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Home My WebLink About202333 09/27/2011 CITY OF CARMEL, INDIANA VENDOR: 363439 Page 1 of 1 ONE CIVIC SQUARE U S A TABLE TENNIS CHECK AMOUNT: $150.00 CARMEL, INDIANA 46032 4525 FOREST VIEW AVE ROCKFORD IL 61108 CHECK NUMBER: 202333 CHECK DATE: 9/27/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1096 4239039 150.00 GENERAL PROGRAM SUPPL Carmel ®Clay Parks Recreation CHECK REQUEST Date: Check payable to r Name: ()S6 f Le u I Q�. Address: 45 _5 f reSk U r- w (AA City, State, Zip R(jr i :61 1 Mail check to payee Return check to requestor Check Amount j •00 Date Required Check needed for: Tovm 1Dr� g r 7 D U( YV'Y Y)u4 To be paid from PO (if applicable) 2 Budget account GL M 5 0 rr� `l Z f J� 3 Budget Line Description 0 0 01 1 e' D Invoice(s) and Purchase Order (if required) MUST be attached. w Requested by (print): Requested by (signature): Approved by (signature of Division Manager): 15 f on this date 01 M 1 L Form revised 7 -7 -08 Shared 1 Administrative 1 Forms Staff forms l Check Request (rev 7 -7 -08) Tournament Sanction Request Instructions: Official Use Only 1. Complete this form and mail with the appropriate sanction fee and a draft of the entry blank to the Regional Tournament Coordinator (RTC) for your region. For 3 R 4 Star tournaments. send your request to the National N ITC 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 Approval: 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 4 Date: months tirior to the tournament for 3- and 4 -Star toumanients. Tournament Information Name of event: frill Date(s): Q To: Io Z 1 1 Level: Star Alternate Dates: n d� 11 2 Venue Address: City: r StateZIP 7 J Club: r') C, Affiliation expires Contact Person: U A Ltrk r Phone: ID'S 3= 1 j24 b E -mail: Miebtr 6 //K5 Address(StreeUCity /State /ZIP): f K Referee /Rank A I 01,40 QT Tournament Director V a1 Tournament Star Level By signing below, 1) 1 agree to submit the required Tournament Report postmarked no later than 14 days after Sanction Processing Fee the last day of the tournament. i understand that the Star Level Prize Money Fee Per Player' appropriate fee penalties will be implemented for delinquent 0 Star' $0 Waived $7' submission of the Tournament Report (see USATT 0 Star $0 -$400 $40.00 $7 Tournament Report Form), 2) 1 agree that the club's I Star $401 41,000 $80.00 $7 affiliation status will be current at the time of the 2 Star $1,000 $3000 $150.00 $7 tournament. If club affiliation is not current at time of tournament, sanction is revoked, results will not be 3 Star $3,001 46,000 $300.00 $7 processed and disciplinary action will be taken, 3) 1 agree 4 Star $6,001+ $400.00 $7 that the USATT rating or iTTF ranking will be the primary 4 Star team tournaments Negotiated $9 source f pl cr ratings. Other' TBD 1 1 Sanction fee enclosed: Check to debit from credit card on file with USATT y 'To be used only for State Gaines Tou a cnt Director '711 J I 1 G 1i 'Special classification determined by the USATT Tournament Committee Processing fee for multi -year or multiple tournament sanction will be paid at current rate at time of the tournament USAFY reserves the right to withhold sanctioning trom any club t has any outstanding bills owed to USAI I or wh ose club atfiliation 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 participants of any tournament or event conducted, sponsored, or organized, or sanctioned by USATT agree to waive and release all rights to receive compensation for use of their names and pictures of their participation. S anctioned tournaments at which mere an ise and/or exhibitor b ooths are ottered tor rent and booth space is available 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. s insurance carrier requires triat participating mem ers sign a waiver ol liaoility to 5e suomitiecl to Individu 1 form ust be signed at the tournament upon checking in. USATT insurance does not cover non USATT members, such as spe s n95 eve is that do not require USATT membership. a' 1 s 11 Submittea by Title I I Date Please see reverse for Ratings List Request Form T -101 (rev ised 1/10) 3 -9 T.G. Jan 2010 Request for Forms Please indicate the number of copies of the following forms. Torunament forms are provided at no cost unless special maili is required. 7, 1'on Request (T -101) Round Robin Draw (4x5 Players)(I -Part T -121) V Tournament Report (T -109) Round Robin Draw (S Players)( T -121) Single Elimination Draw (1 -Part T -I 11) V US.ATT Membership Applications Single Elimination Draw (3 -Part T- 111) \vaiver 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 the tournament. Please indicate below the states for which you are requesting ratings. Formal for ratings: Paper E -mail (format). E -mail address _M IC6 CV0*1 (X (k C 0 CO List States: T N JA 1 Request for Labels Please indicate below the states and /or regions for which you are requesting labels. The cost is S0.05 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 r If late application requires next day air freight (e.g. Federal Express), you will be billed acordingly. at Ship forms and labels to: Form T101, Page 2 Jan 20]0T,G. 3 -10 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 9%5/11 Ck Request Tournament Sanction Fee 150.00 Total 150.00 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. USA Table Tennis Allowed 20 4525 Forest View Av. Rockford, IL 61108 In Sum of 150.00 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT #TTITLE AMOUNT Board Members Dept 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 22 -Sep 2011 Signature 150.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund