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:
43419
Service:
LPT
Call Sign:
K31PA-D
Channel:
31 (UHF)
File Number:
0000089930
FRN:
0001591460
Eligibility Status:
Eligible
Date Submitted:
08/18/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

MOHAVE COUNTY BOARD OF SUPERVISORS

Applicant

Doing Business As: MOHAVE COUNTY BOARD OF SUPERVISORS

Barbara Spoonhour

PO BOX 7000

KINGMAN, AZ 86402

United States

+1 (928) 753-0729 spoonb@mohave.gov Other

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

The Preparer is same as the reimbursement contact.

 

 

 

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 Transition complete required based on T-Mobile/FCC Repackaging

Question Response
Sharee Station Facility ID 43392
Call Sign K34PE-D
Type
Licensee Name MOHAVE COUNTY BOARD OF SUPERVISORS
Status LICENSED
DTS No
Community of License DOLAN SPRINGS, AZ
Pre-auction RF Channel 34
Post-auction RF Channel
Neilsen DMA
Network Affiliation

Transmitters

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

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? 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 Top Mount
Antenna position in stack Top
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels 4
Design power capacity in use 25.0 %
Lower Limit 572.00 MHz
Upper Limit 578.00 MHz
ERP: 100.0 W
Manufacturer
Model 4DR-4S
Year 2019

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? No
Is antenna directional? Yes
Will antenna be located on or in close proximity to an antenna farm? No
New Antenna Manufacturer and Types
Mounting Top Mount
Antenna position in stack Top
Polarization Horizontal
Type Broadband Panel
Number of Stations Supported 1
Number of Panels/Bays 4
Lower Limit 572.00 MHz
Upper Limit 578.00 MHz
Design power capacity in use 25.0 %
ERP: 100.0 W
Manufacturer
Model 4DR-4S
Year 2019
Justification for New Antenna Existing antenna cannot be modified or re-tuned. Assigned frequency requires new antenna build.

Primary Antenna

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Other Antenna Costs

Section Question Response
Elbow Complex Do you require the separate purchase of the Elbow Complex? 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? Yes
Number of Power Dividers 1
Cable Harness Does the panel antenna require cable harness? No

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 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 No
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

Construction

Actual

Staff expenses

8 hours at 63.90

Technical staff expenses

2 hours at 33.95

Cost Information

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Transmitters

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 $8,300.00 $5,655.00 N/A $5,654.51 N/A
Total for all systems $30,687.93 $21,660.52 N/A $21,659.03 N/A
Primary Antenna 4DR-4S $8,300.00 $5,655.00 $5,654.51
UHF Broadband panel antenna (per panel), horizontally-polarized $7,000.00 $5,655.00 Actual costs were higher than the original estimated amount - sales tax and band pass filter included $5,654.51 Uploaded corrected invoices 70, 150490, 150491.
Power Dividers (each, for panel antenna system, if not included in antenna cost) $1,300.00 $0.00 Actual - included in antenna costs N/A N/A

Components

Actual Information Description File Name
UHF Broadband panel antenna (per panel), horizontally-polarized

Component Description:
Band pass filters.
Amount:
$519.65

Component Description:
Purchase of antennas.
Amount:
$4,752.94

Component Description:
Sales tax that was erroneously excluded from invoice 150491.
Amount:
$381.91

Component Description:
Band pass filter purchase.
Amount:
$519.65

Component Description:
Sales tax was erroneously excluded from WECOM Invoice150491.
Amount:
$381.92

Component Description:
Purchase of antennas. No polarization or horizontal mounting was needed.
Amount:
$4,752.95
Power Dividers (each, for panel antenna system, if not included in antenna cost) 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 $9,557.50 $3,175.09 N/A $3,175.09 N/A
Total for all systems $30,687.93 $21,660.52 N/A $21,659.03 N/A
Outside Professional Services $9,557.50 $3,175.09 $3,175.09
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $3,025.00 $0.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $2,102.50 $0.00 N/A $0.00 N/A
Perform engineering study for displacement application $1,800.00 $0.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,052.50 $2,284.72 Actual $2,284.72 The actual amount and the estimated cost appear to be the same. May be a rounding issue with the your system.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $1,577.50 $890.37 Actual $890.37 Uploaded corrected invoices 2448432 and 2457236

Components

Actual Information Description File Name
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application Information not provided.
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application Information not provided.
Perform engineering study for displacement application Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Engineering portions of applications for displacement, including request for waiver for contingent filing.
Amount:
$1,000.00

Component Description:
Engineering assistance with Mohave County's response to FCC/T-Mobile case.
Amount:
$34.72

Component Description:
Preparation and submittal of license.
Amount:
$250.00

Component Description:
Study of Mohave County's overall channel plan compatibility and antenna designs required due to FCC's recent incentive Auction.
Amount:
$1,000.00
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application

Component Description:
Legal services for repackaging.
Amount:
$107.67

Component Description:
Legal services for repackaging.
Amount:
$222.21

Component Description:
Legal services for repackaging.
Amount:
$44.17

Component Description:
Legal services for repackaging.
Amount:
$138.89

Component Description:
Legal services for repackaging.
Amount:
$28.33

Component Description:
Legal services.
Amount:
$9.33

Component Description:
Legal Services
Amount:
$8.50

Component Description:
Legal services for repackaging.
Amount:
$8.50

Component Description:
Legal Services.
Amount:
$222.22

Component Description:
Legal services for repackaging.
Amount:
$181.10

Component Description:
Uploaded corrected invoice.
Amount:
$8.50

Component Description:
Legal services for repackaging.
Amount:
$8.83

Component Description:
Legal services for repackaging.
Amount:
$8.83

Component Description:
Legal services for repackaging.
Amount:
$132.50

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 $12,830.43 $12,830.43 N/A $12,829.43 N/A
Total for all systems $30,687.93 $21,660.52 N/A $21,659.03 N/A
Other Expenses $12,830.43 $12,830.43 $12,829.43
Technical staff expenses $60.43 $60.43 Actual $60.43 Updated the correct invoice amount of $60.43.
Staff expenses $530.00 $530.00 Actual costs were higher than original estimate. $529.00 Uploaded corrected staffing invoice #1.
Construction $12,240.00 $12,240.00 Actual costs for installation were higher because of the site location. $12,240.00 Due to it's location Facility 43419 was worked on twice. The original estimate was incorrect.

Components

Actual Information Description File Name
Technical staff expenses

Component Description:
Engineering staff time assistance with repackaging.
Amount:
$59.76

Component Description:
Updated correct invoice amount.
Amount:
$60.43
Staff expenses

Component Description:
Mohave County staff time working on repackaging.
Amount:
$420.33

Component Description:
Internal staffing charges to work on repackaging.
Amount:
$529.00

Component Description:
Corrected invoice for Mohave County staff.
Amount:
$420.34
Construction

Component Description:
TV maintenance installation costs. Due to it's location Facility 43419 was worked on twice.
Amount:
$12,240.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $30,687.93 $21,660.52 $21,659.03

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. No
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.

Barbara Jo Spoonhour

Administrative Services Director


08/18/2022

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.

Barbara J Spoonhour

Administrative Services Director


08/18/2022

Attachments

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