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:
49177
Service:
LPD
Call Sign:
KMBD-LD
Channel:
20 (UHF)
File Number:
0000086369
FRN:
0019866425
Eligibility Status:
Not Determined
Date Submitted:
07/29/2020

Applicant Information

Back to Top

Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

DTV AMERICA CORPORATION

RENEE ILHARDT

450 PARK AVENUE

30TH FLOOR

NEW YORK, NY 10022

United States

+1 (954) 606-5486 RILHARDT@HC2BROADCASTING.COM Corporation

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

Paul A Cicelski

Legal Representative

Lerman Senter PLLC

Paul A Cicelski

2001 L Street, NW Ste 400

WASHINGTON, DC 20036

United States

+1 (202) 416-6756 Repacking@SummitRidgeGroup.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 This displaced facility is currently in the process of complying with its new displacement construction permit as part of the repack program.

Transmitters

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

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 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 Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Other
Other Antenna Type Panel UHF
ERP: 15.0 kW
Manufacturer
Model TLP16-H
Year 2016

Primary Antenna

Back to Top

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 Elliptical
Type Broadband Panel
Number of Stations Supported 2
Number of Panels/Bays 1
Lower Limit 470.00 MHz
Upper Limit 608.00 MHz
Design power capacity in use 100.0 %
ERP: 3.75 kW
Manufacturer
Model 1x750 0000043
Year 2019
Justification for New Antenna The applicant plans on replacing the existing antenna to support the new displacement construction permit.

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 New
Number of channels supported 2
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? Yes
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? Yes
Power Dividers Does the panel antenna require power dividers? Yes
Number of Power Dividers 3
Cable Harness Does the panel antenna require cable harness? Yes
Number of Cable Harnesses 3

Enter a list of RF channel numbers.

RF Channel Number
25
20

Primary Antenna

Back to Top

Other Antenna Cost Not Listed

Name Description

Combiner

Combiner

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? Yes

Primary Tower

Back to Top

Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
Is tower documented for structural analysis? Yes
Is tower compliant with Rev G? Yes
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1029018
Coordinates (NAD83) Latitude (NAD83) 44° 58' 34.0" N-
Longitude (NAD83) 093° 16' 21.0" W-
Overall Structure Height 886.14 feet
Support Structure Height 774.92 feet
Ground Elevation Above Mean Sea Level (AMSL) 853.99 feet
Structure Type BPOLE - Building with Pole
Tower Owner EIGHTH STREET TOWER CORPORATION _ Please contact Broadcast Services, Inc.
Date Constructed 01/01/1975


Primary Tower

Back to Top

Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study need for guyed or free-standing tower
Tower Reinforcements Please select whether tower reinforcements are needed: No reinforcements needed

Primary Tower

Back to Top

Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower N/A
Helicopter Services Required Are helicopter services required? No

Primary Tower

Back to Top

Other Tower Expenses Not Listed

Information not provided.

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 150
Explanation Outside consulting engineering, legal work, and accounting services, as well as project management for regional and comprehensive repack execution.
Outside RF consulting Engineering Services Perform engineering study for displacement application No
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 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

Back to Top

Other Professional Services Expenses Not Listed

Name Description

Additional Field Engineering Time

Additional Field Engineering Time

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)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
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

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 $46,696.50 $46,696.50 N/A $14,720.75 N/A
Total for all systems $243,885.77 $102,135.77 N/A $32,189.06 N/A
Primary Antenna 1x750 0000043 $46,696.50 $46,696.50 $14,720.75
UHF-Low Power, Side Mount, Broadband Panel, 1 bay, 3.75kW input, Elliptical $23,004.50 $23,004.50 N/A $11,502.25 N/A
Side Mount antenna brackets $4,625.00 $4,625.00 N/A N/A N/A
Sweep test of transmission line and antenna $5,730.00 $5,730.00 N/A N/A N/A
Combiner $6,437.00 $6,437.00 N/A $3,218.50 N/A
Cable harness (each, for panel antenna system, if not included in antenna cost) $3,000.00 $3,000.00 N/A N/A N/A
Power Dividers (each, for panel antenna system, if not included in antenna cost) $3,900.00 $3,900.00 N/A N/A N/A

Components

Actual Information Description File Name
UHF-Low Power, Side Mount, Broadband Panel, 1 bay, 3.75kW input, Elliptical

Component Description:
Antenna cost, 50% down. #PO000621-INV
Amount:
$11,502.25
Side Mount antenna brackets Information not provided.
Sweep test of transmission line and antenna Information not provided.
Combiner

Component Description:
Combiner cost, 50% down. #PO000621-INV
Amount:
$3,218.50
Cable harness (each, for panel antenna system, if not included in antenna cost) Information not provided.
Power Dividers (each, for panel antenna system, if not included in antenna cost) Information not provided.

Cost Information

Back to Top

Transmission Line

Information not provided.

Cost Information

Back to Top

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 $166,450.00 $24,700.00 N/A $16,000.00 N/A
Total for all systems $243,885.77 $102,135.77 N/A $32,189.06 N/A
Primary Tower BPOLE $166,450.00 $24,700.00 $16,000.00
Tower Rigging Tall Tower (greater than 500') $157,750.00 $16,000.00 N/A $16,000.00 N/A
Study needed for guyed or free-standing tower $8,700.00 $8,700.00 N/A N/A N/A

Components

Actual Information Description File Name
Tower Rigging Tall Tower (greater than 500')

Component Description:
Tower work. #VC19329
Amount:
$8,400.00

Component Description:
Tower work. #VC19316
Amount:
$7,600.00
Study needed for guyed or free-standing tower 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 $23,294.27 $23,294.27 N/A $1,468.31 N/A
Total for all systems $243,885.77 $102,135.77 N/A $32,189.06 N/A
Outside Professional Services $23,294.27 $23,294.27 $1,468.31
Additional Field Engineering Time $759.27 $759.27 N/A $759.27 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $1,710.00 N/A N/A N/A
Project management of the transition $15,825.00 $15,825.00 N/A $709.04 N/A
Form 399 assistance or other Program Management costs $5,000.00 $5,000.00 N/A N/A N/A

Components

Actual Information Description File Name
Additional Field Engineering Time

Component Description:
Additional field engineering time. #2250
Amount:
$759.27
Prepare/ Review 399 reimbursement form Information not provided.
Project management of the transition

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #1149
Amount:
$302.67

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #477015
Amount:
$406.37
Form 399 assistance or other Program Management costs 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 $7,445.00 $7,445.00 N/A $0.00 N/A
Total for all systems $243,885.77 $102,135.77 N/A $32,189.06 N/A
Other Expenses $7,445.00 $7,445.00 $0.00
Equipment Delivery and Handling Charges $3,000.00 $3,000.00 N/A N/A N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $3,000.00 $3,000.00 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
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,110.00 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 $243,885.77 $102,135.77 $32,189.06

Reimbursement Status

Back to Top
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

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.

Rebecca Hanson

General Counsel


07/29/2020

Certification

Back to Top
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.

Rebecca Hanson

General Counsel


07/29/2020

Attachments

Back to Top