HomeMy WebLinkAbout236555 08/27/14 u�_t�q
J,% �� CITY OF CARMEL, INDIANA VENDOR: 363439
ONE CIVIC SQUARE U S A TABLE TENNIS CHECK AMOUNT: $*******150.00*
' ® �'a ONE OLYMPIC PLAZA CHECK NUMBER: 236555
r. ,r CARMEL, INDIANA 46032
9y��tON�� COLORADO SPRINGS CO eosos CHECK DATE: 08/27/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4239039 150.00 GENERAL PROGRAM SUPPL
Carmel • Clay
Parks&Recreation CHECK REQUEST
Date: H
AUG 12 2014
Check payable to: / e
Name:
Address: dn.e OlymeT IL'zG.
City, State, Zip CU l O(O'A b Sipr%n!�) C 0 �o b
X Mail check to payee Return check to requestor
Check Amount:$ (5� �d Date Required:
Check needed for:
To be paid from: 11 11
PO#(if applicable)
Budget account-GL# S D• 4 Z Jd 0 5 I
Budget Line Description
Invoice(s)MUST be attached.
Y(print):Requested b : Le V y-
q (p )
Requested by(signature):
Approved by(signature of Division Director): r
on this date 8�12�1y
Form revised 6-5-14 Shared/Forms/Business Services/Check Request Form/Check Request(rev 6-5-14)
� USA AUG 12 2014
\®� Ta9LG TLfmf15
Tournament Sanction Request_
Instructions: Oficial Use Only
1.Complete this form and mail with the appropriate sanction fee and a draft of the entry blank to the Regional
Sanctioning Coordinator(RSC)for your region.For 3&4 Star tournaments,send your request to the National NSC Approval:
Sanctioning Coordinator(NSC). Note that tournaments will not be sanctioned without a copy of the entry blank and
payment of the sanction fee.. RSC Approval:
2. The sanctioning official will notify the Tournament Director the status of the sanction request.
3. Complete and submit this form at least 2 months prior to the tournament for a 2-Star and below or at least 4 Date:
months prior to the tournament for 3 Star and above.
Tournament Information
Name of event: f C o op e n
Date(s): �/�116�, To:
Alternate Dates: (y Web page:
Venue Address: 11 G5(C e }¢nj C di f < hf;v9, !hW City: f/t f Me I State/ZIP: ,L/J 03
Club: M(�."�T(i Affiliation expires 2 L$ 15
Contact Person Mck{t Lthc-r Phone: 317-373••57_1WE-mail: tiirKj.
Address(Street/City/State/ZIP): in's c'ifrt j LrK i)-r_ ' C- 1_A.1 c3 �
Referee/Rank 01 (21C_khAn - Tournament Director Mu,7Hb . r-
Tournament Level By signing below, 1)I agree to submit the required Tournament
Sanction Report postmarked no later than 14 days after,the last day of the
Prize Money Fee tournament. I understand that the appropriate fee penalties will
$0 Waived* be implemented for delinquent submission of the Tournament
$0-$400 $40 Report(see USATT Tournament Report Form), 2) 1 agree that
$40141,000 $80 the club's affiliation status will be current at the time of the
$1,001-$3000 $150
tournament.If club affiliation is not current at time of
$3,00146,000 $300 tournament,sanction is revoked,results will not be processed and
$6,001+ $4Q0 disciplinary action will be taken, 3) 1 agree that the USATT
rating or ITTF ranking will be the primary source for player
Sanction fee enclosed: e1etAQ 't nvv (_r_ ratings.
Star level See attached sheet Z g
( )Check to debit from credit card on file with USATT 9
To be used only for State Games not offering prize money d e
Fees for multi-year or multiple tournament sanction will be paid
at current rate at time of the tournament ournament Director
*USATT reserves the right to withhold sanctioning from any club that has any outstanding bills owed to USATT or whose club affiliation
is not current.USATT encourages local promoters to obtain television coverage.USATT owns all TV,video,motion picture,and any
other reproductive rights for all USATT sanctioned tournaments and events.USATT will normally transfer such rights to
individuals/organizations receiving sanction.However,USATT reserves the right to withhold such transfer.The tournament director and
club agree to obtain signed USATT Waiver and Release of Liability and Photo Release forms from ALL participants.
*Sanctioned tournaments at which merchandise and/or exhibitor booths are offered for rent and booth space is available MUST provide
booth space for manufacturers and distributors of USATT approved equipment,with equal booth fees for like-sized booths.Exemptions
will be granted when the primary tournament sponsor(a sponsor who provides 100%of the prize pool)is a table tennis manufacturer or
distributor.
*USATT's insurance carrier requires that participating USATT members sign a waiver of liability form to be submitted to HQ.
Individual forms must be signed at the tournament upon checking in or be signed and submitted with the entry form.
Submitted by Title Date
***Please see reverse for Ratings List Request*** Form T-101(revised 8/13)
3-11 T.G.2013
Request for Forms
Please indicate the number of copies of the following forms.Tournament forms are provided at no cost unless special
mailii is required.
: Sanction Request(T-101) Round Robin Draw(4x5 Players)(1-Part T 12 1)
Tournament Report(T-109) Round Robin Draw(8 Players)(T 12 1)
Single Elimination Draw(1-Part T-111) /USATT Membership Applications
Single Elimination Draw(3-Part T-111) —/Waiver of Liability forms(2 per page)
Tournament Sanction Checklist
Request for Certificate of Insurance
Request for Rating List
Ratings lists are sent from USATT Headquarters approximately two weeks before th�touent.Please indicate
below the states for which you are requesting ratings. Format for ratings:_Paperrmat).
E-mail address m�e (nTrl�S C�01
List States: 614 DJ HT I L�i
Request for Labels
Please indicate below the states and/or regions for which you are requesting labels.The cost is$0.05 per label,and the cost
of shipping will be included on the invoice for the labels.
Region(s):
States:
Shipping Instructions
All materials will be mailed by the most reasonable method unless a specific request in indicated below:
Next day delivery First class delivery Third class delivery
If late application requires next day air freight(e.g.Federal Express),you will be billed acordingly.
Ship forms and labels to:
Form T101,Page 2
2013 T.G. 3-12
Star Rating Criteria
Required
Category Criteria Points for Star
Level
Lighting Measured on table playing surface(select one)
Minimum standard 300,Lux'��rth'frztures atleast=8 fl above the`floor_
400 Lux 1
600 Lux for feature matches 2 3 and up
600 Lux
800 Lux for feature matches 4
800 Lux 5
Flooring (select one)
Wood floor or rubberized Mat on concrete or Tile for feature 1 3 and up
matches.
Woodfloor or rubberized Mat on concrete or Tile for all 2 1
matches (_�/
Rubberized Mat.on Wood for feature matches 3
-- Rubberized Mat on Wood for all-matches 4
Ceiling Height, (select one)
Minimum standard 8 ftcelin ;;height
10 ft.ceiling,height 1 and up
12 ft ceiling height 1
16 ft ceiling.height 3 and up j
Minimum standard 30 fi length;.10 ft between.tables
12 feet between tables 3 and up
14 feet between tables 4
]9x38 courts for feature matches 5 3 and up
i
19x38 courts 6
23x46 courtsfor feature matches 7
23x96 courts 8
I
Tables (select one))
Minimum standard USA7T6r41TTFAppr9ved: l
No more than two models in use 2 3 and up
All models,alike 3 4 and up
All alike,but show table for feature matches 4
Para table ifwheelcbair players entered add 1
Barriers (select one)-
Barrier
ne)Barrier at net between tables 2
Barrier at net and end of courts between tables 3
Individually barriered court for feature matches 4 3 and up
All courts,fully barriered 6
Time Scheduling (select onef
Minimum standard Event start times.
All events,all rounds 2 3 and up
Published schedule for each player,all rounds 4 5
(select one)See Tournament Guide Ch 9 or referee
Officials
reauirements
Scorekeepers for featured matches 1
Umpires for featured matches 3j 2 and up I'I
Umpires and scorekeepers for featured matches 4 3 and up
Uniformed Umpires and scorekeepers for all matches 6 5
3-13 T.G.2:013
Star Rating Criteria
Required
Category Criteria Points for Star
Level
Event Variety (Select all that applv)(maxinnnn of 4 points)
Novice event 1
Women's event 1
Junior event 1
Para event 1
Team event 1
Doubles event
Prize Money (select one).
