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:
52892
Service:
LPD
Call Sign:
K14RK-D
Channel:
14 (UHF)
File Number:
0000085737
FRN:
0005007976
Eligibility Status:
Not Determined
Date Submitted:
10/10/2019

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

SPANISH INDEPENDENT BROADCAST NETWORK, LLC

Doing Business As: SPANISH INDEPENDENT BROADCAST NETWORK, LLC

Adrian C. Quinones

5030 E. WARNER RD

SUITE 3

PHOENIX, AZ 85044

United States

+1 (480) 684-3802 ADRIAN@38IZTV.COM Limited Liability Company

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 Hire engineer to find vacant channel, apply in window, receive CP, buy new transmitter and antenna,hire tower crew, install equipment. All transition work except repack reimbursement was completed with grant of license LMS 0000064022, on 12/13/2018

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 ATSC 1.5kW DTV TX
Year 2014
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 1.5 kW

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 TRN-5X-U-28-C
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 2.2 kW
Justification for New Transmitter We need a new transmitter because of the need to upgrade from a stringent to a full service emission mask and have special filtering to protect land mobile stations adjacent to Channel 14.

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

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? Yes
Existing Antenna Manufacturer and Type
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
ERP: 1.5 kW
Manufacturer
Model JA/MS-12 SHO
Year 2008

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? No
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 Not in Stack
Polarization Horizontal
Type Slotted Coaxial
ERP: 1.5 kW
Manufacturer
Model AL8-14
Year 2018
Justification for New Antenna Moving from Channel 38 to channel 14; the actual antenna we have for channel 38 won't work at channel 14.

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? 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

ERI-RLA150-050

Reducer EIA 1-5/8" to EIA 7/8"

ERI-STD050-52

Flex 7/8" Coax extension EIA Flange -6

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 Move Equipment
Tower Use Primary (Main)
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? Yes
One or more FM, AM or TV radio broadcaster(s) Yes
Others Types of Users Yes
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Unknown
Existing Tower Structure Registration Do you have a tower registration number? No
Coordinates (NAD83) Latitude (NAD83) 33° 20' 00.1" N-
Longitude (NAD83) 112° 03' 47.5" W-
Overall Structure Height 140.00 feet
Support Structure Height 20.00 feet
Ground Elevation Above Mean Sea Level (AMSL) 2760.00 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner A Communications South Mountain L.L.C.
Date Constructed 03/10/1985

FM, AM or TV radio broadcasters. Facility ID's, Call Signs and Services of other broadcast stations with whom the tower is shared

Facility ID Call Sign Service
20638 KFLR-FM FM
73764 KPDF-CA DTV

Other Types of Users

Users
POINT TO POINT
INTERNET

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

Information not provided.

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 20
Explanation Work with frequency coordinator; explore the best choice in transmitter and antennas; get quotes from vendors; submit permits with City of Phoenix to work at towers; coordinate with crew to remove existing antenna and install new at tower.
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 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

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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 Yes
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

Name Description

Engineering services

Coordinating of permits and clearance to perform disassemble of Channel 38 and install the new channel 14; perform disassemble of Channel 38 transmitter and install and test new transmitter for Channel 14

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 $278,760.00 $32,388.00 N/A $32,388.00 N/A
Total for all systems $365,218.83 $61,714.33 N/A $59,957.15 N/A
Primary Transmitter TRN-5X-U-28-C $278,760.00 $32,388.00 $32,388.00
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW $84,000.00 $27,922.00 N/A $27,922.00 N/A
Channel 14 Mask Filter $189,500.00 $0.00 Cost of filter is included in the price of transmitter $0.00 N/A
RF Consulting Engineer $5,260.00 $4,466.00 N/A $4,466.00 N/A

Components

Actual Information Description File Name
UHF - Air Cooled Solid State Transmitter 1 - 2.5 kW

Component Description:
Transmitter UHF air cooled w/ exciter; RF Output 2.2 kw ATSC UHF; 1 5/8" EIA connector
Amount:
$27,922.00
Channel 14 Mask Filter

Component Description:
Cost of filter is included in price of transmitter.
Amount:
N/A
RF Consulting Engineer

Component Description:
Final engineering analysis; TV Study interference analysis; preparation of engineering portion of K38IZ-D displacement application on Channel 14; e-filling in FCC LMS
Amount:
$1,750.00

Component Description:
Channel search for displaced K38IZ-D; Detailed analysis of channels 13, 14, 23, 25 and 32
Amount:
$1,750.00

Component Description:
Meeting with LPTV coordination plan/maps; Engineering Support: calls, e-mails, texts, and research on behalf of SIBN through June 30, for repack coordination, channel sharing and transmitter re-tune options.
Amount:
$966.00

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 $5,233.83 $5,233.83 N/A $5,186.65 N/A
Total for all systems $365,218.83 $61,714.33 N/A $59,957.15 N/A
Primary Antenna AL8-14 $5,233.83 $5,233.83 $5,186.65
UHF-Low Power, Side Mount, Slotted Coaxial, 1.5kW input, Horizontal $4,623.83 $4,623.83 N/A $4,623.83 N/A
ERI-RLA150-050 $350.00 $350.00 N/A $319.96 N/A
ERI-STD050-52 $260.00 $260.00 N/A $242.86 N/A

Components

Actual Information Description File Name
UHF-Low Power, Side Mount, Slotted Coaxial, 1.5kW input, Horizontal

Component Description:
Final payment for antenna and shipping
Amount:
$2,583.83

Component Description:
First payment and deposit to build antenna for channel 14.
Amount:
$2,040.00
ERI-RLA150-050

Component Description:
Cost of part plus 8.6% tax, and 50% of shipping cost.
Amount:
$319.96
ERI-STD050-52

Component Description:
Cost of part plus 8.6% tax, and 50% of shipping cost.
Amount:
$242.86

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 $56,190.00 $4,800.00 N/A $4,800.00 N/A
Total for all systems $365,218.83 $61,714.33 N/A $59,957.15 N/A
Primary Tower TOWER $56,190.00 $4,800.00 $4,800.00
Tower Rigging Short Tower (less than 500') $56,190.00 $4,800.00 N/A $4,800.00 N/A

Components

Actual Information Description File Name
Tower Rigging Short Tower (less than 500')

Component Description:
Uninstalling antenna for channel 38 and installing new antenna for channel 14
Amount:
$4,800.00

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 $13,752.50 $9,285.00 N/A $7,575.00 N/A
Total for all systems $365,218.83 $61,714.33 N/A $59,957.15 N/A
Outside Professional Services $13,752.50 $9,285.00 $7,575.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $2,100.00 More than normal costs were incurred because of need to locate and notify all nearby land mobile facilities in the 450-470 MHz band that might receive interference from Channel 14 at 470-476 MHz. $2,100.00 More than normal costs were incurred because of need to locate and notify all nearby land mobile facilities in the 450-470 MHz band that might receive interference from Channel 14 at 470-476 MHz.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $0.00 N/A $0.00 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,000.00 N/A $3,000.00 N/A
Project management of the transition $2,110.00 $2,100.00 N/A $2,100.00 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $1,710.00 N/A $0.00 N/A
Perform engineering study for displacement application $1,800.00 $0.00 N/A $0.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $0.00 N/A $0.00 N/A
Form 399 assistance or other Program Management costs $375.00 $375.00 N/A $375.00 N/A

Components

Actual Information Description File Name
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Part of legal bill attributable to application for license to cover - marked with "B" on invoice.
Amount:
$2,100.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application Information not provided.
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Preparation for repack, advice about channels to apply for, filling of applications and obtaining permit for Channel 14, items marked as (A) in the invoice.
Amount:
$3,000.00
Project management of the transition

Component Description:
Follow up of transition, coordinating interference issues, making possible paperwork for final part of transition, items marked as (B) in the invoice.
Amount:
$2,100.00
Prepare/ Review 399 reimbursement form Information not provided.
Perform engineering study for displacement application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Form 399 assistance or other Program Management costs

Component Description:
Legal fees for reimbursement advice and follow up, items marked on the following dates: 7/12/18, 1/15/19, 8/15/19 and 8/28/19, items marked as (C) in the invoice.
Amount:
$375.00

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 $11,282.50 $10,007.50 N/A $10,007.50 N/A
Total for all systems $365,218.83 $61,714.33 N/A $59,957.15 N/A
Other Expenses $11,282.50 $10,007.50 $10,007.50
FCC Filing Fees - Form 2100 license to cover application $335.00 $170.00 N/A $170.00 N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $0.00 N/A $0.00 N/A
Engineering services $9,837.50 $9,837.50 N/A $9,837.50 N/A

Components

Actual Information Description File Name
FCC Filing Fees - Form 2100 license to cover application

Component Description:
Filing Fee for Application for License to Cover CP, LMS0000064022.
Amount:
$170.00
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
Engineering services

Component Description:
Total payment to our engineer after following through the whole process, up to disassemble transmitter for channel 38, installing new one for channel 14, bring it up to full power and check for non interference.
Amount:
$9,837.50

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $365,218.83 $61,714.33 $59,957.15

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.

Adrian C. Quinones

Managing Member


10/10/2019

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.

Adrian C. Quinones

Managing Member


10/10/2019

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.

Adrian C. Quinones

Managing Member


10/10/2019

Attachments

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