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:
14104
Service:
LPT
Call Sign:
K31PK-D
Channel:
31 (UHF)
File Number:
0000086982
FRN:
0004773180
Eligibility Status:
Eligible
Date Submitted:
10/09/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

COUNTY OF KOOCHICHING

Doing Business As: COUNTY OF KOOCHICHING

Jenny Herman

715 4TH STREET

INTERNATIONAL FALLS, MN 56649

United States

+1 (218) 283-1152 jenny.herman@co.koochiching.mn.us 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

LeRoy Hervey

Operating Engineer

Voyageurs Comtronics Corporation

LeRoy Hervey

6063 Highway 11

International Falls, MN 56649

United States

+1 (218) 283-9477 voycomm@gmail.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 The needed equipment was ordered, installed, and placed into operation prior to the T-Mobile deadline as per their letter of intent to commence 600 MHz operations on 8/3/18. See T-Mobile attachment.

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 MXi101U
Year 2009
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 50 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 UAXTE-100
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 100 W
Justification for New Transmitter Larcan, the manufacturer of the existing transmitter, ceased operations on July 10, 2014. This transmitter would not operate on the new channel. See attachments.

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? 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 Slotted Coaxial
ERP: 0.406 kW
Manufacturer
Model SL8
Year 2009

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

Facility ID Call Sign
14119 K33PL-D
12117 K35MY-D

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? Yes
Is antenna directional? No
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 Other
Other Antenna Type Superturnstile
ERP: 0.406 kW
Manufacturer
Model UTV-11/4/LP
Year 2018
Justification for New Antenna The existing antenna would not work at the new frequency.

Primary Antenna

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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

Enter a list of RF channel numbers.

RF Channel Number
33
35

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

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 14
Explanation Engineering: $425 FCC Filing: $550 Grant Filing: $130
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 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

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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 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

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Other Expenses Not Listed

Name Description

Feed Horn Replacement

receive feed horn replacement necessary to accommodate frequency change

Mask Filter

simple

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 $11,678.00 N/A $11,678.00 N/A
Total for all systems $40,932.00 $22,834.00 N/A $22,834.00 N/A
Primary Transmitter UAXTE-100 $13,750.00 $11,678.00 $11,678.00
UHF - Air Cooled Solid State Transmitter 50.001 - 150 Watts $13,750.00 $11,678.00 N/A $11,678.00 N/A

Components

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

Component Description:
Translator turnkey costs (equipment, shipping, flashcut from old frequency to new frequency, installation, setup for proper operation, and disposal of old equipment)
Amount:
$11,678.00

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 $19,834.00 $7,690.00 N/A $7,690.00 N/A
Total for all systems $40,932.00 $22,834.00 N/A $22,834.00 N/A
Primary Antenna UTV-11/4/LP $19,834.00 $7,690.00 $7,690.00
1 kW UHF Combiner (per channel) $14,100.00 $1,956.00 N/A $1,956.00 N/A
UHF-Low Power, Side Mount, Other, 0.406kW input, Horizontal $5,734.00 $5,734.00 N/A $5,734.00 N/A

Components

Actual Information Description File Name
1 kW UHF Combiner (per channel)

Component Description:
Turnkey costs (equipment, shipping, flashcut from old frequency to new frequency, installation, setup for proper operation, and disposal of old equipment)
Amount:
$1,956.00
UHF-Low Power, Side Mount, Other, 0.406kW input, Horizontal

Component Description:
Turnkey costs (equipment, shipping, flashcut from old frequency to new frequency, installation, setup for proper operation, and disposal of old equipment)
Amount:
$5,734.00

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 $4,987.00 $1,105.00 N/A $1,105.00 N/A
Total for all systems $40,932.00 $22,834.00 N/A $22,834.00 N/A
Outside Professional Services $4,987.00 $1,105.00 $1,105.00
Project management of the transition $1,477.00 $550.00 N/A $550.00 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $130.00 N/A $130.00 N/A
Perform engineering study for displacement application $1,800.00 $425.00 N/A $425.00 N/A

Components

Actual Information Description File Name
Project management of the transition

Component Description:
Project management of the transition
Amount:
$550.00
Prepare/ Review 399 reimbursement form

Component Description:
Prepare and review reimbursement form
Amount:
$130.00
Perform engineering study for displacement application

Component Description:
Perform engineering study for displacement application
Amount:
$425.00

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 $2,361.00 $2,361.00 N/A $2,361.00 N/A
Total for all systems $40,932.00 $22,834.00 N/A $22,834.00 N/A
Other Expenses $2,361.00 $2,361.00 $2,361.00
Feed Horn Replacement $900.00 $900.00 N/A $900.00 N/A
Mask Filter $1,461.00 $1,461.00 N/A $1,461.00 N/A

Components

Actual Information Description File Name
Feed Horn Replacement

Component Description:
Turnkey costs (equipment, shipping, flashcut from old frequency to new frequency, installation, setup for proper operation, and disposal of old equipment)
Amount:
$900.00
Mask Filter

Component Description:
Turnkey costs (equipment, shipping, flashcut from old frequency to new frequency, installation, setup for proper operation, and disposal of old equipment)
Amount:
$1,461.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $40,932.00 $22,834.00 $22,834.00

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. Yes

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.

Jenny Herman

Administration Director


10/09/2020

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.

Jenny Herman

Administration Director


10/09/2020

Attachments

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