Attachment HUB5 Form 854

This document pretains to SES-MOD-20120229-00267 for Modification on a Satellite Earth Station filing.

IBFS_SESMOD2012022900267_941135

FCC Form 854 REFERENCE COPY This copy is intended to be used as a reference copy only and MAY NOT be submitted to the FCC as an application for manual filing. FCC 854 Main Form FCC Application for Antenna Structure Registration Approved by OMB 3060 - 0139 Est. Public Burden per Response: 30 minutes File Number: A0756245 Purpose of Filing 1. Purpose of this filing: New 2A. For purpose codes of WD or AM, provide the file number of the pending application currently on file with the FCC: 2B. For purpose codes of MD, CA, AU, DI, NT, DU or OC provide FCC Registration Number: 2C. If purpose code is MD or NT, provide date constructed or Last altered (mm/dd/yy): 2D. If purpose code is DI, give date of dismantlement (mm/dd/yy): Antenna Structure Ownership Information 3A. FCC ID of Owner/Assignee: 3B. Sub-Group Identification Number 3C. FCC Registration Number (FRN) of L01661443 (SGIN) of Owner/Assignee: 000 Owner/Assignee: 0018756155 4A. FCC ID of Assignor (for 4B. Sub-Group Identification Number 4C. FCC Registration Number (FRN) of purpose code OC only): (SGIN) of Assignor: Assignor: 5. Legal Owner of MI: Last Name: Suffix: Structure/Assignee First Name (if individual): 6. Business Name (if other than Individual): VSAT Systems, LLC 7. Attention To: Michael Kister 8. P.O. Box And/Or 9. Street Address: 1520 S. Arlington 10. City: Akron 11. State: OH 12. Zip Code: 44306 13. Telephone Number: 14. E-Mail Address: mkister@vsatsystems.com (330)785-2100 Contact Representative Information (If different from the Owner/Assignee) 15. First Name: Mario MI: A Last Name: Tomaselli Suffix: 16. Business Name: VSAT Systems, LLC 17. P.O. Box: And/Or 18. Street Address: 1520 S. Arlington 19. City: Akron 20. State: OH 21. Zip: 44306 22. Telephone Number: (330)785-2100 23. E-Mail Address: mtomaselli@vsatsystems.com Antenna Structure 24. NAD83 Antenna Structure Latitude (DD-MM-SS.S): 25. NAD83 Antenna Structure Longitude (DDD-MM-SS.S): 41-01-50.6 N (N) N or S 081-29-33.3 W (W) W or E http://wireless2.fcc.gov/UlsApp/AsrSearch/printAuth_FCCForm854.jsp?applKey=4098797[2/29/2012 6:01:07 PM]

FCC Form 854 26. Address or Geographical Location: 961 East Waterloo 27. City: Akron 28. State: OH 29. Elevation of site above mean sea level (refer to "a" in antenna structure examples): 349.5 meters 30. Overall (highest) height above ground (AGL) of an antenna structure INCLUDING all appurtenances (antennas, dishes, lightning rods, obstruction lighting, etc.) (refer to "c" in antenna structure examples): 8.1 meters 31. Overall height above mean sea level (sum total of items 29 and 30): 357.6 meters 32. Overall height above ground level (AGL) of the supporting structure itself WITHOUT appurtenances (refer to "b" in antenna structure examples): 8.1 meters 33. Indicate the code for the type of structure on which antenna will be mounted (i.e., pole, building, water tank, silo, tower, etc.) (See Instructions): TOWER - 34-35. If type of structure is an Array, provide coordinates for center of the array below: 34. NAD83 Array Center Latitude (DD-MM-SS.S): (N) or 35. NAD83 Array Center Longitude (DDD-MM-SS.S): (W) or S S FAA Notification 36. FAA Study Number: 2011-AGL-5519-OE 37. Date Issued (mm/dd/yy): 10/20/2011 Environmental Assessment 38. (No) Yes Would a Commission grant of Authorization for this location be an action which may have significant No environmental effect? See Section 1.1307 of 47 CFR. If \'YES\', submit an environmental assessment as required by 47 CFR, Sections 1.1308 and 1.1311. Certification Statements 1. The applicant certifies that all statements made in this application and in the exhibits, attachments, or documents incorporated by reference are material,are part of this application, and are true, complete, correct, and made in good faith. 2. The applicant certifies that neither the applicant nor any other party to the application is subject to a denial of Federal benefits pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. § 862, because of a conviction for possession or distribution of a controlled substance. See Section 1.2002(b) of the rules, 47 CFR § 1.2002(b), for the definition of \'party to the application\' as used in this certification. Signature 39. Typed or Printed Name of Party Authorized to Sign First Name: Mario MI: A Last Name: Tomaselli Suffix: 40. Title: RF Engineer 41. Signature: Tomaselli , Mario A 42. Date (mmddyy): 02/29/2012 WILLFUL FALSE STATEMENTS MADE ON THIS FORM OR ANY ATTACHMENTS 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, § 312(a)(1)), AND/OR FORFEITURE (U.S. Code, Title 47, § 503). http://wireless2.fcc.gov/UlsApp/AsrSearch/printAuth_FCCForm854.jsp?applKey=4098797[2/29/2012 6:01:07 PM]

ASR Registration 1283084 ASR Registration Search Registration 1283084    Map Registration Registration Detail Reg Number 1283084 Status Granted File Number A0756245 Constructed FAA Study 2011-AGL-5519-OE EMI No FAA Issue Date 10/20/2011 NEPA No Antenna Structure Structure Type TOWER - Free standing or Guyed Structure used for Communications Purposes Location (in NAD83 Coordinates) Lat/Long 41-01-50.6 N 081-29-33.3 W 961 East Waterloo City, State Akron , OH Center of AM Array Heights (meters) Elevation of Site Above Mean Sea Level Overall Height Above Ground (AGL) 349.5 8.1 Overall Height Above Mean Sea Level Overall Height Above Ground w/o Appurtenances 357.6 8.1 Painting and Lighting Specifications None Owner & Contact Information FRN 0018756155 Licensee ID L01661443 Owner VSAT Systems, LLC Attention To: Michael Kister P: (330)785-2100 1520 S. Arlington E: mkister@vsatsystems.com Akron , OH 44306 Contact Tomaselli , Mario A 1520 S. Arlington P: (330)785-2100 Akron , OH 44306 E: mtomaselli@vsatsystems.com Last Action Status Status Granted Received 02/29/2012 Purpose New Entered 02/29/2012 Mode Interactive Related Applications 02/29/2012 A0756245 - New (NE) Comments Comments http://wireless2.fcc.gov/UlsApp/AsrSearch/asrRegistration.jsp?regKey=2682512&printable[2/29/2012 6:36:06 PM]



Document Created: 2012-02-29 18:37:06
Document Modified: 2012-02-29 18:37:06
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