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Home My WebLink About194080 02/03/2011 "q CITY OF CARMEL, INDIANA VENDOR: 365060 Page 1 of 1 0 ONE CIVIC SQUARE A S C A P ,ra CARMEL, INDIANA 46032 21675 NETWORK PLACE CHECK AMOUNT: $740.00 CHICAGO IL 60673 -1216 CHECK NUMBER: 194080 CHECK DATE: 2/3/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4358300 100003202806 740.00 OTHER FEES LICENSES PO BOX 331608 -7515 Page: 1 of 1 Nashville, TN 37203 -9998 Purchase Attn: Account Services Descri tlon �Q �S�P GC�/1S %yl W1 Phone: 1 -800 -505 -4052 p �J Fax: 1- 770 805 -3475 P.O. _4D P 0 f(5) ASCAP G.L. It IAM3 4 Budget Line Deser a L- o!V 4i&lO1l/ -LLai r A Purchaser Date Approval Date Mark Westermeier Re: Carmel Clay Dept Of Parks Recreation Director Of Parks Carmel Clay Dept Of Parks Recreation =r� Carmel Clay Dept Of Parks Recreation 1411 E 116th St 1411 E 116th St Carmel, IN 46032 -3455 Carmel, IN 46032 -3455 If You Have Already Made Payment, Please Disregard This Invoice. u In Case Of Error In Amount Of Bill Or Payment, Contract Terms Shall Govern. ACCOUNT NO. BILLING DATE CURRENT PAST DUE BALANCE, DUE 500640093 12/20/2010 $740.00 $0.00 $740:00 CONTRACT RATE' $740.00 Charges per applicable operating policy and rate schedule "copies available on request IMLA ASCAP TRANSACTION REFERENCE NO: DATE CHECK NO. EXPLANATION OF CHARGES CREDITS FOR THE PERIOD AMOUNT REMAINING BALANCE PREVIOUS BALANCE $0.00 100003202806 12/2012010 License Fee 01/01/2011 to 1213112011 $740.00 $740.00 Thank you in advance for your timely payment. Please submit reports and payments for Special Events 90 days after the conclusion of each Event. Securely manage your account on line and avoid late fees at: www.ASCAP.com Securely manage your account on line at www.AS CAP. comigls_web Happy Holidays and Best Wishes for the New YearW TEAR ON THE DOTTED LINE PLEASE PLACE YOUR CUSTOMER ACCOUNT NO. ON ALL CHECKS AND CORRESPONDENCE. PLEASE MAKE YOUR CHECK PAYABLE TO 'ASCAP Carmel Clay Dept Of Parks Recreation 1411E 116th St ACCOUNT'NO. BALANCE.DUE AMOUNT PA1[3`' Carmel, IN 46032 3455 500640093 $740.00 Is 7 4 0 ASCAP 950064009310000740100 Name, Address, Telephone Changes Licensee: ASCAP I MLA Premise: 21678 Network Ptace Street: Chic ago, IL 1 60673 -1216 City, State, ZIP �I��lt` �ntt��tr�rn�ll��ntt��n�E�tn��t��tt�nr��rt�tn�ft� Contact Name: Telephone: B 12/2012010 A00010000 Page: 2 of 3 LOCAL GOVERNMENT ENTITIES 2011 Rafe Schedule and Report Form ASCAT Account No.: 500640093 Premise Name: Carmel Clay Dept Of Parks Recreation; Carmel, IN Report Due: 12/30/2011 SCHEDULE A: Base Liceense Fee (Due upon execution of Agreement and within 30 days of the Agreement's Renewal Date.) Population Size: o I, 2y Base License Fee: Lio D 0 (Per current U.S. Census Data) (Please refer to attached Rate Schedule) SCHEDULE B: Special Events (Repoif and Payment due 90 days after the conclusion of each Special Event) Event Date (mmlddlyyyy) Gross 'If More than 1 Revenue of If the Event is =vent Per Day, Event Is a Program of Co- Sponsored Please Report (Must Applies Musical Works (Please Identify The As Separate Performers) or Exceed to Gross Attached? co- sponsor's Name, Address, Phone Entries Grou s A earin $25,000 Revenue Event Fee (Yes/No) Number and ASCAP Account Number Name: Address: X .01 Phone Account t No,: Name: Address. X .01 Phone No.: Account No.: Name: Address- Phone No.: Account No.: Name: Address: X .01 Phone No.: Account No.: Special Events" means musical events, concerts, shows, pageants, sporting events, festivals, competitions, and other events of limited duration presented by LICENSEE for which the "Gross Revenue" of such Special Event exceeds $25,000. ""Gross Revenue" means all monies received by LICENSEE or on LICENSEE'S behalf from the sale of tickets for each Special Event. If there are no monies from the sale of tickets, "Gross Revenue" shall mean contributions from sponsors or other payments received by LICENEE for each Special Event. ASCAP, 2675 Paces Ferry Road SE, Suite 350, Atlanta, GA 30339 -3913 1 -800 »505 -4052 770 805 -3475 (FAX) Epayment Websites: http:tlwww.ascap.com /gis_web or http:llwww.ascap.com Report Form Continued On Reverse Side Page: 3 of 3 LOCAL GOVERNMENT ENTITIES (continued) (Please complete form in its entirety.) SCHEDULE C: State Municipal andlor County Leagues or State Associations of Attorneys Report Year: Annual License Fee: $309.00 (Due within 30 days of Renewal Date.) Total Fees Reported From Any or All of Schedules A, B or C: `f 0 0 Base Licensee Fees accompanied b y a completed Report Form are due and payable within 30'.days of the License Agreement's renewal date. Th.e Report along with payment may i�a mailed to the ASCAF address'.bi6low. Contact Person: f Ott ��c� z J� 7} �r fl.�/C i}n (Please print Contact's Name.) (Please print Contact's Title.) Phone No.: Q 11) S73, 4 d Fax No.: 31 5 y13 U Email: I�� z,� Website: I certify that the above information is true and correct. Signature: Dated: lr Ple-A e print Name and Title of Signature name above.) ASCAP, 2675 Paces Ferry Road SE, Suite 350, Atlanta, 30339 -3913 1- 800 -505 -4052 770 -805 -3475 (FAX) Epayment Websites: http:tlwww.ascap.com /gls_web or http:l /www.ascap.com 12/20/2010 F0166_0111 AscAP Account No.: 500640093 Carmel Clay Dept Of Parks Recreation ASCAP IMLA 1411 E 116th St Account Services Carmel, IN 46032 -3455 2675 Paces Ferry Road SE Suite 350 Atlanta GA 30339 -3913 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. 360668 ASCAP Terms 21678 Network Place Chicago, IL 60673 -1216 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 12/20/10 100003202806 License to rebroadcast music 740.00 Total 740.00 I 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. 360668 ASCAP Allowed 20 21678 Network Place Chicago, IL 60673 -1216 4 In Sum of 740.00 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1091 100003202806 4358300 740.00 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 27 -Jan 2011 Signature 740.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund