F Schedule
B
Approved
by OMB
3060
– 0798
See
601 Main Form Instructions
for
public burden estimate
FCC 601
Information and Instructions
Form FCC 601, Schedule B, is a supplementary schedule for use with the FCC Application for Radio Service Authorization: Wireless Telecommunications Bureau and/or Public Safety and Homeland Security Bureau, FCC 601 Main Form. This schedule is used to apply for the required license authorization when the Applicant has been determined to be the winning bidder at the close of an FCC auction. The FCC 601 Main Form must be filed in conjunction with this schedule.
Schedule B
Instructions
Market/Channel Block
Items 1 through 4 are to be completed with the market or markets that are licensed on a geographic licensing area or market basis (e.g., Personal Communications Service) and have been won through an auction (in this case, multiple sites may be completed for each Schedule B).
Item 1 This item identifies the market(s) to which the filing pertains. Market designators are listed in FCC Public Notices or in the FCC rules.
Item 2 This item, in addition to the market designator, identifies the market to which the filing pertains. The market names are listed in FCC Public Notices or in the FCC rules.
Item 3 This item identifies the spectrum, assigned in channel blocks, for the market area listed in Item 1.
Item 4 Complete this item only if the market area listed in Item 1 has been subdivided (in a partition and/or disaggregation).
Note: In some circumstances geographic area Licensees must apply for a site‑specific authorization when either (a) a site requires international coordination, or (b) a site will have an environmental impact, or (c) a base or fixed station in the 700 MHz WCS channels is operating in excess of 1 kW ERP.
(a) Sites requiring international coordination:
International coordination is generally needed when a site is located North of Line A or East of Line C. Appendix I in FCC Form 601 Main Form instructions contains a list of counties/boroughs, by state, having areas North of Line A and East of Line C. In these instances, Licensees must file an application for modification using FCC Form 601 Main Form and Schedule I for microwave radio services or Schedule D and the appropriate technical data schedule for all other radio services.
(b) Sites having an environmental impact:
Sites having a significant environmental effect are defined in Section 1.1307 of the Commission's rules. In these instances, Licensees must file an application for modification using FCC Form 601 Main Form and Schedule I for microwave radio services or Schedule D for all other radio services. Examples of facilities that may have a significant effect on the environment include:
An antenna structure located in a residential area (as defined by applicable zoning laws) that will utilize high intensity aviation obstruction lighting
A facility located in an officially designated wilderness area, wildlife preserve, or floodplain
A facility that affects a site significant in American history
A facility whose construction involves extensive changes in surface features
Facilities, operations, or transmitters that would cause human exposure to levels of radio frequency radiation in excess of the limits as detailed in §§ 1.1310 and 2.109 of the Commission’s rules.
(c) Based or fixed stations in the 700 MHz WCS channels operating in excess of 1 kW ERP:
FCC 601 Schedule B – Instructions
April 2013 - Page 1
Pursuant to Section 27.50(c)(8) of the Commission’s rules, Licensees authorized for the 700 MHz WCS channels that operate base or fixed stations in excess of 1 kW ERP must file an application for modification using FCC Form 601 Main Form and Schedule D. Licensees must provide the coordinates of the facilities on Schedule D and provide as an exhibit the station’s maximum ERP (watts), antenna height above ground (meters) and a depiction of the vertical antenna pattern. Licensees must provide the same technical parameters to all adjacent
Part 27 Licensees authorized to construct and operate a base or fixed station within 75 km of the location(s) indicated on Schedule D.
Item 5 This item will be prefilled from FCC Form 175 that you filed previously with the Commission when the application is submitted.
Item 6 This item will be prefilled from FCC Form 175 that you filed previously with the Commission when the application is submitted.
Item 7 For each market and channel block please indicate whether you will be seeking a tribal lands bidding credit by checking the appropriate block.
Note: The processing of each application requesting a tribal land bidding credit will be suspended for 180 days. This 180-day period provides the Applicant time to secure the required certification(s) from the appropriate tribal government(s) and to amend the application in accordance with the Commission’s rules.
Tribal Lands Information
Complete this section ONLY after you have received the required certification(s) from the tribal government(s).
The information provided in this section will enable the FCC to determine whether an Applicant is eligible to receive a tribal land bidding credit and the amount of the bidding credit.
Item 8 Enter the market designator for those markets where a tribal lands bidding credit is being sought.
Item 9 Enter the assigned channel blocks for the market area listed in Item 8.
Item 10 Enter the names of the tribal lands for which a bidding credit is being sought. The term “tribal lands” shall mean “reservation” as defined by the Bureau of Indian Affairs. A reservation is any federally recognized Indian tribe’s reservation, Pueblo, or Colony, including former reservations in Oklahoma, Alaska Native regions established pursuant to the Alaska Native Claims Settlement Act (85 Stat.688), and Indian allotments.
Item 11 Enter, in square kilometers, the area for each tribal land within the designated market.
Item 12 For each market, place an “x” next to the tribal lands where the required certification(s) has been received and bidding credit is sought. Attach the certification(s) as an exhibit and title it “Tribal Government Certification”.
Item 13 On the first line for each market, enter the dollar amount of the tribal lands bidding credit as calculated in accordance with the Commission’s rules.
Item 14 If requesting a waiver of the Commission’s rules to obtain a tribal lands bidding credit higher than allowed under the rules, enter the additional dollar amount for each market, on the first line for that market, and attach an exhibit justifying the request. You must provide a certification from an independent auditor that the estimated costs set forth in the exhibit are reasonable.
Note: Your tribal lands bidding credit cannot exceed the applicable bidding credit cap as defined in the rules.
Note concerning Items 15 through Items 47: The following information will be prefilled when filing electronically from the FCC Form 175 that you filed previously with the Commission. If any information has changed, you may continue completing the application.
Agreement Identifier
Item 15 This item must be completed. It indicates the action the Applicant wants the FCC to take on this agreement and the type of agreement. Check the appropriate block to either Add or Delete Agreements or Party(ies) to Agreements. Enter the unique identifying name of the agreement and check the appropriate block of the party(ies) to agreement for either Entity Name or Individual Name. If filing for an entity, enter the legal entity name. If filing is for an ‘Individual’, enter the first name, middle initial, last name and suffix of the individual. Provide FCC Registration Number (FRN) of the party to the agreement.
Designated Entity/Closed Bidding Agreement Info
Item 16 Answer this item ‘Y’ if you have you entered into any agreements which could impact your Designated Entity or closed bidding status. Otherwise, enter ‘N’. If answering ‘Y’, attach an exhibit listing the agreements plus a summary.
FCC 601 Schedule B – Instructions
April 2013 - Page 2
Additional Demographic Information (Not Required)
Item 17 Check the appropriate block for Applicant status if a Minority Owned Business, Rural Telephone Company, or a Woman Owned Business if applicable. This item is not required.
Revenue and Asset Information
Item 18 Enter ‘Y’ if any revenue and asset information has changed for the Applicant, the Disclosable Interest Holder, or the Affiliate. Otherwise, enter ‘N’. If ‘Y’, provide details in an attachment.
Revenue and Asset Information for the Applicant
Item 19 Check the block if modifying the Applicant information. When modifying, enter only the items changed. All other information will be copied from the FCC Form 175 filed previously.
Gross Revenue Disclosure
Most Recent Reportable Year
Item 20a Enter ‘Y’ if the Applicant and any predecessors-in-interest were in existence and had gross revenues for the most recent reportable year. If ‘Y’, complete items 20b and 20c. Enter ‘N’ if the Applicant and any predecessors-in-interest were not in existence for the most recent reportable year and explain why in an attachment.
One Year Prior to Most Recent Reportable Year
Item 21a Enter ‘Y’ if the Applicant and any predecessors-in-interest were in existence and had gross revenues for one year prior to the most recent reportable year. If ‘Y’, complete items 21b and 21c. Enter ‘N’ if the Applicant and any predecessors-in-interest were not in existence for one year prior to the most recent reportable year and explain why in an attachment.
Two Years Prior to Most Recent Reportable Year
Item 22a Enter ‘Y’ if the Applicant and any predecessors-in-interest were in existence and had gross revenues for two years prior to the most recent reportable year. If ‘Y’, complete items 22b and 22c. Enter ‘N’ if the Applicant and any predecessors-in-interest were not in existence for two years prior to the most recent reportable year and explain why in an attachment.
Average Gross Revenue
Item 23 The Universal Licensing System will calculate the average gross revenue for the reported years provided in Items 20, 21 and 22.
Asset Disclosure
Item 24 Enter the total assets disclosed as of the application filing deadline.
Financial Statements
Item 25 Check if the Applicant used audited financial statements or unaudited statements prepared in accordance with Generally Accepted Accounting Principles (GAAP) and certified by Applicant’s chief financial officer or the equivalent.
Revenue and Asset Information for the Disclosable Interest Holder (DIH)
Item 26 Select the proper block to Add, Modify, or Delete a DIH. If Adding, complete items 27 through 33. If Modifying, enter only the items changed. If Deleting, complete the Entity Name or the Individual Name and the FRN of the DIH. Modify and Delete are used for Amendments of previously filed application. If necessary, attach additional copies of this page to list more DIHs.
Disclosable Interest Holder
Item 27 Select the proper block for either Entity Name or Individual name of the Disclosable Interest Holder and provide Entity Name or Individual name and the FCC Registration Number (FRN) of the DIH.
Gross Revenue Disclosure
Most Recent Reportable Year
Item 28a Enter ‘Y’ if the DIH and any predecessors-in-interest were in existence and had gross revenues for the most recent reportable year. If ‘Y’, complete items 28b and 28c. Enter ‘N’ if the DIH and any predecessors-in-interest were not in existence for the most recent reportable year and explain why in an attachment.
One Year Prior to Most Recent Reportable Year
Item 29a Enter ‘Y’ if the DIH and any predecessors-in-interest were in existence and had gross revenues for one year prior to the most recent reportable year. If ‘Y’, complete items 29b and 29c. Enter ‘N’ if the DIH and any predecessors-in-interest were not in existence for one year prior to the most recent reportable year and explain why in an attachment.
Two Years Prior to Most Recent Reportable Year
Item 30a Enter ‘Y’ if the DIH and any predecessors-in-interest were in existence and had gross revenues for two years prior to the most recent reportable year. If ‘Y’, complete items 30b and 30c. Enter ‘N’ if the DIH and any predecessors-in-interest were not in existence for two years prior to the most recent reportable year and explain why in an attachment.
Average Gross Revenue
Item 31 The Universal Licensing System will calculate the average gross revenue for the reported years provided in Items 28, 29 and 30.
FCC 601 Schedule B – Instructions
April 2013 - Page 3
Asset Disclosure
Item 32 Enter the total assets disclosed as of the application filing deadline.
Financial Statements
Item 33 Check if the DIH used audited financial statements or unaudited statements prepared in accordance with Generally Accepted Accounting Principles (GAAP) and certified by DIH’s chief financial officer or the equivalent.
Revenue and Asset Information for the Affiliate
Item 34 Select the proper block to Add, Modify, or Delete an Affiliate. If Adding, complete items 35 through 41. If Modifying, enter only the items changed. If Deleting, complete the Entity Name or the Individual Name and the FRN of the Affiliate. Modify and Delete are used for Amendments of previously filed application. If necessary, attach additional copies of this page to list more Affiliates.
Affiliate
Item 35 Select the proper block for either Entity Name or Individual name of the Affiliate and provide Entity Name or Individual name and the FCC Registration Number (FRN) of the Affiliate.
Gross Revenue Disclosure
Most Recent Reportable Year
Item 36a Enter ‘Y’ if the Affiliate and any predecessors-in-interest were in existence and had gross revenues for the most recent reportable year. If ‘Y’, complete items 36b and 36c. Enter ‘N’ if the Affiliate and any predecessors-in-interest were not in existence for the most recent reportable year and explain why in an attachment.
One Year Prior to Most Recent Reportable Year
Item 37a Enter ‘Y’ if the Affiliate and any predecessors-in-interest were in existence and had gross revenues for one year prior to the most recent reportable year. If ‘Y’, complete items 37b and 37c. Enter ‘N’ if the Affiliate and any predecessors-in-interest were not in existence for one year prior to the most recent reportable year and explain why in an attachment.
Two Years Prior to Most Recent Reportable Year
Item 38a Enter ‘Y’ if the Affiliate and any predecessors-in-interest were in existence and had gross revenues for two years prior to the most recent reportable year. If ‘Y’, complete items 38b and 38c. Enter ‘N’ if the Affiliate and any predecessors-in-interest were not in existence for two years prior to the most recent reportable year and explain why in an attachment.
Average Gross Revenue
Item 39 The Universal Licensing System will calculate the average gross revenue for the reported years provided in Items 36, 37 and 38.
Asset Disclosure
Item 40 Enter the total assets disclosed as of the application filing deadline.
Financial Statements
Item 41 Check if the Affiliate used audited financial statements or unaudited statements prepared in accordance with Generally Accepted Accounting Principles (GAAP) and certified by the Affiliate’s chief financial officer or the equivalent.
Closed Bidding /Designated Entity Eligibility
Total Gross Revenues for Most Recent Reportable Year
Item 42 The Universal Licensing System will calculate the total gross revenue for the most recent reportable year and the year end date.
Total Gross Revenues for One Year Prior to Most Recent Reportable Year
Item 43 The Universal Licensing System will calculate the total gross revenue for one year prior to most recent reportable year and the year end date.
Total Gross Revenues for Two Years Prior to Most Recent Reportable Year
Item 44 The Universal Licensing System will calculate the total gross revenue for two years prior to most recent reportable year and the year end date.
Total Aggregate Average Gross Revenues for Designated Entity
Item 45 The Universal Licensing System will calculate the aggregate average gross revenue for the designated entity.
Total Aggregate Average Gross Revenues for Closed Bidding
Item 46 The Universal Licensing System will calculate the aggregate average gross revenue for the closed bidding.
Total Assets Disclosure
Item 47 The Universal Licensing System will calculate the total assets for the closed bidding.
FCC 601 Schedule B – Instructions
April 2013 - Page 4
Certification Statements
By signing the FCC 601 Main Form, the Applicant certifies that the statements listed in this section are true, complete, correct, and made in good faith.
FCC 601 Schedule B – Instructions
April 2013 - Page 5
Schedule B
Approved by OMB
3060 – 0798
See 601 Main Form Instructions
for public burden estimate
chedule for Geographically Licensed Services
MARKET/CHANNEL BLOCK INFORMATION
1) Market Designator
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2) Market Name |
3) Channel Block |
4) Sub-Market Designator |
5) Percentage of Bidding Credit |
6) Open/Closed Bidding |
7) I Am Seeking A Tribal Lands Bidding Credit In This Market |
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( ) Yes ( ) No |
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( ) Yes ( ) No |
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( ) Yes ( ) No |
TRIBAL LANDS INFORMATION - Complete only when attaching the required certification(s) from the tribal government(s)
8) Market Designator
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9) Channel Block |
10) Name of Tribal Lands |
11) Area, in square kms, of tribal lands contained within designated market |
12) Indicate with an “x” those tribal lands where Applicant has secured the required certification(s) from the tribal governments [attach certification(s)] |
13) The amount of bidding credit as defined by FCC Rules (by Market) |
14) Additional amount of bidding credit requested (attach justification) |
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1
T
Agreement
Name:
Party(ies) to Agreement(s)
A
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Legal Entity Name |
FCC Registration Number (FRN): |
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MI |
Last |
Suffix |
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FCC Registration Number (FRN): |
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A
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Legal Entity Name |
FCC Registration Number (FRN): |
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MI |
Last |
Suffix |
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FCC Registration Number (FRN): |
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A
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Legal Entity Name |
FCC Registration Number (FRN): |
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Suffix |
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FCC Registration Number (FRN): |
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FCC 601 Schedule B
April 2013 - Page 1
Designated Entity/Closed Bidding Agreement Info
16) Have you entered into any agreements which would impact your Designated Entity or closed bidding status? If ‘Y’, attach an exhibit. |
( ) Yes No |
17) Additional Demographic Information (Not Required)
Applicant Status:
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Revenue and Asset Information
18) Has any Revenue and Asset information changed for the Applicant, the Disclosable Interest Holder, or the Affiliate? If ‘Y’, explain why in an exhibit. |
( ) Yes No |
Revenue and Asset Information for the Applicant
Purpose (Check Modify and complete all changes different from previously filed FCC Form 175)
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Gross Revenue Disclosure Most Recent Reportable Year
20a) Were the Applicant and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment. |
( ) Yes No |
If ‘Y’, provide the following information.
20b) Gross Revenues $_____________________ (Format: 99,999.99)
20c) Year End Date: _____________________ (Date Format: MM/DD/YYYY)
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One Year Prior to Most Recent Reportable Year
21a) Were the Applicant and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment. |
( ) Yes No |
If ‘Y’, provide the following information.
21b) Gross Revenues $_____________________ (Format: 99,999.99)
21c) Year End Date: _____________________ (Date Format: MM/DD/YYYY)
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Two Years Prior to Most Recent Reportable Year
22a) Were the Applicant and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment. |
( ) Yes No |
If ‘Y’, provide the following information.
22b) Gross Revenues $_____________________ (Format: 99,999.99)
22c) Year End Date: _____________________ (Date Format: MM/DD/YYYY)
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Average Gross Revenue
23) Average Gross Revenue of Reported Years: $_____________________________ (Format: 99,999.99)
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Asset Disclosure
24) Total Assets as of Application Filing Deadline: $_____________________________(Format: 99,999.99)
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Financial Statements
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FCC 601 Schedule B
April 2013 - Page 2
FCC 601
Schedule B
Revenue and Asset Information for the Disclosable Interest Holder (DIH)
Purpose (Select One)
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27) Disclosable Interest Holder
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FCC Registration Number (FRN):
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MI |
Last |
Suffix |
FCC Registration Number (FRN):
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Gross Revenue Disclosure Most Recent Reportable Year
28a) Were the DIH and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment. |
( ) Yes No |
If ‘Y’, provide the following information.
28b) Gross Revenues $_____________________ (Format: 99,999.99)
28c) Year End Date: _____________________ (Date Format: MM/DD/YYYY)
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One Year Prior to Most Recent Reportable Year
29a) Were the DIH and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment. |
( ) Yes No |
If ‘Y’, provide the following information.
29b) Gross Revenues $_____________________ (Format: 99,999.99)
29c) Year End Date: _____________________ (Date Format: MM/DD/YYYY)
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Two Years Prior to Most Recent Reportable Year
30a) Were the DIH and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment. |
( ) Yes No |
If ‘Y’, provide the following information.
30b) Gross Revenues $_____________________ (Format: 99,999.99)
30c) Year End Date: _____________________ (Date Format: MM/DD/YYYY)
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Average Gross Revenue
31) Average Gross Revenue of Reported Years: $_____________________________ (Format: 99,999.99)
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Asset Disclosure
32) Total Assets as of Application Filing Deadline: $_____________________________ (Format: 99,999.99)
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Financial Statements
33) Audited or Unaudited (Check One)
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FCC 601 Schedule B
April 2013 - Page 3
FCC 601
Schedule B
34) Revenue and Asset Information for the Affiliate
Purpose (Select One)
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35) Affiliate
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FCC Registration Number (FRN):
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MI |
Last |
Suffix |
FCC Registration Number (FRN):
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Gross Revenue Disclosure Most Recent Reportable Year
36a) Were the Affiliate and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment. |
( ) Yes No |
If ‘Y’, provide the following information.
36b) Gross Revenues $_____________________ (Format: 99,999.99)
36c) Year End Date: _____________________ (Date Format: MM/DD/YYYY)
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One Year Prior to Most Recent Reportable Year
37a) Were the Affiliate and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment. |
( ) Yes No |
If ‘Y’, provide the following information.
37b) Gross Revenues $_____________________ (Format: 99,999.99)
37c) Year End Date: _____________________ (Date Format: MM/DD/YYYY)
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Two Years Prior to Most Recent Reportable Year
38a) Were the Affiliate and any predecessors-in-interest in existence for a full year of the relevant period? If ‘N’, explain why in an attachment. |
( ) Yes No |
If ‘Y’, provide the following information.
38b) Gross Revenues $_____________________ (Format: 99,999.99)
38c) Year End Date: _____________________ (Date Format: MM/DD/YYYY)
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Average Gross Revenue
39) Average Gross Revenue of Reported Years: $_____________________________ (Format: 99,999.99)
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Asset Disclosure
40) Total Assets as of Application Filing Deadline: $_____________________________ (Format: 99,999.99)
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Financial Statements
41) Audited or Unaudited (Check One)
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FCC 601 Schedule B
April 2013 - Page 4
FCC 601
Schedule B
Closed Bidding/Designated Entity Eligibility
Total Gross Revenues for Most Recent Reportable Year
42a) Gross Revenues $_____________________ (Format: 99,999.99)
42b) Year End Date: _____________________ (Date Format: MM/DD/YYYY)
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Total Gross Revenues for One Year Prior to Most Recent Reportable Year
43a) Gross Revenues: $_____________________ (Format: 99,999.99)
43b) Year End Date: _____________________ (Date Format: MM/DD/YYYY)
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Total Gross Revenues for Two Years Prior to Most Recent Reportable Year
44a) Gross Revenues: $_____________________ (Format: 99,999.99)
44b) Year End Date: _____________________ (Date Format: MM/DD/YYYY)
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Total Aggregate Average Gross Revenues for Designated Entity
45) Aggregate Average Gross Revenue: $_____________________ (Format: 99,999.99)
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Total Aggregate Average Gross Revenues for Closed Bidding
46) Aggregate Average Gross Revenue: $_____________________ (Format: 99,999.99)
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Total Assets Disclosure for Closed Bidding
47) Total Assets: $_____________________ (Format: 99,999.99)
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FCC 601 Schedule B
April 2013 - Page 5
Applicant certifies that they are eligible to obtain the licenses for which they apply. |
For Applicants Claiming Eligibility as a Publicly Traded Corporation
Applicant certifies that they are eligible to obtain the licenses for which they apply and that they comply with the definition of a Publicly Traded Corporation, as set out in the applicable FCC rules. |
For Applicants Claiming Eligibility using a Control Group Structure
Applicant certifies that they are eligible to obtain the licenses for which they apply. |
Applicant certifies that the Applicant’s sole control group member is a pre-existing entity, if applicable. |
For Applicants Claiming Eligibility as a Very Small Business, Very Small Business Consortium, Small Business, or as a Small Business Consortium
Applicant certifies that they are eligible to obtain the licenses for which they apply. |
Applicant certifies that the Applicant’s sole control group member is a pre-existing entity, if applicable. |
For Applicants Claiming Eligibility as a Rural Telephone Company
Applicant certifies that they meet the definition of a Rural Telephone Company as set out in the applicable FCC rules, and must disclose all parties to agreement(s) to partition licenses won in this auction. See applicable FCC rules. |
For Applicants Claiming Tribal Lands Bidding Credit
Applicant certifies that it will comply with the bidding credit buildout requirements and consult with the tribal government(s) regarding the siting of facilities and deployment of service on the tribal land(s) as set out in the applicable FCC rules. |
For Auction Applicants
Applicant provided separate gross revenue information for itself, for each of Applicant's officers and directors; for each of Applicant's other controlling interests; for each of Applicant's affiliates; and for each affiliate of each of Applicant's officers, directors, and other controlling interests. |
Applicant provided separate gross revenue and total asset information for itself, for each of Applicant's officers and directors; for each of Applicant's other controlling interest; for each of Applicant’s affiliates; and for each affiliate of each Applicant's officers, directors, and other controlling interests. |
FCC 601 Schedule B
April 2013 - Page 6
| File Type | application/msword |
| File Title | FCC 601 |
| Author | Sheila Blankenship |
| Last Modified By | judith |
| File Modified | 2013-05-23 |
| File Created | 2013-05-23 |