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CM-2018-1832 - 8/27/2018GOVERNOR GREG ABBOTT ECONOMIC DEVELOPMENT & TOURISM Events Trust Fund Disbursement Request Events Trust Fund, Major Events Reimbursement Program or Motor Sports Racing Trust Fund The Applicant shall complete this form to request a disbursement for an approved Events Trust Fund application, along with supporting documentation. This request and all supporting documentation must be submitted no later than 180 days after the conclusion of the event. Disbursement will only be made to the Applicant. For a request submitted by a Local Organizing Committee, documentation shall be submitted showing the prior approval of the disbursement request by each endorsing entity. TAC Rule § 184.41(a)(6). Please submit all documents to eventsfund@gov.texas. aov. To accommodate large files, secure file transfers are available upon request. Regarding the Events Trust Fund Disbursement Request in the amount of $11,119.68, for the USA Judo Senior National Championships (name of the event) I, Laj4e-Hadley {name of authorized official), approve of each cost submitted for disbursement from the trust fund. I certify that each cost is necessary to fulfill obligations under the Event Support Contract. I certify that the funds will not be used for the purpose of soliciting the relocation of a professional sports franchise already located in this state; and that no costs sought for disbursement from the trust fund are also being disbursed by another entity. I also certify that I have the authority to make this certification statement on behalf of the applying entity, and I take responsibility for the disbursement being requested. Please provide the following information: Entity Disbursement is being made to: City of Round Rock Federal Tax ID Number: 746017485 Texas Tax ID Number: 17460174851 n, ,2M Jf!32 PosT OFFICE BOX 12428 AUSTIN, TExAs 78711 * 512-936-0100 * Gov.TExns.Gov General explanation of costs that the disbursement request represents: Rights Fee Note: Disclosure of Information under the Public Information Act. All disbursement documentation submitted to the Office of the Governor (OOG) is subject to disclosure under the Texas Public Information Act, Chapter 552 of the Texas Government Code ("the Act"), whether created or produced by the applicant or by any third -party. If it is necessary to include proprietary or otherwise confidential information in the documents submitted, that particular information should be clearly identified as such. Merely making a blanket claim that all documents are protected from disclosure because they may contain some proprietary or confidential information is not acceptable, and will not render the information confidential. Any information which is not clearly identified as proprietary or confidential will be released in accordance with the Act. Does the disbursement request documentation contain any items marked as confidential and/or proprietary? Yes ❑ No Primary Contact for Disbursement Request: Debra Doss Primary Contact Phone Number: 512-218-5436 Primary Contact Email: ddoss@roundrocktexas.gov Signatory must be someone the applying entity has determined is eligible to bind the applying entity. Signatu a Printed ame Title and Name o rganization A�f A J14 !Mjef- �lg-lll e Date POST OFFICE BOX 12428 AUSTIN, TEXAS 78711 * 512-936-0100 * GOV.TFXAS.GOV I CID "i �- c ■■ 2 § « 00 § e g b %I \ � m i ! 4 . J � y e � Ln 0 �k Do �o u 0 00 � 0, 20 .2 � § I § . � IA. z :\ c \ o w� § ■ < I—� IL 4 ©22O 1. v al �M�co to CLr § k a k w FL a u _l m §& q q S 2 l § ; / 2 2 ) u ) § 3 C § k � 2 / Lna Z2 k § 2�0c 3 . § LIP `� ma ■�' § �klcc Kf kk § z u 41 3 a; :-i USA Judo, Inc One Olympic Plaza Bill To Citv of Round Rock 231 Cast Alain Street. Suitc ISO , Round Attn: Mariah Rosario Ship To Invoice Date Invo'ce # 2 9'2018 011817-36 P.O. Number Terms Rep Ship Ya F.O.B Project 292018 Quantity Item Code Description Price Each Amount BID FEE 2018 USA Judo Senior National Championship Support 30.000 00 30.0:iO.00 roa�l J- u E $ VZrtGlo� CM- 2n�"l !LA'o 01 Total s30,000.00 Pay Thirty Thousand Dollars and 00 cents ****** To The UNITED STATES JUDO INC Order Of i OLYMPIC PLAZA COLORADO SPRINGS. CO 80909 City of Round Rock, Round Rock, TX 78664 Paye 1 of 1 Check Check Dale Numbe 02/16/2018 10038706 $30,000.00 FILE COPY NON-NEGOTIABLE Check Number. 10038706 rIvoice tate Invoice Number Descripliar� Cit of Round Rock Vendor City FYIi I'll 221 Main Street Number Round Rock, TX 78664 61862 HOST PARTNER AGREEMENT CM -20 Phn. ( 512) 218,540-) Pay Thirty Thousand Dollars and 00 cents ****** To The UNITED STATES JUDO INC Order Of i OLYMPIC PLAZA COLORADO SPRINGS. CO 80909 City of Round Rock, Round Rock, TX 78664 Paye 1 of 1 Check Check Dale Numbe 02/16/2018 10038706 $30,000.00 FILE COPY NON-NEGOTIABLE Check Number. 10038706 rIvoice tate Invoice Number Descripliar� tr►vdBcaArnount 02/09/2018 011817-36 HOST PARTNER AGREEMENT CM -20 $30,000.00 DOC ID# 60777 Vendor No. Vendor NameI=.,CliedNo.. i.�Clieel['l]a#e�y _. _.ChedC�tt 61862 UNITED STATES JUDO INC 10038706 02/16/2018 $30,000.00 City of Round Rock TExns AO°` Agenda Item Summary Agenda Number: Title: Consider authorizing an Events Trust Fund Disbursement Request in association with the USA Judo Senior National Championships at the Round Rock Sports Center Type: City Manager Item Governing Body: City Manager Approval Agenda Date: 8/24/2018 Dept Director: Susan Morgan, CFO Cost: Indexes: Attachments: USA Judo Senior National Championships at the Round Rock Sports Center Department: Finance Department Text of Legislative File CM -2018-1832 Consider authorizing an Events Trust Fund Disbursement Request in association with the USA Judo Senior National Championships at the Round Rock Sports Center The Events Trust Fund Program is a program for local governments and local organizing committees to apply for State funds to help pay for qualified expenses associated with an event, to which both the State and City must contribute. The Events Trust Fund application associated with this event was approved in December 2017 on CM -2017-1571. The disbursement amount being requested is $11,119.68. The disbursement request is the final step in the Events Trust Fund program from the Governor's Office. The City is seeking disbursement from the State for the USA Judo Senior National Championships, held at the Round Rock Sports Center from 05/11/18-05/13/18. City o1 Round Rock Page f Printed on 8/23/2078