TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
ONEIDA COUNTY TRANSLATOR DISTRICT Doing Business As: ONEIDA COUNTY TRANSLATOR DISTRICT	ONEIDA COUNTY TRANSLATOR DISTRICT 10 COURT STREET MALAD CITY, ID 83252 United States	+1 (208) 315-0513	NAJAUSSI@YAHOO.COM	Government Entity

Applicant

Address

Phone

Applicant Type

ONEIDA COUNTY TRANSLATOR DISTRICT

Doing Business As: ONEIDA COUNTY TRANSLATOR DISTRICT

ONEIDA COUNTY TRANSLATOR DISTRICT

10 COURT STREET

MALAD CITY, ID 83252

United States

+1 (208) 315-0513

NAJAUSSI@YAHOO.COM

Government Entity

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant	Address	Phone	Email
[Confidential]

Preparer Contact Information

Preparer Contact Name and Information

Applicant	Address	Phone	Email
The Preparer is same as the reimbursement contact.

Broadcaster Information and Transition Plan

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 K47MH-D to K25PO-D. Install new Antenna and channel combiner. Coordinated efforts with Idaho Public Television to design new relay from Holbrook to Malad for KISU, KIDK. Added a new facility. Costs shared with Idaho Public Television.

Transmitters

Section	Question	Response
Transmitter Related Expenses	Do you have transmitter related expenses?	No

Antennas

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

Primary Antenna

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?	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	Other
	Other Antenna Type	Paraslot
	ERP:	1.0 kW
	Manufacturer
	Model	SL8-3
	Year	2014

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

Facility ID	Call Sign
191248	K31PJ-D
182578	K21OA-D

Primary Antenna

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	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Broadband Panel
	Number of Stations Supported	3
	Number of Panels/Bays	4
	Lower Limit	470.00 MHz
	Upper Limit	860.00 MHz
	Design power capacity in use	40.0 %
	ERP:	1.0 kW
	Manufacturer
	Model	K72314
	Year	2018
	Justification for New Antenna	The original para slot antenna was made for UHF channels 43,45,47 and was not re-tunable. A new broadband antenna was needed.

Primary Antenna

Other Antenna Costs

Section	Question	Response
Combiner for Shared Antenna	Do you need a Combiner for a Shared Antenna?	Yes
	Type	New
	Number of channels supported	3
	Frequencies of channels supported	RF channel
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
Power Dividers	Does the panel antenna require power dividers?	No
Cable Harness	Does the panel antenna require cable harness?	No

Enter a list of RF channel numbers.

RF Channel Number
31
21
25

Primary Antenna

Other Antenna Cost Not Listed

Name	Description
Antenna Clamps	Additional mounting clamps needed due to Salesperson Error on original order.
Antenna Installation	Installation of new Antenna array by CWC Construction.

Transmission Line

Section	Question	Response
Transmission Line Related Expenses	Do you have transmission line related expenses?	No

Tower Equipment And Rigging Costs

Section	Question	Response
Tower Equipment or Rigging Costs Changes	Do you have tower equipment or rigging costs changes?	No

Outside Professional Services Costs

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	No
	Prepare engineering section of Form FCC License to Cover Application	No
	Prepare request for Special Temporary Authority	No
	Prepare Form 601	No
Attorney and Other Outside Consulting Services	Prepare and file Form FCC Construction Permit Application	No
	Prepare and file Form FCC License to Cover Application	No
	Prepare request for Special Temporary Authority	No
	Negotiation of Lease and other Matter for Shared Locations	No
	Prepare or Review FCC Form 399 for Reimbursement	No
	Form 399 assistance or other program management costs	Yes
RF Field Engineering Services	Comprehensive coverage verification via field study	No
	RF exposure measurements	No
	Additional Field Engineering Service	No

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Name	Description
Jaussi Electronics	Planning and Engineering services for transitioning K47MH-D to new channel
399 Review	Review documents, make corrections to 399 for re-submission

Other Expenses

Section	Question	Response
AM Pattern Disturbance	Is an Impact Study needed?	No
AM Pattern Disturbance	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

Other Expenses Not Listed

Name	Description
Air conditioners	Air conditioners for new building
Anywave exciters	Quantity of two purchased for new relay.
B. W. St. Clair	STA preparation and filing
Ken Eliason	Back Hoe work for new building
New Building for relay	New building for KIDK, KISU relay to Malad
VHF Transmitter	VHF transmitter for New relay for KIDK and KISU Idaho public Television
new building wiring	New building wiring charges from D & T Electric
transmission line	Transmission line used for transmit and receive antennas for KISU, KIDK relay
Border States electrical	building electrical supplies 1
Electrical wholesale.002	building electrical s4524447.002
Hess Lumber 10-31-18	building electrical 10/31/18
Hess lumber 8-31-18	building Electrical 8-31-18
lowes, home depot	lowe's, home depot electrical supplies

Cost Information

Transmitters

Information not provided.

