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:
13841
Service:
LPD
Call Sign:
K22MQ-D
Channel:
22 (UHF)
File Number:
0000089315
FRN:
0007251655
Eligibility Status:
Eligible
Date Submitted:
11/13/2019

Applicant Information

Back to Top

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

Cooperative Television Association of Southern Minnesota

David Sunderman

PO Box 8

Mankato, MN 56002

United States

+1 (507) 387-7963 daves@benco.org Not-for-Profit

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

Back to Top

Preparer Contact Name and Information

Applicant Address Phone Email

Sam Hariton

Widelity, Inc.

Sam Hariton

4031 University Drive

Suite 100

Fairfax, VA, VA 22030

United States

+1 (339) 222-8107 sam.hariton@widelity.com

Broadcaster Information and Transition Plan

Back to Top
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 K22MQ-D is planning to retune its transmitter and reuse the existing antenna and transmission line on the existing tower.

Question Response
Sharee Station Facility ID 13838
Call Sign K21DG-D
Type
Licensee Name COOPERATIVE TELEVISION ASSOCIATION OF SOUTHERN MINNESOTA
Status LICENSED
DTS No
Community of License ST. JAMES, MN
Pre-auction RF Channel 21
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 190114
Call Sign K20LP-D
Type
Licensee Name COOPERATIVE TELEVISION ASSOCIATION OF SOUTHERN MINNESOTA
Status LICENSED
DTS No
Community of License ST. JAMES, MN
Pre-auction RF Channel 20
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 13847
Call Sign K17MW-D
Type
Licensee Name Cooperative Television Association of Southern Minnesota
Status LICENSED
DTS No
Community of License ST. JAMES, MN
Pre-auction RF Channel 17
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 182381
Call Sign K31KV-D
Type
Licensee Name COOPERATIVE TELEVISION ASSOCIATION OF SOUTHERN MINNESOTA
Status LICENSED
DTS No
Community of License ST. JAMES, MN
Pre-auction RF Channel 31
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 13839
Call Sign K19LI-D
Type
Licensee Name Cooperative Television Association of Southern Minnesota
Status LICENSED
DTS No
Community of License ST. JAMES, MN
Pre-auction RF Channel 19
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 13846
Call Sign K18NE-D
Type
Licensee Name Cooperative Television Association of Southern Minnesota
Status LICENSED
DTS No
Community of License ST. JAMES, MN
Pre-auction RF Channel 18
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 13836
Call Sign K16CG-D
Type
Licensee Name COOPERATIVE TELEVISION ASSOCIATION OF SOUTHERN MINNESOTA
Status LICENSED
DTS No
Community of License ST. JAMES, MN
Pre-auction RF Channel 16
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 13848
Call Sign K24JV-D
Type
Licensee Name COOPERATIVE TELEVISION ASSOCIATION OF SOUTHERN MINNESOTA
Status LICENSED
DTS No
Community of License ST. JAMES, MN
Pre-auction RF Channel 24
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 13837
Call Sign K35KI-D
Type
Licensee Name COOPERATIVE TELEVISION ASSOCIATION OF SOUTHERN MINNESOTA
Status LICENSED
DTS No
Community of License ST. JAMES, MN
Pre-auction RF Channel 35
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 167234
Call Sign K29IE-D
Type
Licensee Name COOPERATIVE TELEVISION ASSOC OF SOUTHERN MINNESOTA
Status LICENSED
DTS No
Community of License ST. JAMES, MN
Pre-auction RF Channel 29
Post-auction RF Channel
Neilsen DMA
Network Affiliation
Question Response
Sharee Station Facility ID 13842
Call Sign K23MF-D
Type
Licensee Name COOPERATIVE TELEVISION ASSOCIATION OF SOUTHERN MINNESOTA
Status LICENSED
DTS No
Community of License ST. JAMES, MN
Pre-auction RF Channel 23
Post-auction RF Channel
Neilsen DMA
Network Affiliation

Transmitters

Back to Top
Section Question Response
Transmitter Related Expenses Do you have transmitter related expenses? Yes

Primary Transmitter

Back to Top

Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Retune Existing
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 Axcera
Model CUORD-5
Year 2014
Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity .15 kW

Primary Transmitter

Back to Top

Retuning Transmitter Costs

Section Question Response
New Mask Filter Does the transmitter require a new mask filter? Yes
Mask Filter Type Stringent
Power 100-200W
New Exciter Is a new exciter needed? No

Primary Transmitter

Back to Top

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

Back to Top

Other Transmitter Cost Not Listed

Information not provided.

Antennas

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

Primary Antenna

Back to Top

Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Retune Existing
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 Broadband Panel
Number of Stations Supported 12
Number of Panels 16
Design power capacity in use 8.33 %
Lower Limit 482.00 MHz
Upper Limit 806.00 MHz
ERP: 2.0 kW
Manufacturer Micro Communications
Model 955116
Year 2009

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

Facility ID Call Sign
13846 K18NE-D
13836 K16CG-D
13837 K35KI-D
13838 K21DG-D
13839 K19LI-D
13842 K23MF-D
13847 K17MW-D
13848 K24JV-D
167234 K29IE-D
182381 K31KV-D
190114 K20LP-D

Primary Antenna

Back to Top

Adjustment to Existing Antenna

Section Question Response
Sweep Test of Existing Antenna Do you need a sweep test of existing antenna?

Primary Antenna

Back to Top

Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna? Yes
Type Additional Module
Number of channels supported 1
Frequencies of channels supported Upper and lower frequency
Frequency 482.0 MHz - 602.0 MHz

Primary Antenna

Back to Top

Other Antenna Cost Not Listed

Information not provided.

Transmission Line

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

Tower Equipment And Rigging Costs

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

Outside Professional Services Costs

Back to Top
Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 254
Explanation K22MQ-D requires the aid of outside project management services to fulfill the requirements of the repack. K22MQ-D will hire an outside firm to facilitate and support K22MQ-D in these tasks and others to ensure a timely and well managed transition.
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 Yes
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

Back to Top

Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

Back to Top
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

Back to Top

Other Expenses Not Listed

Information not provided.

Cost Information

Back to Top

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 $12,762.50 $12,762.50 N/A $0.00 N/A
Total for all systems $56,774.15 $66,983.15 N/A $0.00 N/A
Primary Transmitter CUORD-5 $12,762.50 $12,762.50 $0.00
Retune - UHF and VHF - minor re-channel issues $11,000.00 $11,000.00 N/A N/A N/A
100-200W w mask filter Stringent $1,762.50 $1,762.50 N/A N/A N/A

Components

Information not provided.

Cost Information

Back to Top

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 $3,747.15 $3,747.15 N/A $0.00 N/A
Total for all systems $56,774.15 $66,983.15 N/A $0.00 N/A
Primary Antenna 955116 $3,747.15 $3,747.15 $0.00
2.0 kW UHF Combiner $3,747.15 $3,747.15 Please see "Justification K22MQ-D Combiner Estimated Cost" N/A N/A

Components

Information not provided.

Cost Information

Back to Top

Transmission Line

Information not provided.

Cost Information

Back to Top

Tower Equipment and Rigging Costs

Information not provided.

Cost Information

Back to Top

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 $38,819.50 $49,028.50 N/A $0.00 N/A
Total for all systems $56,774.15 $66,983.15 N/A $0.00 N/A
Outside Professional Services $38,819.50 $49,028.50 $0.00
Prepare/ Review 399 reimbursement form $1,710.00 $315.00 Please see Justification Cooperative Television Legal Fees N/A N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $716.00 Please see Justification Cooperative Television Legal Fees N/A N/A
Project management of the transition $26,797.00 $41,910.00 See K22MQ-D-LPTV Strategic Support Quote N/A N/A
Perform engineering study for displacement application $1,800.00 $600.00 Please see Justification K22MQ-D Engineering Study for Displacement N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $2,102.50 N/A N/A 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 Form 601 $755.00 $755.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 N/A N/A N/A

Components

Information not provided.

Cost Information

Back to Top

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 $1,445.00 $1,445.00 N/A $0.00 N/A
Total for all systems $56,774.15 $66,983.15 N/A $0.00 N/A
Other Expenses $1,445.00 $1,445.00 $0.00
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,110.00 N/A N/A N/A
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

Back to Top

Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $56,774.15 $66,983.15 $0.00

Reimbursement Status

Back to Top
Question Response
The facility has ceased operating on its pre-auction channel.
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

Back to Top
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.

David Sunderman

Manager


11/13/2019

Attachments

Back to Top