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:
43398
Service:
LPT
Call Sign:
K26OK-D
Channel:
26 (UHF)
File Number:
0000089963
FRN:
0001591460
Eligibility Status:
Eligible
Date Submitted:
02/18/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

MOHAVE COUNTY BOARD OF SUPERVISORS

Applicant

Doing Business As: MOHAVE COUNTY BOARD OF SUPERVISORS

Barbara Spoonhour

PO BOX 7000

KINGMAN, AZ 86402

United States

+1 (928) 753-0729 spoonb@mohave.gov Other

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 Transition complete required based on T-Mobile/FCC Repackaging

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? No
Existing Transmitter Manufacturer and Type Manufacturer
Model PA-140 UHF
Year 2019
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 140 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? Yes
Manufacturer
Model PA UHF 140
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 140 W
Justification for New Transmitter To facilitate T-Mobile/FCC Repackaging

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 Yes
Size 1 inches
Length 26.0 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? Yes
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 Top Mount
Antenna position in stack Top
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels 4
Design power capacity in use 25.0 %
Lower Limit 542.00 MHz
Upper Limit 548.00 MHz
ERP: 200.0 W
Manufacturer
Model 4DR-4S
Year 2019

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 Top Mount
Antenna position in stack Top
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels/Bays 4
Lower Limit 542.00 MHz
Upper Limit 548.00 MHz
Design power capacity in use 25.0 %
ERP: 100.0 W
Manufacturer
Model 4DR-4S
Year 2019
Justification for New Antenna Existing antenna system cannot be modified or re-tuned. Requires specific build to match frequency.

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
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 1
Cable Harness Does the panel antenna require cable harness? No

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

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? 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 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? 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

Name Description

Construction

Actual

Staff expenses

6 hours at 63.90

Technical staff expense

2 hours at 40.00

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 $15,625.00 $11,710.80 N/A $1,875.00 N/A
Total for all systems $38,063.50 $25,897.07 N/A $15,265.35 N/A
Primary Transmitter PA UHF 140 $15,625.00 $11,710.80 $1,875.00
1" Rigid Conduit and Wiring $1,875.00 $1,875.00 The actual cost was higher than the original estimated cost. $1,875.00 The actual cost for rewiring was higher than the original estimate.
UHF - Air Cooled Solid State Transmitter 50.001 - 150 Watts $13,750.00 $9,835.80 Actual $0.00 N/A

Components

Actual Information Description File Name
1" Rigid Conduit and Wiring

Component Description:
Commercial rewiring services.
Amount:
$1,875.00
UHF - Air Cooled Solid State Transmitter 50.001 - 150 Watts

Component Description:
Purchase of transmitter.
Amount:
$9,835.80

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 $8,300.00 $6,430.19 N/A $5,654.51 N/A
Total for all systems $38,063.50 $25,897.07 N/A $15,265.35 N/A
Primary Antenna 4DR-4S $8,300.00 $6,430.19 $5,654.51
UHF Broadband panel antenna (per panel), horizontally-polarized $7,000.00 $4,928.00 The original estimate did not include the sales tax that was erroneously missing from WECOM Invoice 150491. The estimate also did not include the purchase of band pas filters. $4,871.46 N/A
Power Dividers (each, for panel antenna system, if not included in antenna cost) $1,300.00 $1,502.19 Actual $783.05 N/A

Components

Actual Information Description File Name
UHF Broadband panel antenna (per panel), horizontally-polarized

Component Description:
Purchase of band pass filter.
Amount:
$519.65

Component Description:
Sales tax that was erroneously missing from WECOM Invoice #150491.
Amount:
$323.10

Component Description:
Purchase of antennas.
Amount:
$4,028.71
Power Dividers (each, for panel antenna system, if not included in antenna cost)

Component Description:
Shipping on dividers was erroneously excluded from WECOM invoice 150491.
Amount:
$58.81

Component Description:
Purchase of Dividers.
Amount:
$724.24

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 $9,557.50 $3,175.08 N/A $3,175.08 N/A
Total for all systems $38,063.50 $25,897.07 N/A $15,265.35 N/A
Outside Professional Services $9,557.50 $3,175.08 $3,175.08
Perform engineering study for displacement application $1,800.00 $0.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $0.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $2,284.72 Actual $2,284.72 The estimated amount and the actuals are the same.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $0.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $890.36 The actual costs were higher than the estimated amount. $890.36 The actual costs were higher than the original estimate.

Components

Actual Information Description File Name
Perform engineering study for displacement application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Study of Mohave County's overall channel plan compatibility and antenna designs required due to FCC incentive auction.
Amount:
$1,000.00

Component Description:
Engineering portions of applications for displacement, including request for waiver for contingent filing.
Amount:
$1,000.00

Component Description:
Engineering assistance with Mohave County responses to FCC.
Amount:
$34.72

Component Description:
Preparation and submittal of license.
Amount:
$250.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Legal services for repackaging.
Amount:
$9.33

Component Description:
Legal services for repackaging.
Amount:
$8.83

Component Description:
Legal services for repackaging.
Amount:
$181.10

Component Description:
Legal services for repackaging.
Amount:
$132.50

Component Description:
Legal services for repackaging.
Amount:
$8.83

Component Description:
Legal services for repackaging.
Amount:
$138.89

Component Description:
Legal services for repackaging.
Amount:
$222.21

Component Description:
Legal services for repackaging.
Amount:
$8.50

Component Description:
Legal services for repackaging.
Amount:
$107.67

Component Description:
Legal services for repackaging.
Amount:
$28.33

Component Description:
Legal services for repackaging.
Amount:
$44.17

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 $4,581.00 $4,581.00 N/A $4,560.76 N/A
Total for all systems $38,063.50 $25,897.07 N/A $15,265.35 N/A
Other Expenses $4,581.00 $4,581.00 $4,560.76
Staff expenses $421.00 $421.00 The actual staff time cost was higher than the original estimate. $420.33 The actual staff time was higher than the original estimate.
Technical staff expense $80.00 $80.00 Actual $60.43 N/A
Construction $4,080.00 $4,080.00 Actual $4,080.00 N/A

Components

Actual Information Description File Name
Staff expenses

Component Description:
Mohave County staff time working on repackaging.
Amount:
$420.33
Technical staff expense

Component Description:
Engineering staff time assisting with application process.
Amount:
$60.43
Construction

Component Description:
Installation costs.
Amount:
$4,080.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $38,063.50 $25,897.07 $15,265.35

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.

Barbara Jo Spoonhour

Administrative Services Director


02/18/2022

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.

Barbara Jo Spoonhour

Administrative Services Director


02/18/2022

Attachments

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