Kansas Cycling Association Equipment Check-Out Form Revised: 9/7/2017 Name of Promoter: Organization/Team: Date of Event: Name of Event: Contact Ian Pepin at 785-727-8559 or at least one week prior to your event to schedule a date and time to reserve the equipment you will need. Ian will document all equipment checked out and document it on this page. You will also want to schedule with Ian a time and date to return the equipment so he can confirm it is all returned and is still in working condition. Any shortages will be noted during check in and you will be assessed the cost to repair/replace those items. I acknowledge receipt of the following equipment and agree to return it to Ian Pepin at Anderson Rental, 1312 W. 6th Street Lawrence, KS 66044 within thirty six hours of my event. Receiving Promoter Signature and Phone Number Date of Receipt Date: Date: Original Equipment Equipment Value/Ea Count # Checked Out # Returned Discrepancy 36” Cone – Orange $27 9 28” Cone – Orange $17 59 28” Cone – Blue $17 2 18” Cone – Orange $13 2 18” Cone – Blue $13 42 Barricone Barricade System $21 30 Disc Cone (Large) $2 523 Disc Cone (Small) $2 88 Flutter Flags 10’. One Staging and One Red 1K. $279 1 With One pole/ground stake assembly. Weighted Flutter Flag Base stand (in baseball $60 1 bag) Lap Counter $500 1 Wheel Pit Signs $20 2 Generator Honda EU2000i $1100 1 Hand Truck (cart) 1 Awards Podium 1 Megaphone (Recharge! or 6-D batteries) $35 1 Pyle Model PMP45R PA System (2 speakers, carrying case for mic, 1 cables etc) Wooden stakes 7 tubs 7 tubs Plastic stakes 15 rolls Snow fence Prior to returning the equipment, please contact Ian Pepin to report any discrepancies. Returning Promoter Signature Date of Return
Kansas Cycling Association Equipment Check-Out Form Revised: 9/7/2017 Name of Promoter: Organization/Team: Date of Event: Name of Event: Contact Ian Pepin at 785-727-8559 or at least one week prior to your event to schedule a date and time to reserve the equipment you will need. Ian will document all equipment checked out and document it on this page. You will also want to schedule with Ian a time and date to return the equipment so he can confirm it is all returned and is still in working condition. Any shortages will be noted during check in and you will be assessed the cost to repair/replace those items. I acknowledge receipt of the following equipment and agree to return it to Ian Pepin at Anderson Rental, 1312 W. 6th Street Lawrence, KS 66044 within thirty six hours of my event. Receiving Promoter Signature and Phone Number Date of Receipt Date: Date: Equipment Value/Ea Original Count # Checked Out # Returned Equipment Discrepancy 36” Cone – Orange $27 9 28” Cone – Orange $17 59 28” Cone – Blue $17 2 18” Cone – Orange $13 2 18” Cone – Blue $13 42 Barricone Barricade System $21 30 Disc Cone (Large) $2 523 Disc Cone (Small) $2 88 Flutter Flags 10’. One Staging and One Red 1K. With One pole/ground stake assembly. $279 1 Weighted Flutter Flag Base stand (in baseball bag) $60 1 Lap Counter $500 1 Wheel Pit Signs $20 2 Generator Honda EU2000i $1100 1 Hand Truck (cart) 1 Awards Podium 1 Megaphone (Recharge! or 6-D batteries) Pyle Model PMP45R $35 1 PA System (2 speakers, carrying case for mic, cables etc) 1 Wooden stakes 7 tubs Plastic stakes 7 tubs Snow fence 15 rolls Prior to returning the equipment, please contact Ian Pepin to report any discrepancies. Returning Promoter Signature Date of Return