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195696 03/16/2011
CITY OF CARMEL, INDIANA VENDOR: 363439 Page 1 of 7 ONE CIVIC SQUARE USA TABLE TENNIS CHECK AMOUNT: $150.00 CARMEL, INDIANA 46032 4525 FOREST VIEW AVENUE %fit ROCKFORD IL 61108 CHECK NUMBER: 195696 CHECK DATE: 3/1612011 DE PARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMO D ESCRIPTION 1096 4239039 2/23 150.00 GENERAL PROGRAM SUPPL INVOICE Date: February 23, 2011 To: Mr. Matt Leber Adult Recreation Supervisor n,( The Monon Community Center V Carmel Clay Parks Recreation 1235 Central Park Drive East Carmel, IN 46032 ITEM DESCRIPTION AMOUNT Monon Community Center 2 -Star Tournament Sanction Fee $150.00 (scheduled for July 16, 2011) Total: $150.00 Prepared by: Terry Casey Purchase Description `fowr 4y F E B 201 P.O. P o G.I_ ]b4�.50• rF23�163� BY Line Descr Purchaser Qate I Approv Date 2 .23. I Carmel o Clay Parks &Recreation CHECK REQUEST Date: 2/23/11 Check payable to Name: USA Table Tennis Attn. Ed Hogshead Address: 4525 Forest View Ave. City, State, Zip Rockford, Illinois 61108 Mail check to payee X Return check to requestor Check Amount 150.00 Date Required 3/2/11 Check needed for USATT 2 star table tennis tournament sanction fee To be paid from PO (if applicable) Budget account GL 1096.50.4239039 Budget Line Description General Program Supplies Invoice(s) and Purchase Order (if required) MUST be attached. Requested by (print): Matt Leber Requested by (signature): Approved by (signature of Division Manager): on this date Form revised 7 -7 -08 Shared Administrative Forms Staff forms Check Request (rev 7 -7 -08) V TournartientSanction Request Instructions: Official Use Only: 1. Complete this form and mail with the appropriate sanction fee along with a draft of the entry blank to the Regional Tournament Coordinator (RTC) for your region. For 3 4 Star tournaments, send your request to the National NTC Approval Tournament Coordinator (NTC). Note that tournaments will not be sanctioned without.a copy of the entry blank and payment of the sanction fee. RTC Approvai 2. The sanctioning official will notify the Tournament Director on 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 Dare 4 months prior to the tournament for a 3- and 4 -Star tournaments. Tournament Information Name of Event: ©1 t' Level: Star Starts Ends I t0 Alternate Dates Web Link: �eZLU ta�, CG. r% prcvbro ms_'+ilS Venue Address: P UK A Y City r r +b StatelTip Club: M "f 0n cen+6Y ub Affiliation Expires Contact Person M14 LdxY 'Phone: t) I f e�� 3 J� T E tulatl L rAf/11£�lt�> �P j't'� Address (Street/City /StatelZip): �'Py�'�l7lYf ,y; {/��5 Q�'%�, CD'�- Reteree/Rank: Tournament Director r Tournament Star Level By sigh l below,'1)''I'agree to the required;.T,ournament- Repo"rC Star Level Priae Money Sanction Processing Fee postmarked no later,than 14 days after the ast day of the Tournament. Fee Per Pla er l understand that the appropriate fee penalties will be implemented 0 Star! $0 Waived $7 delinquent submission of the Tournament Report (see USATT 0 Star $0-$400 $40 $7 Tournament Report Form), 2) I agree that the.ctub's affiliation status will 1 Star $401 -$1000 $80 $7 be current at the time of the tournament. if club affifiationJs not current 2 Star $100143000 $150 $7 at of tournament, sanction is revoked, results will 'not be'pr'ocessed` 3 Star $3001 -$6000 $300 $7 and disciplinary, action will betaken, 3) I agree.that.the USATT rating 4 Star $6001+ $400 $7 or ITTF r king wil be the primary source of players,ratings. 4 Star team tournaments INegotiated Other" TBD Sanction Fee Enclosed A6 j p Tournament,Director. r Dat Check to debit from credit card on file wit h "USATT To be used only for State °Games Special classification determir ed'by the USATT Tournament Committee. 1 Processing fee tar multi -year or multiple tournament sanctions will be paid at current rate at time of the tournament 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 focal 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. Ho weverc USATT reserves the right to withhold such transfer. The participants of any tournament or event conducted;'sponsored, organized, or sanctioned by'USATT agree to waive and release all ,rights to receive compensation for the use of their names and pictures of their participation. 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 tobe` submitted to Hp. Individual forms must be signed at the tournament upon checking in. USATT insurance does not cover non USATT "members; such'as spectators or entrants in events that do not require USATT membership T Submitted by Title Date Please see reverse for Ratings List Requesf Form T 101 (revised 112010) 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 4525 Forest View Av. Rockford, IL 61108 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 2123111 2123 Tournament Sanction Fee 28230 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 aF CkS Allowed 20 4525 Forest View Av. Rockford, IL 61108 biFff:apr APDZC In Sum of I 150.00 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT #/TlTLE AMOUNT Board Members Dept 1096 -50 2123 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 10 -Mar 2011 Signature 150.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund