212399 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 363439 Page 1 of 1
ONE CIVIC SQUARE U S A TABLE TENNIS
CARMEL, INDIANA 46032 1 OLYMPIC PLAZA CHECK AMOUNT: $150.00
COLORADO SPRINGS CO 80909
CHECK NUMBER: 212399
CHECK DATE: 8/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4239039 150 . 00 GENERAL PROGRAM SUPPL
Carmel • Clay
Parks&Recreation CHECK REQUEST
� ��T177ID
Date: 8/10/12 t;
AUG 13 2012
BY: —--
Check payable to: —
Name: USA Table Tennis
Add ss: One Olympic Plaza
Cit , State, Zip Colorado Springs, CO 80909
X Mail check to payee __Return check to requestor
Check Amount: $ 150 Date Required: 8/24/12
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):
r
Approved by(signatu a of Division Manager-.1r,
01 /1"47
on this date 0
Form revised 7-7-08 Shared/Administrative/Forms/Staff forms/Check Request(rev 7-7-08)
W TABLE T[NNIS A U G 13 2012
Tournament Sanction Request �; ._ _ _
Instructions:
I. Complete this form and mail with the appropriate sanction fee and a draft of the entry blank to the Regional Official Use Only
Tournament Coordinator(RTC)for your region. For 3&4 Star tournaments, send your request to the National
Tournament Coordinator(NTC). Note that tournaments will not be sanctioned without a copy of the entry blank and TC Approval:
payment of the sanction fee..
2. The sanctioning official will notify the Tournament Director on the status of the sanction request RTC Approval:
3. Complete and submit this form at least 2 months prior to the tournament for a 2-Star and below or at least 4 months
rior to the tournament for -and 4-Star t umament. Date:
Tournament Information
Name of event: CC , 2012
Date(s): ) 12„ To: 11 /0 Level: 2 Star
Alternate Dates:
Web Link: UJ U1 W,C0.f nl IC f KS• (n
Venue Address: 11 QS G?AA r_4 rt(K bC,& �S�' City: ( �( I StateZIP 1ml�
Club: _Mnnhn 'DM)L)ni-f-b
7-1' n� r Affiliation expires: Contact Person:�a•�{ �Phone: -2h 3- 5 Z$$ mail: ( Gl(Address(Street/City/State/ZIP): 3j �� ti
Referee/Rank Tournament Director R6,+1 Lebe.r
Tournament Star Level By signing below, 1)I agree to submit the required
Tournament Report postmarked no later than 14 days after
—Sanction Processing ee the last day of the tournament. I understand that the
Star Level Prize Money Fee Per Players appropriate fee penalties will be implemented for
0 Start $0 Waived $7' delinquent submission of the Tournament Report(see
0 Star $0-$400 $40.00 $7 USATT Tournament Report Form), 2) I agree that the
1 Star $401-$1,000 $80.00 $7 club's affiliation status will be cturent at the time of the
2 Star $1,000-$3000 $150A0 $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) I 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 for,player ratings.
Other'
TBD (prj I Z
Sanction fee enclosed: J�eoV date
'To be used only for State Games Tournament 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
USATT reserves the ri ght 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 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.
0 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.USATT insurance does not cover non-USATT members, such as
spectators or entrants in events that do not require USATT membership.
Submitted by Title .Date
* **Please see reverse for Ratings List Request*** Form T-101(revised 1/10)
Request for Forms
Please indicate the number of copies of the following forms.Torunament forms are provided at no cost unless special
mailing is required.
Sanction Request(T-101) Round Robin Draw(4x5 Players)(I-Part T-121)
Tournament Report(T-109) Round Robin Draw(8 Players)(T-121)
Single Elimination Draw(I-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 the tournament.Please indicate
below the states for which you are requesting ratings. Format for ratings:_Paper _E-mail(format).
E-mail address
List States:
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
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 invoice(s)or bill(s)) PO# Amount
8110112 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.
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#/TITLE 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
23-Aug 2012
Signature
$ 150.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund