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Home My WebLink About212706 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