$1004400 1
$40141000 3
$1001-$3000 5
$3001-$6000 7
$6001-$10000 10
$10001 and up 15
Drink and food Available inside venue
Player's lounge Available 1
Officials Lounge Available 1
Spectator Seating (select one)
100 seats available 1 3
250 seats available 4
500 seats available 3 5
Media coverage (Select all that apply)
Print 2
TV 2
Live streaming 3 5
Certification Designation by NSC as 5 Star 5
Add all points Total:
Star level: Determined by total points and all requirements met
0 star(0-10 points) -
1 star(11-20 points)
2 star(21-30 points) Z
3 star(31-40 points)
4 star(41-50 points)
5 star(51 points and up)
Sanction Fees Sanction Fees will be based on total Prize Money Fee
<$400 $40
$401-$1000 $80
$1001-$3000 $150
$3001-$6000 $300
$6001 and up $400
2013 T.G. 3-14
Monon
Community Carmel a Clay
`. Comm
Center Parks&Recreation
MCC Spring Open
2 Star Table Tennis Tournament
Saturday v
Februar 21St, 2015
Location: Monon Community Center, Carmel Clay Parks & Recreation
1195 Central Park Drive West
Carmel, Indiana 46032
Sponsored By: Carmel Clay Parks & Recreation and JoolaUSA
Sanction: USA Table Tennis Association
Director: Matt Leber
Email: mieber@carmelclayparks.com Phone: 317-573-5248
Referee/Umpire: Al Grambo CR and RU or designated alternate
Format: Matches are best of 5 games to 11 points. RR groups of 4-5. The USATT-rated player
with best record in each RR group will advance to crossover play in the form of a Single
Elimination Tournament. Unrated players will not advance to crossover play and are not
eligible for prize money/trophies with the exception of Open Singles. Scores will be 11-7, 11-7,
and 11-7 on all defaults.
Tournament Eligibility& Rules: The tournament is open to all USATT members. All USATT rules
and regulations apply including USATT dress code (no white clothing!). The tournament
management may modify the format and prize money with a reduced number of entries.
Events with insufficient entries may be cancelled and fees refunded. Eligibility will be based on
ratings
Ratings and Registration: Ratings for entry, listed as of February 6th, 2015. Ratings for seeding
based on February 13th, 2015. Only paid entrees will be registered. If you mail your entry
please send Matt Leber an email at mieber@carmelclayparks.com to confirm registration.
You may register by phone with a credit card by contacting Matt Leber at 317.573.5248.
Registration Deadline: Friday February 13th, 2015 by 11:59pm.
Refund Policy: No refunds will be given after February 13th, 2015.
Equipment: 3 Killerspin, 3 Joola, and 6 DHS Tables in Gym,Joola 3 star white balls (provided by
JoolaUSA), partially barriered courts. Hardwood floor. Only USATT approved equipment may be
used. No white shirts or shorts!
Prize Money: Prize Payment will be in the form of Visa gift cards on the day of the tournament.
General Information: hgp://www.carmelcl43Marks.com
Default Policy: Start time is default time. Please arrive to check in 30 minutes prior to your
first event. Be prepared to play 10 minutes prior to your event start time.
Hours: Club opens at 8:00am. Concessions on site as well as a locker room, fitness center, and
indoor pool.
JOOLA
for the Champion In YaLlt
o
Comm uni Carmel • Clay
Center Parks&Recreati®n
All events are round robin
Event# Event Fee Player Limit Start Time 15t 2nd Yd
1 Open RR *$30.00 24 12:00 pm . $400 $250 $100
2 U2300 RR $25.00 24 3:00 pm $200 $100 $50
3 U2000 RR $20.00 24 9:00 am $75 $50 $25
4 U1800 RR $15.00 16 12:00 pm $50 $25 $15
5 U1500 RR $15.00 16 3:00 pm $25 Medal Medal
6 U 1200 RR $15.00 16 9:00 am $25 Medal Medal
7 U 1000 RR $15.00 16 12:00 pm $25 Medal_ Medal
Please do not enter two events starting at the same time
*Event 1, Open RR: U2000 players the fee is.$20.00
Monon Community Center Fall Open, November 10th, 2012.
Name
Address Date of Birth
City/State/Zip Phone
Club Rating USATT# Exp. Date
Email Doubles Partner
Events (Circle the events you wish to register for)
1 2 3 4 5 6 7
Entry Fees
USATT Membership Required - = Rating Fee- $7.00 _
Adult$49-one year$130-three years USATT
Junior 17 & under/full time college $25-one year Membership
Household $90- one year, $250-three years
Send to: Matt Leber Carmel Clay Parks & Recreation 1235 Central Park Drive East, Carmel,
Indiana 46032. Payment: Checks made out to Carmel Clay Parks & Recreation
JOOLA '
for the Charnmon in You'
t
o
CCarmel * Clay
Community y
Center Parks&Recreation
On my behalf and on behalf of my heirs and assigns,I HEREBY RELEASE,WAIVE,DISCHARGE,COVENANT NOT TO SUE AND AGREE TO HOLD HARMLESS
THE CARMEL/CLAY BOARD OF PARKS AND RECREATION,THE CARMEL/CLAY PARKS AND RECREATION DEPARTMENT,CITY OF CARMEL,CITY OF CARMEL,
CLAY TOWNSHIP,ITS AND THEIR OFFICIALS,OFFICERS,MEMBERS,INDEPENDENT CONTRACTORS,EMPLOYEES AND VOLUNTEERS(the"Releasees"),from
any and all claims or liability for personal injury or property damage my child and/or I may cause or suffer directly or indirectly arising out of or relating in
any respect to participation in a program,event,service or facility provided by or made available through the Carmel/Clay Parks&Recreation
Department.This waiver and release of all claims,demands,actions,and liability shall include,without limitations,any injury,damage or loss to person
or property which may be(a)caused by any act,or failure to act,by Releasees even if said injury,damage or loss results from the negligence of any or all
of the above-identified Releasees or(b)sustained by me during and/or at the Carmel/Clay Parks and Recreation program,event,service or facility in
which I and/or my child participate(s).
Photo&Video Policy:Photos and video are periodically taken of participants in a class,during a special event or at Carmel/Clay parks and facilities.
Please be aware that these photos and video footage are for the Carmel/Clay Parks&Recreation Department's use only and may be used in the
Department's publications and website.All photos are the property of the Carmel/Clay Board of Parks&Recreation.For more information,please
contact the Marketing Manager at 317.573.4020 or Ilabas@carmeIclayparks.com
Statement of Accessibility:The Carmel/Clay Parks.&Recreation Department encourages participation by everyone!If you or a family member have,
special needs and would like to participant in a program or use a facility,we will happy to make reasonable accommodations to meet your needs.Please
indicate on the registration form if any accommodations are needed for successful inclusion into a program or service in accordance with the American
with Disabilities Act.
Code of Conduct:All users of facilities are expected to exhibit appropriate behavior at all times will participating,spectating or attending any program,
event,service and/or facility provided by the Carmel/Clay Parks&Recreation Department.This includes in programs,events,services or facilities that
may or may not require an admission fee,spectating at athletic events,concerts or attending special events.The following guidelines are designed to
provide safe and enjoyable facilities for all users.Users shall:
Show respect to all users and facility staff/supervisors.
Take direction from facility staff/supervisors.
Refrain from using abusive or foul language.
Refrain from causing bodily harm to self,other users or facility staff/supervisors.
Refrain from damaging equipment,supplies and facilities.
A written or verbal warning shall be given to users/spectators if the Code of Conduct rules have been violated.If there is a second occurrence,
users/spectators shall be withdrawn from the facility without a refund.
Possible Changes in Listings:Carmel Clay Parks&Recreation reserves the right to cancel,combine or divide classes;to change time,date or location of
classes;to change instructor assignments;and to make any other changes that may be necessary.We apologize in advance for any inconvenience this
may cause.
Declined Auto Payments/Returned Checks:Passport privileges and participating in fee-based programs and services shall be suspended until all
delinquent fees are paid in full.
Refund Policy:A full refund will only be given when a class is cancelled by Carmel Clay Parks&Recreation.A refund request at least one week prior to
the first class meeting will receive a refund minus a$7.00 surcharge fee.NO REFUNDS will be given after that point.All check refunds are subject to State
Board of Accounts claim procedures and may take up to 3-4 weeks to process.
I hereby assume all risk and responsibility for my participation in this tournament. I release any and all sponsors,The Morton
Center Table Tennis Club,Carmel Clay Parks and Recreation,USATT,the tournament directors,referee and umpires from any
claims,actions,or demands for any loss,damage or injury sustained by my person or property. I will abide by all USATT
regulations and rules and the decisions of the referee and tournament directors. Parent or legal guardian must sign for minor.
Signature Date (Parent or Guardian if
minor)
J001A
for the Champion In Yov%
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
USA Table Tennis Terms
One Olympic Plaza
Colorado Springs, CO 80909
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
8/8/14 Ck Request Tournament Sanction Fee $ 150.00
Total $ 150.00
1 hereby certify that the attached invoice(s), or bill(s)is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
, 20
Clerk-Treasurer
Voucher No. Warrant No.
USA Table Tennis Allowed 20
One Olympic Plaza
Colorado Springs, CO 80909
In Sum of$
$ 150.00
ON ACCOUNT OF APPROPRIATION FOR
109 -Monon Center
Po#or Board Members
Dept#
INVOICE NO. CCT#/TITL AMOUNT
1096-50 Ck Request 4239039 $ 150.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
21-Aug 2014
Signature
$ 150.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund