212706 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 360470 Page 1 of 1
ONE CIVIC SQUARE NATIONAL RECREATION&PARK ASSOC
CARMEL, INDIANA 46032 PO Box 5007 CHECK AMOUNT: $100.00
4 rod�o MERRIFIELD VA 22116-5007 CHECK NUMBER: 212706
CHECK DATE: 9/12/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4359000 100 . 00 APPLICATION FEE
Carmel ® Clay
Parks&Recreation CHECK REQUEST
Date: 9/4/2012
Check payable to:
Name: National Recreation and Park Association
Address: 22377 Belmont Ridge Rd
City, State, Zip Ashburn, VA 20148
Mail check to payee X Return check to requestor
Check Amount: $ $100.00 Date Required: 9/30/12 or sooner
Check needed for: CAPRA application for accreditation fee
To be paid from:
PO#(if applicable)
Budget account-GL# 101-1125-1-4359000
Budget Line Description Special Projects
Invoice(s) and Purchase Order(if required) MUST be attached.
Requested by(print): Michael Klitzing
Requested by(signature):
Approved by(signature of Division Manager):
on this date 9/4/2012
Form revised 7-7-08 Shared/Forms/Business Services/Check Request Form/Check Request(rev 7-7-08)
AGENCY RESPONSIBILITIES
We herewith submit our Application for Accreditation and $100 Application Fee. It is our understanding that:
We are responsible for understanding and following the CAPRA Accreditation Handbook and Agency
Accreditation Standards in preparation for accreditation review. These documents are available for download
from the CAPRA website at: htip://www.Ma.org/capra.
We are encouraged to participate in the formal CAPRA Training Program to ensure agency staff understand the
requirements for accreditation. An updated list of CAPRA trainings can be found on the CAPRA website at:
http://pMa.orf4/Content.aspx?id=118 3.
The Self-Assessment Report and Review Fee must be submitted at least eight weeks prior to the scheduled on
site accreditation visit. The Review Fee amount,based on our operating budget,is determined according to the
scale below and is established by the Commission. Agencies are required to comply with the review fee schedule
in effect at the time of this form.
Level Operating Budget Review Fee
I Under$500,000 $165
2 $500,000- $ 1 million $275
3 $1 million- $2.5 million $550
4 $2.5 million- $5 million $1,100
5 $5 million - $10 million $1,650
6 $10 million- $15 million $2,200
7 $15 million- $25 million $2,750
8 Over$25 million $3,300
We acknowledge our responsibility for covering the travel expenses of the visitation team. In addition, we
acknowledge our responsibility for covering the expenses of the visit chair to attend the Commission meeting at
the time of our Agency's hearing(initial accreditation only).
Send forms and fees to:
National Recreation and Park Association
Attn: CAPRA Accreditation Manager
22377 Belmont Ridge Road
Ashburn, VA 20148
Fax: 703-858-0794
Phone: 703-858-2195
Email: CAPRAgLiMa.org
Page 2 of 2
S`ON FOR ACC,,
T
CAPRA ,z
CAPRA
APPLICATION FOR ACCREDITATION
'9r'Na REfnEA'nO`'PO�= Please type or print clearly
AGENCY INFORMATION Date Completed: 9/4/2012
Agency Name: Carmel Clay Parks&Recreation
Address: 1411 E. 116th Street
City: Carmel State: IN Zip: 46032
General Phone: (317)848-7275 General Fax: (317)571-4136
General Email: info @carmelclayparks.com
Administrator Name: Mark Westermeier Administrator Title: Director
Administrator Email: mwestermeier @carmelclayparks.com Administrator Phone: (317)573-4017
ACCREDITATION PRIMARY CONTACT
Name: Michael Klitzing Job Title: Assistant Director
Phone: (317)573-4018 Fax: (317)571-4136
Email: mklitzing@carmelclayparks.com
LOCAL GOVERNMENT ENTITY
Local Government Entity Name: Carmel/Clay Board of Parks and Recreation
Chief Executive Name: Mark Westermeier Title: Director
City/County/Town Manager: N/A
(if applicable)
CHARACTERISTICS OF AGENCY
Population Served Operating Budget Type of Entity Policy Structure Scope of operation
❑Class 1 -250,000+ ❑Level 1 -Under$500,000 ❑borough ❑independent board ❑parks only
❑Class 2-100,000-250,000 ❑Level 2-$500,000-$1 million ❑town ®under a policy governing body ❑recreation only
®Class 3-50,000-99,999 ❑Level 3-$1 million-$2.5million ❑private district ❑Other(describe below): ®both parks&recreation
❑Class 4-20,000-49,999 ❑Level 4-$2.5 million-$5 million ❑county Number of Employees:
❑Class 5-Under 20,000 ❑Level 5-$5 million-$10 million [D regional/mctro authority Full-time:63
®Level 6-$10 million-$15 million ❑military Part-time:530
❑Level 7-$15 million-$25 million ®Other(describe): Separate political subdivision under Indiana law formed
❑Level 8-$25 million+ through an Interlocal Cooperation Agreement between the City
of Carmel and Clay Township
ON-SITE ACCREDITATION VISIT DATES
We request the accreditation visit be scheduled for dates between July 1,2014 and July 31, 2014
SIZaTURES
g l 417_
Public Entity Chief Executive Date
z
Park and Recreation Agency Administrator —� Date
Page] of 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.
360470 National Recreation & Park Assoc. Terms
22377 Belmount Ridge Road
Ashburn, VA 20148
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
914112 Application CAPRA application for accreditation fee $ 100.00
Total $ 100.00
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.
360470 National Recreation & Park Assoc. Allowed 20
22377 Belmount Ridge Road
Ashburn, VA 20148
In Sum of$
$ 100.00
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1125 Application 4359000 $ 100.00 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
6-Sep 2012
Signature
$ 100.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund