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:
43383
Service:
LPT
Call Sign:
K29LO-D
Channel:
29 (UHF)
File Number:
0000089894
FRN:
0001591460
Eligibility Status:
Eligible
Date Submitted:
04/22/2022

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? No

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? No
Existing Antenna Manufacturer and Type
Mounting Top Mount
Antenna position in stack Top
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 3
Number of Panels 12
Design power capacity in use 25.0 %
Lower Limit 560.00 MHz
Upper Limit 566.00 MHz
ERP: 100.0 W
Manufacturer
Model BCA/MJ
Year 2019

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

Facility ID Call Sign
43386 K35MX-D
43379 K33OD-D

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? No
New Antenna Manufacturer and Types
Mounting Top Mount
Antenna position in stack Top
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 3
Number of Panels/Bays 12
Lower Limit 560.00 MHz
Upper Limit 566.00 MHz
Design power capacity in use 25.0 %
ERP: 100.0 W
Manufacturer
Model BCA/MJ
Year 2019
Justification for New Antenna T-Mobile/Re-Pack required. New channel assignments required combined antenna due to no available tower space.

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
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 2
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 Yes
Type 6/11 GHz Licensed Part 101

Other Expenses

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Other Expenses Not Listed

Name Description

Hayden to Goat Hill

Required due to co-channeling of Rx/Tx frequencies in proximity.

Staff expenses

8 hours at 63.90

Technical staff expenxe

2 hours at 33.95

Construction expense

Antenna removal, install, cabling, dressing and grounding.

Cost Information

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Transmitters

Information not provided.

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 $23,600.00 $6,532.65 N/A $6,532.65 N/A
Total for all systems $67,686.93 $29,478.40 N/A $29,478.40 N/A
Primary Antenna BCA/MJ $23,600.00 $6,532.65 $6,532.65
Power Dividers (each, for panel antenna system, if not included in antenna cost) $2,600.00 $0.00 N/A N/A N/A
UHF Broadband panel antenna (per panel), horizontally-polarized $21,000.00 $6,532.65 Actual cost $6,532.65 N/A

Components

Actual Information Description File Name
Power Dividers (each, for panel antenna system, if not included in antenna cost) Information not provided.
UHF Broadband panel antenna (per panel), horizontally-polarized

Component Description:
Purchase of antennas.
Amount:
$6,532.65

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 $5,175.09 N/A $5,175.09 N/A
Total for all systems $67,686.93 $29,478.40 N/A $29,478.40 N/A
Outside Professional Services $9,557.50 $5,175.09 $5,175.09
Perform engineering study for displacement application $1,800.00 $0.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $890.37 Actual. $890.37 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $0.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $4,284.72 Actual cost $4,284.72 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $0.00 N/A N/A N/A

Components

Actual Information Description File Name
Perform engineering study for displacement application Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Legal services.
Amount:
$8.50

Component Description:
Legal services.
Amount:
$8.83

Component Description:
Legal services.
Amount:
$107.67

Component Description:
Legal services.
Amount:
$28.33

Component Description:
Legal services.
Amount:
$132.50

Component Description:
Legal services.
Amount:
$8.83

Component Description:
Legal services.
Amount:
$138.89

Component Description:
Legal services.
Amount:
$44.17

Component Description:
Legal services.
Amount:
$222.22

Component Description:
Legal services.
Amount:
$9.33

Component Description:
Legal services.
Amount:
$181.10
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Engineering assistance with FCC questions.
Amount:
$34.72

Component Description:
Engineering portion of applications (early launch) for displacement; engineering portions of requests for Special Temporary Authority including engineering support for requests for waiver.
Amount:
$3,000.00

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

Component Description:
Preparation and submittal of license. This is a flat fee.
Amount:
$250.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $34,529.43 $17,770.66 N/A $17,770.66 N/A
Total for all systems $67,686.93 $29,478.40 N/A $29,478.40 N/A
Other Expenses $34,529.43 $17,770.66 $17,770.66
Technical staff expenxe $60.43 $60.43 Actual Costs. $60.43 04/14/22: Uploaded corrected memo for invoice 30253 04/22/22: Uploaded corrected memo for invoice 30253.
Staff expenses $529.00 $529.00 Actual internal labor costs. $529.00 04/14/22: Uploaded corrected memo for invoice 1.
Construction expense $5,440.00 $5,440.00 Actual $5,440.00 N/A
Hayden to Goat Hill $0.00 $0.00 N/A N/A N/A
New Point to Point Microwave System: 6/11 GHz Licensed Part 101 $28,500.00 $11,741.23 Actual cost for microwave. $11,741.23 Purchase of microwaves was needed to remove interference and allow the County to continue serving its customers.

Components

Actual Information Description File Name
Technical staff expenxe

Component Description:
Technical staff charges to assist with applications.
Amount:
$60.43

Component Description:
Technical staff charges to work on applications.
Amount:
$60.73

Component Description:
Technical staff charges to assist with repackaging applications.
Amount:
$60.43
Staff expenses

Component Description:
Internal staff charges to work on applications.
Amount:
$529.00

Component Description:
Internal staff charges for repackaging.
Amount:
$529.00
Construction expense

Component Description:
TV maintenance labor for repackaging.
Amount:
$5,440.00
Hayden to Goat Hill Information not provided.
New Point to Point Microwave System: 6/11 GHz Licensed Part 101

Component Description:
Purchase of microwaves. Needed to reduce interference from repackaging.
Amount:
$11,741.23

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $67,686.93 $29,478.40 $29,478.40

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


04/22/2022

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


04/22/2022

Attachments

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