Application Form [pdf]

This document pretains to SES-MOD-20030903-01204 for Modification on a Satellite Earth Station filing.

IBFS_SESMOD2003090301204_332607

Approved by OMB 3060−0678 Date & Time Filed: Sep 3 2003 9:49:11:923AM File Number: SES−MOD−INTR2003−01734 FCC APPLICATION FOR SPACE AND EARTH STATION:MOD OR AMD − MAIN FORM FCC Use Only FCC 312 MAIN FORM FOR OFFICIAL USE ONLY APPLICANT INFORMATION Enter a description of this application to identify it on the main menu: IMPSAT USA, INC. MOD 1−8. Legal Name of Applicant Name: Impsat USA, Inc. Phone Number: 954−779−7171 x3120 DBA Fax Number: 954−779−3766 Name: Street: 2040 North Dixie Highway E−Mail: jravelo@impsat.com City: Wilton Manors State: FL Country: USA Zipcode: 33305 − Attention: Ms Johanna Ravelo 1

9−16. Name of Contact Representative (If other than applicant) Name: Ms. Johanna Ravelo Phone Number: 954−779−7171 Company: Impsat USA, Inc. Fax Number: 954−779−3766 Street: 2040 North Dixie Highway E−Mail: jravelo@impsat.com City: Wilton Manors State: FL Country: USA Zipcode: 33305− Contact General Counsel Relationship: Same Title: CLASSIFICATION OF FILING 17. Choose the button next to the classification that applies to this filing for (N/A) b1. Application for License of New Station both questions a. and b. Choose only one (N/A) b2. Application for Registration of New Domestic Receive−Only Station for 17a and only one for 17b. (N/A) b3. Amendment to a Pending Application (N/A) b4. Modification of License or Registration a1. Earth Station b5. Assignment of License or Registration a2. Space Station b6. Transfer of Control of License or Registration (N/A) b7. Notification of Minor Modification (N/A) b8. Application for License of New Receive−Only Station Using Non−U.S. Licensed Satellite (N/A) b9. Letter of Intent to Use Non−U.S. Licensed Satellite to Provide Service in the United States (N/A) b10. Other (Please specify) 2

17c. Is a fee submitted with this application? If Yes, complete and attach FCC Form 159. If No, indicate reason for fee exemption (see 47 C.F.R.Section 1.1114). Governmental Entity Noncommercial educational licensee Other(please explain): 17d. Fee Classification A CGX − Fixed Satellite Transmit/Receive Earth Station 18. If this filing is in reference to an 19. If this filing is an amendment to a pending application enter both fields, if this filing is a existing station, enter: modification please enter only the file number: (a) Call sign of station: (a) Date pending application was filed: (b) File number: E990499 SESLIC1999110301966 3

TYPE OF SERVICE 20. NATURE OF SERVICE: This filing is for an authorization to provide or use the following type(s) of service(s): Select all that apply: a. Fixed Satellite b. Mobile Satellite c. Radiodetermination Satellite d. Earth Exploration Satellite e. Direct to Home Fixed Satellite f. Digital Audio Radio Service g. Other (please specify) 21. STATUS: Choose the button next to the applicable status. Choose 22. If earth station applicant, check all that apply. only one. Using U.S. licensed satellites Common Carrier Non−Common Carrier Using Non−U.S. licensed satellites 23. If applicant is providng INTERNATIONAL COMMON CARRIER service, see instructions regarding Sec. 214 filings. Choose one. Are these facilities: Connected to a Public Switched Network Not connected to a Public Switched Network N/A 24. FREQUENCY BAND(S): Place an ’X’ in the box(es) next to all applicable frequency band(s). a. C−Band (4/6 GHz) b. Ku−Band (12/14 GHz) c.Other (Please specify upper and lower frequencies in MHz.) Frequency Lower: Frequency Upper: (Please specify additional frequencies in an attachment) 4

TYPE OF STATION 25. CLASS OF STATION: Choose the button next to the class of station that applies. Choose only one. a. Fixed Earth Station b. Temporary−Fixed Earth Station c. 12/14 GHz VSAT Network d. Mobile Earth Station e. Geostationary Space Station f. Non−Geostationary Space Station g. Other (please specify) 26. TYPE OF EARTH STATION FACILITY: Transmit/Receive Transmit−Only Receive−Only N/A "For Space Station applications, select N/A." 5

PURPOSE OF MODIFICATION 27. The purpose of this proposed modification is to: (Place an ’X’ in the box(es) next to all that apply.) a −− authorization to add new emission designator and related service b −− authorization to change emission designator and related service c −− authorization to increase EIRP and EIRP density d −− authorization to replace antenna e −− authorization to add antenna f −− authorization to relocate fixed station g −− authorization to change frequency(ies) h −− authorization to add frequency i −− authorization to add Points of Communication (satellites & countries) j −− authorization to change Points of Communication (satellites & countries) k −− authorization for facilities for which environmental assessment and radiation hazard reporting is required l −− authorization to change orbit location m −− authorization to perform fleet management n −− authorization to extend milestones o −− Other (Please specify) 6

ENVIRONMENTAL POLICY 28. Would a Commission grant of any proposal in this application or amendment have a significant environmental Yes No impact as defined by 47 CFR 1.1307? If YES, submit the statement as required by Sections 1.1308 and 1.1311 of the Commission’s rules, 47 C.F.R. 1.1308 and 1.1311, as an exhibit to this application.A Radiation Hazard Study Exhibit A must accompany all applications for new transmitting facilities, major modifications, or major amendments. ALIEN OWNERSHIPEarth station applicants not proposing to provide broadcast, common carrier, aeronautical en route or aeronautical fixed radio station services are not required to respond to Items 30−34. 29. Is the applicant a foreign government or the representative of any foreign government? Yes No N/A 30. Is the applicant an alien or the representative of an alien? Yes No N/A 31. Is the applicant a corporation organized under the laws of any foreign government? Yes No N/A 32. Is the applicant a corporation of which more than one−fifth of the capital stock is owned of record or voted by Yes No N/A aliens or their representatives or by a foreign government or representative thereof or by any corporation organized under the laws of a foreign country? 7

33. Is the applicant a corporation directly or indirectly controlled by any other corporation of which more than Yes No N/A one−fourth of the capital stock is owned of record or voted by aliens, their representatives, or by a foreign government or representative thereof or by any corporation organized under the laws of a foreign country? 34. If any answer to questions 29, 30, 31, 32 and/or 33 is Yes, attach as an exhibit an identification of the aliens or foreign entities, their nationality, their relationship to the applicant, and the percentage of stock they own or vote. BASIC QUALIFICATIONS 35. Does the Applicant request any waivers or exemptions from any of the Commission’s Rules? Yes No If Yes, attach as an exhibit, copies of the requests for waivers or exceptions with supporting documents. 36. Has the applicant or any party to this application or amendment had any FCC station authorization or license Yes No revoked or had any application for an initial, modification or renewal of FCC station authorization, license, or construction permit denied by the Commission? If Yes, attach as an exhibit, an explination of circumstances. 8

37. Has the applicant, or any party to this application or amendment, or any party directly or indirectly controlling Yes No the applicant ever been convicted of a felony by any state or federal court? If Yes, attach as an exhibit, an explination of circumstances. 38. Has any court finally adjudged the applicant, or any person directly or indirectly controlling the applicant, Yes No guilty of unlawfully monopolizing or attemptiing unlawfully to monopolize radio communication, directly or indirectly, through control of manufacture or sale of radio apparatus, exclusive traffic arrangement or any other means or unfair methods of competition?If Yes, attach as an exhibit, an explanation of circumstances 39. Is the applicant, or any person directly or indirectly controlling the applicant, currently a party in any pending Yes No matter referred to in the preceding two items? If yes, attach as an exhinit, an explanation of the circumstances. 40. If the applicant is a corporation and is applying for a space station license, attach as an exhibit the names, address, and citizenship of those stockholders owning a record and/or voting 10 percent or more of the Filer’s voting stock and the percentages so held. In the case of fiduciary control, indicate the beneficiary(ies) or class of beneficiaries. Also list the names and addresses of the officers and directors of the Filer. 9

41. By checking Yes, the undersigned certifies, that neither applicant nor any other party to the application is Yes No subject to a denial of Federal benefits that includes FCC benefits pursuant to Section 5301 of the Anti−Drug Act of 1988, 21 U.S.C. Section 862, because of a conviction for possession or distribution of a controlled substance. See 47 CFR 1.2002(b) for the meaning of "party to the application" for these purposes. 42a. Does the applicant intend to use a non−U.S. licensed satellite to provide service in the United States? If Yes, Yes No answer 42b and attach an exhibit providing the information specified in 47 C.F.R. 25.137, as appropriate. If No, proceed to question 43. 42b. What administration has licensed or is in the process of licensing the space station? If no license will be issued, what administration has coordinated or is in the process of coordinating the space station? 43. Description. (Summarize the nature of the application and the services to be provided). (If the complete description does not appear in this box, please go to the end of the form to view it in its entirety.) POINT TO POINT PRIVATE DATA NETWORK. 10

CERTIFICATION The Applicant waives any claim to the use of any particular frequency or of the electromagnetic spectrum as against the regulatory power of the United States because of the previous use of the same, whether by license or otherwise, and requests an authorization in accordance with this application. The applicant certifies that grant of this application would not cause the applicant to be in violation of the spectrum aggregation limit in 47 CFR Part 20. All statements made in exhibits are a material part hereof and are incorporated herein as if set out in full in this application. The undersigned, individually and for the applicant, hereby certifies that all statements made in this application and in all attached exhibits are true, complete and correct to the best of his or her knowledge and belief, and are made in good faith. 44. Applicant is a (an): (Choose the button next to applicable response.) Individual Unincorporated Association Partnership Corporation Governmental Entity Other (please specify) 45. Name of Person Signing 46. Title of Person Signing MAURICIO CEBALLOS PRESIDENT 47. Please supply any need attachments. Attachment 1: Attachment 2: Attachment 3: 11

WILLFUL FALSE STATEMENTS MADE ON THIS FORM ARE PUNISHABLE BY FINE AND / OR IMPRISONMENT (U.S. Code, Title 18, Section 1001), AND/OR REVOCATION OF ANY STATION AUTHORIZATION (U.S. Code, Title 47, Section 312(a)(1)), AND/OR FORFEITURE (U.S. Code, Title 47, Section 503). 12

SATELLITE EARTH STATION AUTHORIZATIONS FCC Form 312 − Schedule B:(Technical and Operational Description) FOR OFFICIAL USE ONLY Location of Earth Station Site E1: Site Identifier: N/A E5. Call Sign: E990499 E2: Contact Name JOHANNA E6. Phone 954−779−7171 RAVELO Number: E3. Street: 2040 NORTH E7. City: WILTON DIXIE HIGHWAY MANORS E8. County: BROWARD E4. State FL E9. Zip Code 33305 E10. Area of Operation: 2040 North Dixie Highway E11. Latitude: 26 °9 ’3.0 "N E12. Longitude: 80 °7 ’6.0 "W E13. Lat/Lon Coordinates are: NAD−27 NAD−83 N/A E14. Site Elevation (AMSL): 1.52 meters E15. If the proposed antenna(s) operate in the Fixed Satellite Service (FSS) with geostationary satellites, do(es) the proposed antenna(s) comply with the antenna gain patterns specified in Section 25.209(a) and (b) as demonstrated Yes No N/A by the manufacturer’s qualification measurement? If NO, provide as a technical analysis showing compliance with two−degree spacing policy. 13