Cost Information

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	$21,480.00	$380.00	N/A	$380.00	N/A
Total for all systems	$24,546.66	$1,746.66	N/A	$1,746.66	N/A
Primary Antenna K72314	$21,480.00	$380.00		$380.00
Antenna Installation	$380.00	$380.00	N/A	$380.00	N/A
Antenna Clamps	$0.00	$0.00	N/A	$0.00	N/A
1 kW UHF Combiner (per channel)	$14,100.00	$0.00	N/A	$0.00	N/A
UHF Broadband panel antenna (per panel), horizontally-polarized	$7,000.00	$0.00	N/A	$0.00	N/A

Components

Actual Information Description	File Name
Antenna Installation	Component Description: installation Amount: $380.00 Component Description: antenna installation Amount: $380.00
Antenna Clamps	Information not provided.
1 kW UHF Combiner (per channel)	Information not provided.
UHF Broadband panel antenna (per panel), horizontally-polarized	Component Description: Invoice total $5598.26 minus Idaho PBS reimbursement of $1866.00 equals $3732.26 Amount: $3,732.26

Cost Information

Transmission Line

Information not provided.

Cost Information

Tower Equipment and Rigging Costs

Information not provided.

Cost Information

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	$3,066.66	$1,366.66	N/A	$1,366.66	N/A
Total for all systems	$24,546.66	$1,746.66	N/A	$1,746.66	N/A
Outside Professional Services	$3,066.66	$1,366.66		$1,366.66
Form 399 assistance or other Program Management costs	$600.00	$600.00	N/A	$600.00	N/A
Perform engineering study for displacement application	$1,800.00	$100.00	N/A	$100.00	N/A
399 Review	$0.00	$0.00	N/A	N/A	N/A
Jaussi Electronics	$666.66	$666.66	N/A	$666.66	N/A

Components

Actual Information Description	File Name
Form 399 assistance or other Program Management costs	Component Description: 399 Review Amount: $600.00
Perform engineering study for displacement application	Component Description: TVStudy and exhibit Amount: $100.00
399 Review	Information not provided.
Jaussi Electronics	Component Description: invoice portion for K25PO-d facility ID # 181291 Amount: $666.66

Cost Information

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	$0.00	$0.00	N/A	$0.00	N/A
Total for all systems	$24,546.66	$1,746.66	N/A	$1,746.66	N/A
Other Expenses	$0.00	$0.00		$0.00
lowes, home depot	$0.00	$0.00	N/A	N/A	N/A
Hess lumber 8-31-18	$0.00	$0.00	N/A	N/A	N/A
Hess Lumber 10-31-18	$0.00	$0.00	N/A	N/A	N/A
Electrical wholesale.002	$0.00	$0.00	N/A	N/A	N/A
Border States electrical	$0.00	$0.00	N/A	N/A	N/A
transmission line	$0.00	$0.00	N/A	N/A	N/A
new building wiring	$0.00	$0.00	N/A	N/A	N/A
VHF Transmitter	$0.00	$0.00	N/A	$0.00	N/A
New Building for relay	$0.00	$0.00	N/A	$0.00	N/A
Ken Eliason	$0.00	$0.00	N/A	N/A	N/A
B. W. St. Clair	$0.00	$0.00	N/A	N/A	N/A
Air conditioners	$0.00	$0.00	N/A	N/A	N/A
Anywave exciters	$0.00	$0.00	N/A	N/A	N/A

Components

Information not provided.

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$24,546.66	$1,746.66	$1,746.66

Reimbursement Status

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.	Yes

Certification

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.
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. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. 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). 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. 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. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. 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.	William Jaussi Reimbursement contact 10/14/2022

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.

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.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
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).
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.
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.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
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.

William Jaussi

Reimbursement contact

10/14/2022

Certification

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.
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. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. 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. 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. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. 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.	William Jaussi Reimbursement contact 10/14/2022

Section

Question

Response

Submission of Final Allocation or Accounting Information Statements

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.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
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.
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.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
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.

William Jaussi

Reimbursement contact

10/14/2022

(REFERENCE COPY - Not for submission) FCC Form 399: Reimbursement Request

Applicant Information

Applicant Name, Type, and Contact Information

Reimbursement Contact Information

Reimbursement Contact Name and Information

Preparer Contact Information

Preparer Contact Name and Information

Broadcaster Information and Transition Plan

Transmitters

Antennas

Primary Antenna

Existing Antenna Information

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

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Enter a list of RF channel numbers.

Primary Antenna

Other Antenna Cost Not Listed

Transmission Line

Tower Equipment And Rigging Costs

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Cost Information

Antennas

Components

Cost Information

Transmission Line

Cost Information

Tower Equipment and Rigging Costs

Cost Information

Outside Professional Services

Components

Cost Information

Other Expenses

Components

Cost Information

Grand Total

Reimbursement Status

Certification

Certification

Attachments