CM-2022-124 - 6/3/2022GOVERNOR 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 $10,000.00, for the 2022 NIRSA Flag
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Football National Championships (name of the event) I,.ey {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
POST OFFICE Box 12428 Aus-rm, TEXAS 78711 * 512-936-0100 * GOv.TsxAs.Gov -7 j
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: Andrea Saiz
Primary Contact Phone Number: 512-218-7021
Primary Contact Email: asaiz@roundrocktexas.gov
Signatory must be someone the applying entity has determined is eligible to bind the applying entity.
Signature Printe Name
Title and Na a of Organiza Ion
1�--r3- anag_
Date
POST OFFICE SOX 12428 AUSTIN, TEXAS 78711 * 512-936-0100 * Gov.TEXAS.GOv
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YNSCr1lo_ r-S0001 , 154,-�q INVOICE
NlRSA Services Corporation
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NIRSA oa- INVOICE N: INV•02752
4105 SW Research Way DATE: 12/15/2021
Corvallis, OR 97333 DUE DATE: 01/07/2022
Phone: 541.766-82t1 Fax: 541.766.8284
TOTAL AMOUNT: $ 10,000.00
BALANCE DUE: $ 10,000.00
BILL City of Round Rock, texas
TO: 721 East Main Street
Round Rock, TX 78664
— DESCRIPTION / MEMO — -- — - —�-- - -- .l AMOUNTI
Right Fee for 2021 NIRSA National Flag Football Championships 1 10,000.00
January 7.9, 2022 j
TOTAL AMOUNT l $10,000.00
CREDIT CARD REMITTANCE
FAX TO: 541.766.8284
VISA MASTERCARD AIAEX DISCOVER
CRED T CARD NUMBER: EXPIRATION DATE:
PAYMENT AMOUNT- $
CARD HOLDER'S NAME:
SIGNATURE:
Invoice Date: 121151202% Terms Due Date: 011071JU22 Customer ID: C•10482
City of Round Rock, Round Rock, TX 78664 PAGE: 1 OF 1 CHECK NUMBER. 10063340
INVOICEDATE INVOICEDESCRIPTION INVOICEAMOUNT;
12/15/2021 INV-02752 Host Partner Agreement - Right Fee for NIRSA Nall $10,000.00
DOC [DO 190200
VENDOR NUMBER VENDOR NAME CHECK NUMBER CHECK DATE CHECK AMOUNT
62724 NIRSA SERVICES CORP 10063340 12/2312021 $10,000.00
0 u O�
City of Round Rock
r 221 I-. Main Street
v� Round Rock, TX 78664
4t Phn (512)218-5400
y�iyyl,�J
Pay "Ten Thousand Dollars and 00 Cents`
To the NIRSA SERVICES CORP
Order Of 4185 SW RESEARCH WAY
CORVALLIS, OR 97333-0000
Vendor Number Check Number Check Date
62724 10063340 12/23/2021
$10,000.00
FILE COPY
NON-NEGOTIABLE
ROUND ROCK
TEXAS
City of Round Rock
Agenda Item Summary
Agenda Number:
Title: Consider executing Application with the office of the Governor Economic
Development and Tourism for Events Trust Fund Program NIRSA Flag Football
National Championships
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 6/3/2022
Dept Director: Chad McKenzie
Cost:
Indexes:
Attachments: CMAF ETF Disbursement Request, Disbursement Packet - NIRSA
Department: Sports Management & Tourism
Text of Legislative File CM-2022-124
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 Application associated with this event was approved August
06, 2021 CM-2021-202.
The disbursement request is the final step in the Events Trust Fund Program form the Governor's Office.
The City is seeking disbursement from the State for the NIRSA Flag Football Championships held at the
Round Rock Multipurpose Complex Jan 7-9, 2022. The disbursement amount being requested is
$10,000.00.
City of Round Rock Page 1 of 1