E16. If the proposed antenna(s) do not operate in the Fixed Satellite Service (FSS), or if they operate in the Fixed Satellite Service (FSS) with non−geostationary satellites, do(es) the proposed antenna(s) comply with the antenna Yes No N/A gain patterns specified in Section 25.209(a2) and (b) as demonstrated by the manufacturer’s qualification measurements? E17. Is the facility operated by remote control? If YES, provide the location and telephone number of the control point. Yes No E18. Is frequency coordination required? If YES, attach a frequency coordination report as Exhibit D Yes No E19. Is coordination with another country required? If YES, attach the name of the country(ies) and plot of coordination contours as Yes No E20. FAA Notification − (See 47 CFR Part 17 and 47 CFR part 25.113(c)) Where FAA notification is required, have you attached a copy of a completed FCC Form 854 and/or the FAA’s study regarding the potential hazard of Yes No the structure to aviation? FAILURE TO COMPLY WITH 47 CFR PARTS 17 AND 25 WILL RESULT IN THE RETURN OF THIS APPLICATION. POINTS OF COMMUNICATION Satellite Name: OTHERIf you selected OTHER, please enter the following: E21. Common Name: Intelsat 903 E22. ITU Name: E23. Orbit Location: 34.5 W.L. E24. Country: USA POINTS OF COMMUNICATION (Destination Points) E25. Site Identifier: 14

E26. Common Name: E27. Country: ANTENNA Site ID E28. Antenna Id E29. Quantity E30. E31. Model E32. Antenna E41/42. Antenna Manufacturer Size<meters> Gain Transmint and/or Recieve (____dBi at _____GHz) N/A 0 1 PRODELIN 1381 3.8 0 dBi at 0 42 dBi at 4 46 dBi at 6 E28. Antenna E33/34. E35. Above E36. Above Sea E37. Building E38. Total E39. Maximum E40. Total Id Diameter Ground Level Level(meters) Height Above Input Power at Antenna Height EIRP for al Minor/Major (meters) Ground Level antenna flange Above Rooftop carriers(dBW) (meters) (meters) (Watts) (meters) 0 / 4.2 5.72 0.0 10.0 0.0 56.0 FREQUENCY E28. Antenna Id E43/44. E45. E46. Antenna E47. Emission E48. Maximum E49. Maximum Frequency Bands T/R<br>Mode Polarization(H,V, Designator EIRP per Carrier ERIP Density per (MHz) L,R) (dBW) Carrier (dBW/4kHz) 0 3700 4200 R Left Hand Circular 204KG7D 0.0 0.0 15

E50. Modulation and Services (If the complete description does not appear in this box, please go to the end of the form to view it in its entirety.) Digital, QPSK, 3/4 FEC, 2048 kbps 0 5925 6425 T Right Hand 204KG7D 49.3 32.2 Circular E50. Modulation and Services (If the complete description does not appear in this box, please go to the end of the form to view it in its entirety.) Digital, QPSK, 3/4 FEC, 2048 kbps FREQUENCY COORDINATION E28. E51. Satellite E52/53. E54/55. E56. Earth E57. E58. Earth E59. E60. Antenna Id Orbit Type Frequency Range of Station Antenna Station Antenna Maximum Limits(MHz) Satellite Arc Azimuth Elevation Azimuth Elevation EIRP Density Eastern/West Angle Angle Angle Angle toward the ern Limit Eastern Limit Eastern Limit Western Western Horizon Limit Limit (dBW/4kHz) 0 3700 325.5/34.5 113.3 31.5 113.3 31.5 0.0 4200 5925 325.5/34.5 113.3 31.5 113.3 31.5 −19.4 6425 REMOTE CONTROL POINT LOCATION 16

E61. Call Sign E66. Phone Number NOTE: Please enter the callsign of the controlling station, not the callsign for which this application is being filed. E62. Street Address E63. City E68. County E67/68. E64. Zip Code State/Country / FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT The public reporting for this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the required data, and completing and reviewing the collection of information. If you have any comments on this burden estimate, or how we can improve the collection and reduce the burden it causes you, please write to the Federal Communications Commission, AMD−PERM, Paperwork Reduction Project (3060−0678), Washington, DC 20554. We will also accept your comments regarding the Paperwork Reduction Act aspects of this collection via the Internet if you send them to jboley@fcc.gov. PLEASE DO NOT SEND COMPLETED FORMS TO THIS ADDRESS. Remember − You are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number or if we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060−0678. THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104−13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507. 17


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Document Modified: 2019-04-10 10:22:11
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