205621 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 363439 Page 1 of 1
ONE CIVIC SQUARE U S A TABLE TENNIS
q t, CHECK AMOUNT: $150.00
CARMEL, INDIANA 46032 4525 FOREST VIEW AVE
L .oN e ROCKFORD IL 61108 CHECK NUMBER: 205621
CHECK DATE: 1/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4239039 2012 150.00 GENERAL PROGRAM SUPPL
Carmel •Clay
Parks &Recreation CHECK REQUEST
Date: 12/14/11
Check payable to OEC I 2011
Name: USA Table Tennis
Address: One Olympic Plaza
City, State, Zip Colorado Springs, CO 80909
Mail check to payee _X Return check to requestor
Check Amount 150 Date Required 12//28/11
Check needed for 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 I Administrative Forms I Staff forms I 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 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 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 mior to the tournament for 3- and 4 -Star tournaments.
Tournament Information
Name of event: 0go Z 012—
Date(s): f Z To: Z Level: Star
Alternate Dates:
Venue Address: 1 Q 5 YI FtLl r gK l/ t City: Co r fft StateZIP y 2
Club: Mori&\ CUmi91urufV (Ufff Affiliation expires Contact Person: M(fiA Le�rr
Phone: i S 3 rj 2t'1O E mail:
Address(Street/City /ZIP): I Z S, Z
Referee /Rank ,r Tournament Director L466� r
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 Pla er' 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) I agree that the club's
1 Star $40141,000 $$0.00 $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
3 Star $3,001 $6,000 $300.00 $7 tournament, sanction is revoked, results will not be
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 r player ratings.
Other' LB .L
Sanction fee enclosed: L 16o. 06 .tc
Check to debit from credit card on file with USATT
'To be used only for State Games oumamcnt Director
'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
USAY"F reserves the right to withhold sanctioning from any club that has any outstanding bills owed to USAM 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 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 merchandise and/or exhibitor booths are ofi tor rent and booth space is available
provide booth space for manufacturers and distributors of USATT approved equipment, with equal booth fees for lake -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 re participarlug mem ers sign a waiver or is t t y T orm o 5e suormuca to
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 requite USATT membership.
Submitted by Title Date
Please see reverse for Ratings List Request Form T -101 (revised 1 /10)
3 -9 T. G. Jan 2010
Request for Forms
Please indicate the number of copies of the following forms. fouunament forms are provided at no cost unless special
mailin s' required.
Sanction Request (T -101) Round Robin Draw (4x5 Players )(1 -Part T -121)
Y TonrnamentReport (T -109) Round Robin Draw (8 Players)( T -121)
Single Elimination Draw (I -Part T -I l I USATT Membership Applications
Single Elimination Draw (3 -Part T -I 11) $t7 Waiver of Liability forms (2 per page)
Tournament Sanction Checklist
Request for Certificate of Insurance
Request for Rating List
Ratings lists are sent from USATT Headquarters approximately two weeks before the tournament. Please indicate
below the states for which you are requesting ratings. Format for ratings: Paper E -mail (format).
E -mail address m ���e r e, u.r Cji m
List States: JN L
Request for Labels
Please indicate below the states and /or regions for which you are requesting labels. The cost is 50.05 per label, and the cost of shipping will
be included on the invoice for the labels.
Region(s):
States:
Shipping Instructions
All materials will be mailed by the most reasonable method unless a specific request in indicated below.
Next day delivery First class delivery Third class delivery
If late application requires next day air freight (e.g. Federal Express), you will be billed acordingly.
Ship forms and labels to:
Fonn T'101, Page 2
Jan 2010 T.G. 3.10
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
363439 USA Table Tennis Terms
1 Olympic Plaza
Colorado Springs, CO 80909 -5769
Invoice Invoice Description
Date Number (or note attached invoices) or bill(s)) PO Amount
12/19/11 2012 Tournament sanction fee 150.00
Total 150.00
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
363439 USA Table Tennis Allowed 20
1 Olympic Plaza
Colorado Springs, CO 80909 5769
In Sum of$
150.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #fTITLE AMOUNT Board Members
Dept
1096 -50 2012 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
11 -Jan 2012
LAfb P�
Signature
150.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund