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:
61135
Service:
LPT
Call Sign:
K23OS-D
Channel:
23 (UHF)
File Number:
0000090079
FRN:
0006808117
Eligibility Status:
Eligible
Date Submitted:
10/21/2020

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

SOUTH LANE TELEVISION, INC.

Lloyd L. Williams

PO Box 301

COTTAGE GROVE, OR 97424

United States

+1 (541) 942-1310 lloydlwilliams@msn.com Not-for-Profit

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

Ronald A Irvine

Attorney

Ronald A Irvine PC

Ronald A Irvine

PO Box 387

Cottage Grove, OR 97424

United States

+1 (541) 942-3832 ronairvine1@aol.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 transmitter will be combined with 4 others into a single antenna making it necessary to construct a new combining filter. Need a new transmitter as the existing one which is a converted analog transmitter will not make power on the new lower channel.

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 XL20UU
Year 1992
Type Solid State
Solid State Cooling Air Cooled
Solid State Power Capacity 15 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 TRN-U-200-D-FB
Transmitter Type Solid State
Solid State Cooling Air Cooled
Solid State Power capacity 200 W
Justification for New Transmitter The existing transmitter is a 27 year old converted analog which will not make licensed power on the lower channel. It was not designed to be broadband. Parts and service are unavailable due to the manufacturer having gone out of business.

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 Retune Existing
Antenna Use Primary (Main)
Ownership Owned
Is the existing antenna shared with another station or stations? Yes
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 Log Periodic
ERP: 0.012 kW
Manufacturer Scala
Model CL-1469
Year 1992

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

Facility ID Call Sign
61137 K35JH-D
61136 K33KD-D
61138 K27JY-D
61139 K31PI-D

Primary Antenna

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Adjustment to Existing Antenna

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

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 5
Frequencies of channels supported RF channel
Frequency N/A

Enter a list of RF channel numbers.

RF Channel Number
35
23
27
31
33

Primary Antenna

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Other Antenna Cost Not Listed

Information not provided.

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? 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 Log Periodic
ERP: 0.012 kW
Manufacturer
Model CL-1469
Year 1992

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

Facility ID Call Sign
61139 K31PI-D
61136 K33KD-D
61137 K35JH-D
61138 K27JY-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? 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 Horizontal
Type Broadband Panel
Number of Stations Supported 5
Number of Panels/Bays 3
Lower Limit 470.00 MHz
Upper Limit 610.00 MHz
Design power capacity in use 10.0 %
ERP: 0.012 kW
Manufacturer
Model CL-1469
Year 1992
Justification for New Antenna Please disregard the above information regarding a new antenna. There is no need for a new antenna, the old antenna has been retuned and a new combining filter has been purchased to accommodate the new repack channels

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 5
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
Power Dividers Does the panel antenna require power dividers? No
Cable Harness Does the panel antenna require cable harness? No

Enter a list of RF channel numbers.

RF Channel Number
27
31
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? No
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 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

Information not provided.

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 $34,500.00 $13,060.00 N/A $13,060.00 N/A
Total for all systems $93,415.00 $20,635.00 N/A $20,635.00 N/A
Primary Transmitter TRN-U-200-D-FB $34,500.00 $13,060.00 $13,060.00
UHF - Air Cooled Solid State Transmitter 5 - 50 Watts $10,200.00 $13,060.00 ***System Notice: Estimate adjusted and locked because line has been superseded.***The manufacturer states that almost all of the components are in common with their transmitter which is the next step up in power and they cannot therefore manufacture smaller ones at less cost. $13,060.00 N/A
UHF - Air Cooled Solid State Transmitter 160 - 300 Watts $24,300.00 $0.00 The estimated cost for this component is $13,060.00 and is set forth in the following component (UHF-Air Cooled Solid State Transmitter 5-50 Watts" which has been locked. $0.00 The actual cost for this item- UHF-Air Cooled Solid State Transmitter 160-300 Watts is $13,060.00 and is set forth under the following item "UHF-Air Cooled Solid State Transmitter 5-50 Watts"- please see the attachment approved by Myrna Penn

Components

Actual Information Description File Name
UHF - Air Cooled Solid State Transmitter 5 - 50 Watts

Component Description:
New transmitter required as a result of repack-see attached Invoice with Revised Cover Letter
Amount:
$13,060.00
UHF - Air Cooled Solid State Transmitter 160 - 300 Watts Information not provided.

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 $52,250.00 $3,750.00 N/A $3,750.00 N/A
Total for all systems $93,415.00 $20,635.00 N/A $20,635.00 N/A
Primary Antenna CL-1469 $23,500.00 $3,750.00 $3,750.00
1 kW UHF Combiner (per channel) $23,500.00 $3,750.00 N/A $3,750.00 N/A
Primary Antenna CL-1469 $28,750.00 $0.00 $0.00
UHF Broadband panel antenna (per panel), horizontally-polarized $5,250.00 $0.00 Not required $0.00 Please disregard this item it is a duplicate entered by mistake
1 kW UHF Combiner (per channel) $23,500.00 $0.00 Please disregard this item it is a duplicate entered by mistake $0.00 Please disregard this item- it is a duplicate entered by mistake

Components

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

Component Description:
One half of cost to retrofit/reconstruct combining filter due to repack- see attached cover letter with Invoice #934
Amount:
$3,750.00
UHF Broadband panel antenna (per panel), horizontally-polarized Information not provided.
1 kW UHF Combiner (per channel) 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 $6,665.00 $3,825.00 N/A $3,825.00 N/A
Total for all systems $93,415.00 $20,635.00 N/A $20,635.00 N/A
Outside Professional Services $6,665.00 $3,825.00 $3,825.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $750.00 N/A $750.00 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $925.00 N/A $925.00 N/A
Perform engineering study for displacement application $1,800.00 $1,250.00 N/A $1,250.00 N/A
Prepare/ Review 399 reimbursement form $1,710.00 $900.00 N/A $900.00 N/A

Components

Actual Information Description File Name
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Prepare and file station license application for repack translator K23OS-D- See Cover Letter
Amount:
$750.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Prepare and file construction permit application for repack translator K23OS-D - see Cover Letter
Amount:
$925.00
Perform engineering study for displacement application

Component Description:
Search for open channel for London Springs Translator K43LQ-D (new K23OS-D) due to repack- see Cover Letter
Amount:
$1,250.00
Prepare/ Review 399 reimbursement form

Component Description:
Preparation and review of Form 399 Reimbursement Forms for repack channel K23OS-D
Amount:
$900.00

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 $0.00 $0.00 N/A $0.00 N/A
Total for all systems $93,415.00 $20,635.00 N/A $20,635.00 N/A
Other Expenses $0.00 $0.00 $0.00

Components

Information not provided.

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $93,415.00 $20,635.00 $20,635.00

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. 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.

Ronald A Irvine

Attorney


10/21/2020

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.

Ronald A Irvine

Attorney


10/21/2020

Attachments

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