 tim.hannan@npgco.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

The Preparer is same as the reimbursement contact.

 

 

 

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. Yes
Briefly describe transition plan Please see Transition Plan Description Exhibit

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 AT7120
Year 2009
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 120 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 UAXTE-1-P1R37
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 200 W
Justification for New Transmitter Please see Transition Plan Description Exhibit

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

Miscellaneous Electrical

Miscellaneous Electrical

Mask Filter System

Mask Filter System

Antennas

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Section Question Response
Antenna Related Expenses Do you have antenna related expenses? Yes

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Purchase New
Antenna Use Primary (Main)
Ownership Owned
Is the existing antenna shared with another station or stations? Yes
Is the existing antenna directional? Yes
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Other
Other Antenna Type Panel
ERP: 0.5 kW
Manufacturer
Model 560-656 MHZ
Year 2009

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

Facility ID Call Sign
59014 KOAA-TV

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? Yes
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types
Mounting Side Mount
Antenna position in stack Middle
Polarization Horizontal
Type Other
Other Antenna Type Panel
ERP: 5.0 kW
Manufacturer
Model 2x3 Broadband Panel
Year 2019
Justification for New Antenna Please see Transition Plan Description Exhibit

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? No
Elbow Complex Do you require the separate purchase of the Elbow Complex? No
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna? No
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? No

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Miscellaneous Antenna Costs

Miscellaneous Antenna Costs

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 Owned
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
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) 38° 59' 11.9" N-
Longitude (NAD83) 105° 04' 09.9" W-
Overall Structure Height 164.04 feet
Support Structure Height 164.04 feet
Ground Elevation Above Mean Sea Level (AMSL) 8979.65 feet
Structure Type LTOWER - Lattice Tower
Tower Owner NPG
Date Constructed 10/30/2019


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

Name Description

Remove Existing 6 Bay Panel Antenna

Remove Existing 6 Bay Panel Antenna

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? No
Outside RF consulting Engineering Services Perform engineering study for displacement application 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 No
Prepare Form 601 No
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 No
Negotiation of Lease and other Matter for Shared Locations No
Prepare or Review FCC Form 399 for Reimbursement Yes
Form 399 assistance or other program management costs 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

Name Description

Additional Displacement Legal Services Not Otherwise Specified in Form 399

Additional Displacement Legal Services Not Otherwise Specified in Form 399

Local City Building Permit for Antenna Installation

Local City Building Permit for Antenna Installation

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)? No
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? No
Does this relocation require Equipment Storage? No
Point to Point Microwave (STL/ICR) Frequency Coordination for Unidirection System No
Frequency Coordination for Bi-Direction System No
New Point to Point Microwave System No

Other Expenses

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Other Expenses Not Listed

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 $29,097.55 $23,429.33 N/A $23,429.33 N/A
Total for all systems $113,756.93 $57,548.51 N/A $50,245.67 N/A
Primary Transmitter UAXTE-1-P1R37 $29,097.55 $23,429.33 $23,429.33
UHF - Air Cooled Solid State Transmitter 160 - 300 Watts $24,300.00 $18,631.78 N/A $18,631.78 N/A
Miscellaneous Electrical $541.26 $541.26 N/A $541.26 N/A
Mask Filter System $4,256.29 $4,256.29 N/A $4,256.29 N/A

Components

Actual Information Description File Name
UHF - Air Cooled Solid State Transmitter 160 - 300 Watts

Component Description:
New UAXTE-1-P1R37 Transmitter
Amount:
$18,631.78
Miscellaneous Electrical

Component Description:
New 20-amp 208-volt circuit from panel to rack; installation of new 20-amp 2-pole breaker in panel
Amount:
$541.26
Mask Filter System

Component Description:
Mask Filter System
Amount:
$4,256.29

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 $8,578.39 $8,578.39 N/A $6,102.15 N/A
Total for all systems $113,756.93 $57,548.51 N/A $50,245.67 N/A
Primary Antenna 2x3 Broadband Panel $8,578.39 $8,578.39 $6,102.15
UHF-Low Power, Side Mount, Other, 5.0kW input, Horizontal $8,235.54 $8,235.54 N/A $5,759.30 N/A
Miscellaneous Antenna Costs $342.85 $342.85 N/A $342.85 N/A

Components

Actual Information Description File Name
UHF-Low Power, Side Mount, Other, 5.0kW input, Horizontal

Component Description:
SCALA Broadband Panel Antenna
Amount:
$4,292.57

Component Description:
SCALA Feed Assembly
Amount:
$1,466.73
Miscellaneous Antenna Costs

Component Description:
UHF Digital Bandpass Filter
Amount:
$342.85

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 $62,248.99 $6,058.99 N/A $6,058.99 N/A
Total for all systems $113,756.93 $57,548.51 N/A $50,245.67 N/A
Primary Tower LTOWER $62,248.99 $6,058.99 $6,058.99
Remove Existing 6 Bay Panel Antenna $6,058.99 $6,058.99 Additional expenses were incurred as indicated in the attached invoices. $6,058.99 Additional expenses were incurred as indicated in the attached invoices.
Tower Rigging Short Tower (less than 500') $56,190.00 $0.00 N/A N/A N/A

Components

Actual Information Description File Name
Remove Existing 6 Bay Panel Antenna

Component Description:
Labor to rig tower and remove existing panel antenna
Amount:
$2,784.80

Component Description:
Labor to rig tower and remove Ch. 45 antenna; additional labor for clearing ice from tower and cables; freight and taxes
Amount:
$3,274.19
Tower Rigging Short Tower (less than 500') 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 $13,497.00 $19,146.80 N/A $14,655.20 N/A
Total for all systems $113,756.93 $57,548.51 N/A $50,245.67 N/A
Outside Professional Services $13,497.00 $19,146.80 $14,655.20
Local City Building Permit for Antenna Installation $500.00 $500.00 N/A $500.00 N/A
Additional Displacement Legal Services Not Otherwise Specified in Form 399 $1,729.50 $1,729.50 Additional expenses were incurred as indicated in the attached invoices. $1,729.50 Additional expenses were incurred as indicated in the attached invoices.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 N/A $575.50 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,025.00 N/A $587.90 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
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,600.00 Additional expenses were incurred as indicated in the attached invoices. $2,600.00 Additional expenses were incurred as indicated in the attached invoices.
Prepare/ Review 399 reimbursement form $1,710.00 $6,787.30 Additional expenses were incurred as indicated in the attached invoices. $6,787.30 Additional expenses were incurred as indicated in the attached invoices.
Perform engineering study for displacement application $1,800.00 $1,875.00 Additional expenses were incurred as indicated in the attached invoices. $1,875.00 N/A

Components

Actual Information Description File Name
Local City Building Permit for Antenna Installation

Component Description:
Assistance with local city building permits for antenna installation
Amount:
$500.00
Additional Displacement Legal Services Not Otherwise Specified in Form 399

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$73.50

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$105.50

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$102.00

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$585.00

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$78.00

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$51.00

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$255.00

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$255.00

Component Description:
Additional Displacement Legal Services Not Otherwise Specified in Form 399
Amount:
$224.50
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Prepare and file displacement license application
Amount:
$575.50
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepare and file displacement construction permit
Amount:
$587.90
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Engineering for Amendment to displacement application for Channel 19 MX resolution
Amount:
$375.00

Component Description:
TPO Calculation for CP configuration
Amount:
$125.00

Component Description:
Engineering for Amendment to displacement application to reflect new antenna
Amount:
$500.00

Component Description:
Engineering portion of displacement application
Amount:
$1,050.00

Component Description:
Engineering for Amendment to displacement application
Amount:
$50.00

Component Description:
Engineering for Amendment to displacement application
Amount:
$500.00
Prepare/ Review 399 reimbursement form

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$1,914.50

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$73.50

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$548.50

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$392.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$539.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$104.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$119.40

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$51.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$1,996.20

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$147.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$147.00

Component Description:
Prepare/review Form 399
Amount:
$91.20

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$147.00

Component Description:
Prepare/ Review 399 reimbursement form
Amount:
$517.00
Perform engineering study for displacement application

Component Description:
TPO Calculations for Displacement Channel
Amount:
$125.00

Component Description:
Search for Displacement Channel
Amount:
$1,500.00

Component Description:
Channel 18 study amendment
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 $335.00 $335.00 N/A $0.00 N/A
Total for all systems $113,756.93 $57,548.51 N/A $50,245.67 N/A
Other Expenses $335.00 $335.00 $0.00
FCC Filing Fees - Form 2100 license to cover application $335.00 $335.00 N/A 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 $113,756.93 $57,548.51 $50,245.67

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. 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.

James W. DeChant

VP of Technology


06/08/2021

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.

James W. DeChant

VP of Technology


06/08/2021

Attachments

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