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:
14158
Service:
LPD
Call Sign:
K29NN-D
Channel:
29 (UHF)
File Number:
0000089333
FRN:
0007328453
Eligibility Status:
Eligible
Date Submitted:
09/29/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

COUNTY OF SAN BERNARDINO, CSA 29 (COUNTY SERVICE AREA)

Doing Business As: COUNTY OF SAN BERNARDINO, CSA 29 (COUNTY SERVICE AREA)

Special Districts Department - Frank Haggard

222 West Hospitality Lane, 2nd Floor

SAN BERNARDINO, CA 92415

United States

+1 (760) 248-7048 frank.haggard@sdd.sbcounty.gov Government Entity

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

Michael Couzens

Attorney at Law

Michael Couzens Law Office

Michael Couzens

6536 Telegraph Avenue, Suite B201

Oakland, CA 94609

United States

+1 (510) 658-7654 cuz@well.com

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 Three stations at Lucerne Valley were required to change channel and move inside the core. They have done so, and licenses have been applied for and granted.

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 TAUD-100
Year 2013
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 100 W

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 TAUD-100
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 100 W
Justification for New Transmitter See atachment TECHNALOGIX ID NUMBER 98-1333495

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? No

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? Yes
Number of Hours 32
Explanation Attorney Hours in displacement applications and reimbursement application
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 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 Yes
Quantity 3
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

Combiner

three stations shared an antenna previously and only required the purchase of a new combiner for the three channels. No new antenna.

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 $13,750.00 $14,475.00 N/A $14,745.00 N/A
Total for all systems $34,382.73 $27,534.37 N/A $23,010.86 N/A
Primary Transmitter TAUD-100 $13,750.00 $14,475.00 $14,745.00
UHF - Air Cooled Solid State Transmitter 50.001 - 150 Watts $13,750.00 $14,475.00 Corrected to match actual cost $14,745.00 see three iinvoices

Components

Actual Information Description File Name
UHF - Air Cooled Solid State Transmitter 50.001 - 150 Watts

Component Description:
Modulator
Amount:
$5,600.00

Component Description:
TAUD-100
Amount:
$9,145.00

Component Description:
Invoice includes three stations
Amount:
$9,135.85

Component Description:
Invoice covers three stations.
Amount:
$1,684.22

Component Description:
Invoice covers three stations
Amount:
$3,729.60

Cost Information

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Antennas

Information not provided.

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 $17,501.82 $11,373.46 N/A $6,579.95 N/A
Total for all systems $34,382.73 $27,534.37 N/A $23,010.86 N/A
Outside Professional Services $17,501.82 $11,373.46 $6,579.95
Attorney Fees - Prepare and File request for Special Temporary Authorization $6,705.00 $0.00 N/A $0.00 N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $1,577.50 N/A $338.33 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $3,025.00 N/A $910.00 We did not prepare these estimates. The bill for legal servcices was not broken out into the categories in the form.
Form 399 assistance or other Program Management costs $1,108.32 $1,108.32 Actual Attorney Fees $1,108.32 Actual Attorney Fees for 399 Filing
Project management of the transition $3,376.00 $3,376.00 N/A $1,936.66 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $2,286.64 Actual Attorney Fees $2,286.64 N/A

Components

Actual Information Description File Name
Attorney Fees - Prepare and File request for Special Temporary Authorization

Component Description:
Do not understand the question
Amount:
N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
License Filing
Amount:
$128.33

Component Description:
This is distributed to other categories in legal services.
Amount:
N/A

Component Description:
License Filing
Amount:
$210.00
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
CP Displacement Filing
Amount:
$910.00

Component Description:
Legal services divided among three displacements
Amount:
$2,191.14
Form 399 assistance or other Program Management costs

Component Description:
1876 Filing
Amount:
$81.66

Component Description:
1876 Filing
Amount:
$793.33

Component Description:
1876 Filing
Amount:
$233.33

Component Description:
This is not a category that was broken pout separately in the legal bills.
Amount:
N/A
Project management of the transition

Component Description:
Proj Management
Amount:
$1,155.00

Component Description:
Proj Management
Amount:
$46.66

Component Description:
Proj Management
Amount:
$735.00
Prepare/ Review 399 reimbursement form

Component Description:
399 Filing
Amount:
$653.33

Component Description:
399 Filing
Amount:
$396.66

Component Description:
Work apportioned among three stations
Amount:
$1,573.42

Component Description:
399 Filing
Amount:
$466.66

Component Description:
399 Filing
Amount:
$46.66

Component Description:
399 Filing
Amount:
$723.33

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 $3,130.91 $1,685.91 N/A $1,685.91 N/A
Total for all systems $34,382.73 $27,534.37 N/A $23,010.86 N/A
Other Expenses $3,130.91 $1,685.91 $1,685.91
Combiner $1,685.91 $1,685.91 Actual Cost $1,685.91 N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $0.00 government entity fee exempt N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $0.00 government entity fee exempt N/A N/A

Components

Actual Information Description File Name
Combiner

Component Description:
Combiner
Amount:
$1,685.91
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $34,382.73 $27,534.37 $23,010.86

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 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.

Frank Haggard

Area Manager


09/29/2020

Attachments

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