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Home My WebLink About233061 05/28/14 `+',.ceA,�� CITY OF CARMEL, INDIANA VENDOR: 355486 ® 31 ONE CIVIC SQUARE INDIANA ALCOHOL&TOBACCO COMIVlVHECK AMOUNT: $"""'""150.00" r ?�; CARMEL, INDIANA 46032 302 W WASHINGTON ST ROOM E114 CHECK NUMBER: 233061 'M,�TOH�` INDIANAPOLIS IN 46204 CHECK DATE: 05/28/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1096 4239039 APP 150.00 GENERAL PROGRAM SUPPL C�IvED Carmel e Cla MAY �01� Parks&Recreati® ECK REQUEST Date:Wednesday, May 14, 2014 Check payable to: Name: Indiana Alcohol &Tobacco Commission Address: Indiana Government Center South, Room E-114; 302 W.Washington Street City, State, Zip Indianapolis, IN 46204 Mail check to payee X Return check to requestor h m Check Amount: $ 150.00 Date Required:June 5 , 2014 Check needed for: Temporary BeerNVine Permit for the 3 Monon Mixer events at The Waterpark To be paid from: `/v PO#(if applicable) Requisition#: X(-5q Budget account-GL# 1096.60.4239039 Budget Line Description General Program Supplies Invoice(s) MUST be attached. Requested by(print):Traci Broman Requested by(signature): J� Approved by(signature of Division Manager): on this date 5Aq/14 Form revised 7-7-08 Shared/Forms/Business Services!Check Request Form/Check Request(rev 7-7-08) 0t APPLICATION FOR TEMPORARY BEER I WINE PERMIT e State Form 35494(R6110-06) Type of permit �4 � oy�wr: Approved by State Board of Accounts 1996 118 t Amount received INSTRUCTIONS: 1.You must attach floor plan 2.You must obtain authority from local officials. Permit number TM S7+€P 1.k1AiLIt+tG�?INSTRl9C,�tO,�itS Return permit to Carmel Clay Parks&Recreation Address(number and street) 1235 Central Park Drive East City,ZIP code Carmel,46032 Telephone number 317.848.7275 �� '�ss ��:.� ,. ,S�;fP2;•Get+tER'1JfLiN_F_O�tiIAA'rl0_N � ��^��'�''t '�x,�; �,,,,�', Name of applicant(organization,dub,corporation,lndh4dual) Carmel Clay Parks&Recreation Name of person making application Traci Broman Address of applicant(number and street,city,state,ZIP code) 1235 Central Park Drive East,Carmel, IN 46032, County of event Telephone number of person making application Hamilton 317.573.5243 Date(s)(month,day,year) From: June 12, 2014 _ _ _ __ To and including:June 12,2014 Hours of event From: 7:30 ❑AM ❑PM To:10:30 ❑AM ❑PM Exact address of event(number and street city, state,ZIP code) Jurisdiction(town,city,county name) 1195 Central.Park Drive West,Carmel, IN 46032 Carmel >;' x w<' tiY3�EV T NFORM g a r u , -x y J STIG £tV,l ATION. r Ir . 1.State the name of person in charge(rn case ofamergency) Telephone number 1 Telephone number 2 Traci Broman 1317-573-5243 1317-473-7652 2.Is the event open to the public? ElYes ON. 3.Has the applicant or any partner or any officer ever been convicted of a felony,misdemeanor,or a violation of the ATC laws? ❑Yes ON. If yes,explain: 4.How marry persons can you expect In dally attendance? 100-400 Security provided ❑Yes 0 No If yes,name of security S.Name of event• Monon Mixer at The Waterpark ❑✓ Not-for-profit ❑For profit 6.Is the applicant,partnership,or corporation the holder of any kind of Indiana alcoholic beverage permit? If Yes,state: El Yes [D No a.type of permit b.permit number c.name on permit In order to qualify for a temporary permit,the following guidelines must be met: 1.There must be a well defined premises,i.e.building,tent,enclosure,or fenced-in or designated area. 2.You must submit a floor flan or diagram(8 1/2 x 11)showing either a beer garden/bar room(for adults only)or beer garden/bar room and family area (for families to consume food). All alcoholic beverages must be dispensed from the beer garden/bar room. Minors will be allowed in the family area with a parent or guardian to consume food. 3.There shall be NO carry-out privileges,NO carry-in privileges,and NO spirituous beverages allowed. 4.Each applicant must designate an individual to be responsible for the event and such person must sign the application. 5.ANY and ALL persons dispensing or selling,or accepting payment for alcoholic beverages MUST POSSESS a valid ATC employee permit 6.The event must meet applicable Board of Health requirements,particularly with regard to restroom facilities. 7.Legal hours of dispensing alcoholic beverages(Prevailing time) Monday through Saturday—7a.m.to 3 a.m.the following day Sunday—7:00 a.m.to 3:00 a.m.the following day 8.Applicant must file with the ATC at least 15 days prior to the event Failure to comply is grounds for denial. 9.The temporary permit must be posted in the most conspicuous place at the location of the event. An excise officer or commissioner,for good cause, has the authority to revoke a temporary permit during the event. The applicant,swears or affirms under penalties of pejury that the information in this application is true and accurate. The applicant also acknowledges the following: Initial It is a crime to drive with a blood-alcohol content of.OB. It is a class B Misdemeanor,punishable by up to 6 months in jail and a$1,000 fine for knowingly serving an Intoxicated person. That an excise officer may enter,inspect,and search your premises without a warrant and you must produce your permit on demand. That an excise officer may,for good cause,revoke a temporary permit during the event. Signature pp Date(month,day,year) - - s,T,EP_-' C(31iAMuIP ITt1tF.�1F"C SIGNATURES MUST BE RECEIVED IN ORDER LISTED Before the Commission will consider the Issuance of such temporary alcoholic beverage permit,the following signatures of the law enforcement officials of the community shall be obtained: We,the undersigned,herebyd the issuance of temporary alcoholic beverage permit to: 1.Signature of Sheriff of nt lef of Police,or Marshall ofjurisdiction where event will be held Date signed - /. .0- 2.Signalu a of the eyor([(the event Is held in Ft.Wayne) Date signed 3.Signatur6d Excise Police representative Date signed 1. ALL EVENTS ARE$50.00 PER DAY. The fee must be paid by business check,money order,certified check or 2. SERVING PAST MIDNIGHT,NO LATER THAN 3 A.M.,IS ONE DAY. cashiers check. Cash will only be accepted if the application is hand- 3. NO RAIN CHECKS ON ANY OF THE ABOVE EVENTS. delivered to the ATC in Indianapolis. RETURN COMPLETED APPLICATION AND PROPER FEE TO THE LOCAL EXCISE OFFICE AT LEAST 15 DAYS PRIOR TO EVENT INFORMATION ON HOW TO CONTACT YOUR LOCAL EXCISE OFFICE CAN BE FOUND AT http://www.in.govrsep Page 2 ,� ' APPLICATION FOR TEMPORARY BEER/WINE PERMIT �� State Form 35494(R6/10-06) Type of permit 'ti 's' Approved by State Board of Accounts 1996 Ila 0 Amount received INSTRUCTIONS. 1.You must attach floor plan 2.You must obtain authority from local officials. Permit number TM S_WP 1.M_A14ttdG_,1,STRUE_T ONS Return permit to: Carmel Clay Parks&Recreation Address(number and street). 1235 Central Park Drive East City,ZIP code Carmel,46032 Telephone number 317.848.7275 S_T1P72_-GENERAI_iNFORMAT.It�I+_1� T` .r�` f Name of applicant(organization,dub,corporation,individual/ Carmel Clay Parks&Recreation Name of person making applica0an Traci Broman Address of applicant(number and street,dty,state,ZIP code) 1235 Central Park Drive East,Carmel, IN 46032 County of event Telephone number of person making application Hamilton 317.573.5243 Date(s)(month,day,year) _ . _From: 4u1y,10 2014___ ^_ ___ __ _._Toand.including:July 10,2014_ Hours of event From: 7:30 ❑AM 21 PM To:10:30 ❑AM ❑✓ PM Gact address of event(number and street,city, state,ZIP code) Jurisdiction(town,city,county name) 1195 Central Park Drive West,Carmel,IN 46032 Carmel ., -. STEP 3 EVENT[NFRtiIQT ONI,'_ ;' a �¢g 1.State the name of person in charge Qn case ofemergency) Telephone number 1 Telephone number 2 Traci Broman 1317-573-5243 1317-473-7652 2.Is the event open to the public? ❑✓ Yes ❑No 3.Has the applicant or any partner or any officer ever been convicted of a felony,misdemeanor,or a violation of the ATC laws? ❑Yes 0 No If yes,explain: 4.How many persons can you expect in daily attendance? 100-400 Security provided ❑Yes 0 No If yes,name of security 5.Name of event Monon Mixer at The Waterpark ❑✓ Not-for-profit ❑For profit 6.Is the applicant,partnership,or corporation the holder of any kind of Indiana alcoholic beverage permit? If Yes,state: Dyes ED No a.type of permit b.permit number c.name on permit In order to qualify for a temporary permit,the following guidelines must be met: 1.There must be a well defined premises,i.e,building,tent,enclosure,or fenced-in or designated area. 2.You must submit a floor flan or diagram(8 1/2 x 11)showing either a beer garden/bar room(for adults only)or beer garden/bar room and family area (for families to consume food). All alcoholic beverages must be dispensed from the beer garden/bar room. Minors will be allowed in the family area with a parent or guardian to consume food. 3.There shall be NO carry-out privileges,NO carry-in privileges,and NO spirituous beverages allowed. 4.Each applicant must designate an individual to be responsible for the event and such person must sign the application. 5.ANY and ALL persons dispensing or selling,or accepting payment for alcoholic beverages MUST POSSESS a valid ATC employee permit. 6.The event must meet applicable Board of Health requirements,particularly with regard to restroom facilities. 7.Legal hours of dispensing alcoholic beverages(Prevailing time) Monday through Saturday—7a.m.to 3 a.m.the following day Sunday—7:00 a.m.to 3:00 a.m.the following day 8.Applicant must file with the ATC at least 15 days prior to the event. Failure to comply Is grounds for denial. 9.The temporary permit must be posted in the most conspicuous place at the location of the event. An excise officer or commissioner,for good cause, has the authority to revoke a temporary permit during the event. The applicant,swears or affirms under penalties of perjury that the information in this application is true and accurate. The applicant also acknowledges the following: Initial It is a crime to drive with a blood-alcohol content of.08. It is a class B Misdemeanor,punishable by up to 6 months in jail and a$1,000 fine for knowingly serving an intoxicated person. �i That an excise officer may enter,inspect,and search your premises without a warrant and you must produce your permit on demand. That an excise officer may,for good cause,revoke a temporary permit during the event. Signat re Date(month,day,year) . S'fif SaCQN(JVIUy1 SIGNATURES MUST BE RECEIVED IN ORDER LISTED Before the Commisslon will consider the issuance of such temporary alcoholic beverage permit,the following signatures of the law enforcement officials of the community shall be obtained: We,the undersigned,hereb to the issuance of a temporary alcoholic beverage permit to: 1.Signature o�ou of Police,or T n Marshall of jurisdiction where event will be held Date signed 2.Signature orlyor(if the event is held in Ft.Wayne) ate gned 3.Signature of Excise Police representative Date signed _7TtR6,CU:S7fOF PE iNITS k ' L_. r &ANA'i 1. ALL EVENTS ARE$50,00 PER DAY. The fee must be paid by business check,money order,certified check or 2. SERVING PAST MIDNIGHT,NO LATER THAN 3 A M.,IS ONE DAY. cashiers check. Cash will only be accepted if the application is hand- 3. NO RAIN CHECKS ON ANY OF THE ABOVE EVENTS. delivered to the ATC in Indianapolis. RETURN COMPLETED APPLICATION AND PROPER FEE TO THE LOCAL EXCISE OFFICE AT LEAST 15 DAYS PRIOR TO EVENT INFORMATION ON HOW TO CONTACT YOUR LOCAL EXCISE OFFICE CAN BE FOUND AT http://Www.in.gov/isep Page 2 ` APPLICATION FOR TEMPORARY BEERIF WINE PERMIT �pJ1 State Form 35494(R6!10-06) Type of permit �:yi,• Approved by State Board of Accounts 1996 118 0 Amount received INSTRUCTIONS: 1.You must attach floor plan 2.You must obtain authority from local officials. Permit number TM . + ' SfE� .lYlAt NG11NS RUjVT1Q31_ Return permit to: Carmel Clay Parks&Recreation Address(number and street) 1235 Central Park Drive East City,ZIP code Carmel,46032 Telephone number 317.848.7275 w. S EP�2 GENERAL W&19 IpAT.iQN1: Name of appficant(organ&efion,club,corporation,individual/ Carmel Clay Parks&Recreation Name of person making application Traci Broman Address of applicant(number and street,city,state,ZIP code) 1235 Central Park Drive East, Carmel, IN 46032 County of event Telephone number of person making application Hamilton 317.573.5243 Date(s)(month,day,year) From:August 7,2014 To and including:August 7,2014 Hours of event From: 7:30 ❑AM ❑✓ PM To:10:30 ❑AM QPM Exact address o1 event(number and street,city, state,ZIP code) Jurisdiction(town,city,county name) 1195 Central Park Drive West,Carmel,IN 46032 Carmel 1.State the name o1 person In charge On case of emergency) Telephone number 1 Telephone number 2 Traci Broman 317-573-5243 317-473-7652 2.Is the event open to the public? BY.. ❑No 3.Has the applicant or any partner or any officer ever been convicted of a felony,misdemeanor,or a violation of the ATC laws? [:1 Yes Q No If yes,explain: 4.How many persons can you expect In deity attendance? 100-400 Security provided ❑Yes ID No If yes,name of security 5.Name of event: Monon Mixer at The Waterpark ❑✓ Not-for-profit ❑For profit 6.Is the applicant,partnership,or corporation the holder of any kind of Indiana alcoholic beverage permit? It Yes,state: 11 Yes �No a.type of permit b.permit number c.name on permit In order to qualify for a temporary permit,the following guidelines must be met: 1.There must be a well defined premises,i.e.building,tent,enclosure,or fenced-in or designated area. 2.You must submit a floor flan or diagram(6 1/2 x 11)showing either a beer garden/bar room(for adults only)or beer garden/bar room and family area (for families to consume food). All alcoholic beverages must be dispensed from the beer garden/bar room. Minors will be allowed in the family area with a parent or guardian to consume food. 3.There shall be NO carry-out privileges,NO carry-In privileges,and NO spirituous beverages allowed. 4.Each applicant must designate an individual to be responsible for the event and such person must sign the application. 5.ANY and ALL persons dispensing or selling,or accepting payment for alcoholic beverages MUST POSSESS a valid ATC employee permit. 6.The event must meet applicable Board of Health requirements,particularly with regard to restroom facilities. 7.Legal hours of dispensing alcoholic beverages(Prevailing time) Monday through Saturday—7a.m.to 3 a.m.the following day Sunday—7:00 a.m.to 3:00 a.m.the following day 8.Applicant must file with the ATC at least 15 days prior to the event. Failure to comply is grounds for denial. 9.The temporary permit must be posted in the most conspicuous place at the location of the event. An excise officer or commissioner,for good cause, has the authority to revoke a temporary permit during the event. The applicant,swears or affirms under penalties of perjury that the information in this application is true and accurate. The applicant also acknowledges the following: Initial 01 It is a crime to drive with a blood-alcohol content of.08. K It is a class 8 Misdemeanor,punishable by up'to 6 months in jail and a$1,000 fine for knowingly serving an intoxicated person. hK That an excise officer may enter,inspect,and search your premises without a warrant and you must produce your permit on demand. That an excise officer may,for good cause,revoke a temporary permit during the event. Signature Dale(month,day,year) GG• �.. rev _.: STEI?,&.od MUtIiTaY'CLEARANJCE SIGNATURES MUST BE RECEIVED IN ORDER LISTED Before the Commission witl consider the issuance of such temporary alcoholic beverage permit,the following signatures of the law enforcement officials of the community shall be obtained: We,the undersigned,hereby d he issuance of a temporary alcoholic beverage permit to: 1.Signature of She riffDf iefof Poli Marshall of Jur sdiction where event will behold Date signed OF 2.Signature of th ey6r(if the event is held in FL Wayne) Date signed 3.Signature of Excise Police representative Date signed sTE s cosy o�PEI?MITs` x, _� z . 1. ALL EVENTS ARE$50.00 PER DAY. The fee must be paid by business check,money order,certified check or 2. SERVING PAST MIDNIGHT,NO LATER THAN 3 AM.,IS ONE DAY. cashiers check. Cash will only be accepted if the application is hand- 3. NO RAIN CHECKS ON ANY OF THE ABOVE EVENTS. delivered to the ATC in Indianapolis. RETURN COMPLETED APPLICATION AND PROPER FEE TO THE LOCAL EXCISE OFFICE AT LEAST 15 DAYS PRIOR TO EVENT INFORMATION ON HOW TO CONTACT YOUR LOCAL EXCISE OFFICE CAN BE FOUND AT http://www.in.govlisep Page 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. 355486 Indiana Alcohol &Tobacco Commission Terms IN Government Center South, Room E114 302 W. Washington Street Indianapolis, IN 46204 Invoice Invoice Description Date Number (or note attached invoice(s)or bill(s)) PO# Amount 5/14/14 Application Temporary Beer/Wine permit for 3 Monon mixers xx593 $ 150.00 Total $ 150.00 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. 355486 Indiana Alcohol &Tobacco Commission Allowed 20 IN Government Center South, Room E114 302 W. Washington Street Indianapolis, IN 46204 In Sum of$ $ 150.00 i ON ACCOUNT OF APPROPRIATION FOR 109 -Monon Center PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1096-60 Application 4239039 $ 150.00 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 22-May 2014 Signature $ 150.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund