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Home My WebLink About258825 05/26/16 y w.c�gM 4/ �. CITY OF CARMEL, INDIANA VENDOR: 355486 "® z) ONE CIVIC SQUARE INDIANA ALCOHOL &TOBACCO COMMCHECK AMOUNT: $"*""""*150.00* s. �� CARMEL, INDIANA 46032 302 W WASHINGTON ST ROOM El 14 CHECK NUMBER: 258825 9M/f i'ON��. INDIANAPOLIS IN 46204 CHECK DATE: 05/26/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1096 4239039 051316 150.00 GENERAL PROGRAM SUPPL Voucher No. Warrant No. 355486 Indiana Alcohol &Tobacco Commission Allowed 20 IN Government Center South, Room E114 302 W. Washington Street Indianapolis, IN 46204 In Sum of$ $ 150.00 ON ACCOUNT OF APPROPRIATION FOR 109 -Monon Center PO#or INVOICE NO. ACCT XTITLE 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 May 19, 2016 Signature $ 150.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund 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 5/13/16 Application Temporary Beer/Wine permit for Monon mixers xx3788 $ 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 .Carmd. o Clad' Parks&Recreation CHECK REQUEST Date: Friday, May 13,2016 MAY 1 2016 Check paVabie to: Name=Indiana Alcohol:&:Tobacco Commission Address: Indiana Government Center South Room E-114.302 W Washington Street City;:5tate,Zip Indianapolis, IN 46204 Mail check to payee X _Return check to requester Check Amount:$150.00 bate Required:June V,2016. Purpose of Check: Temporary beer/wine permit for the 3 Monon Mixer Events at'rhe Waterpark Supporting documentation or invoices)MUST be attached. To be paid from: JJ PO4'(ifapplickle). . n x . Nag Qudget;account-GL# 1096.60.4239039 Budget Line Description General ProRram Supplies: Requested by(print): Traci Broman Requested by(signature/date): �ljl Approved by(print), Lindsay Labas Approved by'(signature/date) Form recreated 3/10/15(Business Services) i r BEER I WINE!AUTHORITY I TYPE 118 Send, T 1 t,er,or Emil to: x QISTRICT . DISTRICT 4 State Form 35494(R811.1-45) 52422 Cour►ty Road 17, 65T S.Commerce Dr. +� Approved by State Soard•ofAccounts,2015 Bristol,IN•46507. Seymour,IN 47274 '• Telephone:(57.4),264-9480' Telephone:(812)523-8314 INSTRUCTIONS. 1. Applicant must complete all requested information: DiSgRltrT 2 DISTRICT 5 2. Please type or print clearly. 1353.SouftCovemom Drive. 3650 South US Hwy 41: 3.. Submit;application and'payment to the local excise. Columbia 6ity,,tP146725: Vincennes,IN 47591 Telephone..(260)244�i285= Telephone:(812)882-1292' district office.. DiSTMT 3 DISTRICT 6 279 West.300.North; 6400 East 30th Street CrawfordsvIb,,K-47933: Indianapolis,IN 46219 \ Telepltonet(765}362-88'15. Telephone:(317)541-4100• STEP 1. GENERAL INFORMA117110t9 Name of applibant applying.for permit(orgpnPtatiorr,dub..corporation,individual) WPermit number(rssued by ATC) 3 Carmel Clay Paries:&Rtt ueeftltria Address of applicant(rrumber.andsfieet.dtyq state,and'ZlPeode) E-maWaddress 1235 Central Park Cn:.E;;�,M 461M `ffimanan@icamneiclayparks.com. Name of person making•appiicatibn. Fax numbs► Emergency contact telephone number Traci Broman 317-T 5x73 52 ( 31.7 ).5733-52431, Printed name of contact persoacif'event. ,Emergency contact telephone number Traci Broman i (' 31`7)' 51012-6330- STEP 2. EVENT INFORmAno Beginning day B6g(nning,date(month;day,year): Ending;day Endtng;date(month,.day,year) Thursday :June 16,20,1:6 Thursday Cut M 16,;2016' Time of event Start time 81cEtDt E]'AM Q PM End dime TowQ AM �.PM Type or description of event: Monon Mixer-Adultn euw,21n event at The 1tUaferpark-:. Exact address of.event(number andsteeY crt .state,,and'21Pcode)l. 1195 Central Park Cit,,,Wes%, IN 46032 STEP 3. FLOOR PLAN See Step 4,Nun;ber'2)i 1-1 �IMPM� , Alcohol r Zone E .b aa+x v t Aww y3 t * ' Allf^ MP StatToa+ _ The Y►atetpark, Entrance trr " Lockers Page 1 of 2 STEP 4. ACKNOWLEDGEMENT In order to qualify for this authority to serve beer and'wine,the following guidelines must be.met., 1. There must be a well defined premises,i.e,building,tent,enclosure;or fenced4n.or,alestgnated.area.. 2. You must have a.defined floor plan,or diagram. This is to be drawn on Page 1,,Step 3oftift.applicalficrnL. If minors are to be present,you must have a defined separation between the bar area and family,area. (Must be on floor pfaan.)' 3. There shah be.NO carry-out privileges,NO carry-in privileges and-NO spirituous.beverage&aftied.. 4. Each applicant.-must designate an individual to be responsible:for the event•and such.perseinishafRsil;p.the,authority. 5. ANY and ALL persons dispensing or accepting payment for alcoholic beverages.MUST'POSSESS a:.vati ATC•employee permit. 6. The event must.meet applicable Indiana-State Board of Health requirements„particularly with,regard tkr restroom facilities. 7.. If the event is held.in a town park,you-must have approval from the town,board. 8. Legal Hours of dispensing alcohoric-beverages:(Prevailing:time),, Monday thrmugh Saturday-7 AMto,3 AM the.following day, Sunday—7 AM to 3 AM thefollowirtg day-- 9. ay:9. Applicant must:file with:the district office at which the event will be held ataeast.ft ,d cbys:PnOF to the event. 10. The authoRity trout be posted in themost conspicuous place at locatioh azt',the everA.An.excite,of mror commissioner,for good!cause,has the authority to Revoke the authority during,the event. STEP 5..COMMUNITY CLEARANCE 1.Signature of Sheriff•'mA w ice wn Marshall of Jurisdiction wheretthe:eventwiltbe,held! Date signed(month,day,.year)r 2. Signature of cr-(, the.event is hehim Fort.Wayne),' Date sltped'(month,day,.year)i Notes Please post your approved request in.a conspicuous place where the alcoholic beverages,are.heiitg;dispensed at the location_ If for any reason this, request.is deriW.,you may. be notified either in person or by,telephone.. I swear or athrmundiert penalties of perjury that the information is true and accurate.. Signature';of peratifte.//agent(Your signature a as that you.have read:and-wil1'abide:by'tba,mfes.andgiftrjhm j tErate-signed!(month;day,.year); • � .S II Zia � .._ FOR DISTRICT USE ONLY. District number Date issued(h7ontf4,day/.year}] I Reviewed by Excise Police:iF3istdcLRepresentative -ApprmverE' 0:Denied i 1. ALL EVENTS ARE$5t1, F'E DA( BUSINESS'CHECKS OR WHEY O RIDERS A- RE ACCEPTED,MADE OUT TO THE AND'TOBACCO COMMISSION. 2. SERVING PAST MIDNIGHT NO LATER THAN 3AM„IS ONE. ''l DAX. 3. NO RAIN:CHECKS ON ANY OF THE ABOVE EVENTS!:. Page 2 of 2 BEER/VVINE AUTHORITY/TYPE•118 Send,deliver,or mail to: DISTRICT 1. DISTRICT 4 State.Form 35494(R8,l,11-15) 52422 County+Road 1.7 651 S.Commerce Dr. •e ��w a Approved by,State Board of Accounts,2015 Bristol,,11.46507 Seymour,IN 47274 Telephone:(57,4.),-264-9480 Telephone:(812)523-8314 INSTRUCTIONS: 1- Applitantmust complete all requested information. 2: Please DISTRICT 2. DISTRICT 5 type or print dearly. 1353 South:6avemors.Drive, 3650 South US Hwy 41, 3: Submit application and payment to the local excise Columbia City,,.IN 46725 Vincennes,IN 47591 distrld ofte- Telephone:(260),244-4285 Telephone:(812)882-1292 DISTRICT S DISTRICT 6 279West:300;LVortfi, 6400 East 30th Street CaWbrdsvdfe;,IN:47933 Indianapolis,IN 46219 Telephow(765}362-8815 Telephone:(317)541.4100 STEP 1. GENERAL INFORMATION Nameof applicant appVrrg'fbc permit(organizabbn,.dub,corporation,individual) TM:Permit number(issued byA7G) Carmel Clay Patiits9.Rta=eaffnn Address of applicant(lwrnbenan&sMwt,•.dty,,state;and ZIP code). E-mail address 1.235 Central Pati:M..E;,Cmnmk,1 146032 !throman@parmeltiayparks.com Name of person.maldng,appficatibre Fax number, :Emergency contact telephone number Traci Broman �.3117 )57131-5 317 ) 571-5243 Printed name of contact'person,ofievent Emergency contact telephone number. Traci Broman 317 )' 502-6336' STEP 2. EVENT INFORMATION Beginning day Beginning:date(month,day,year): Ending day ;Ending date(month,,day,year).. Thursday My 14,2016- Thursday I .i'Iltily 14,2016 Time of event Start time: $;Q� AM Q✓ PM End bane. T0.30 Q AM 2,PM! Type or descripribb of event. Monon Mixer-•>dl{if;,oweq-21.event at The Waterpark.. Exact address.of event.(numberandlshwet&y,.state;and ZIP.code)I 1195 CentraQ Pam:�ltf ,�atmme9,IPSO 46032 STEP 3. FLOOR PLAN(See Step 4,Number 2) l I � ti ®Alcoholone Ab "� dl ''�' r. Peri}'tent :'• � � ',. i tr �,. _ t � - . ` J ® StaCcm•' v�)• The tl Muparti Entrance ��' Lockers Page 1 of 2 STEP 4. ACKNOWLEDGEMENT' In order to qualify for this authority to serve beer and wine,the following guidelines must:b&met. 1. There must be a.well defined premises,i.e.building,tent,enclosure,or fenced-in eudesignated;area: 2. You must have adeflned floor plan or diagram. This is to be drawn on Page 1,Step,3;ofahisapplicatiorL if minors are to be present,you must-have a defirted separation.between the bar area and family area. (Must be on floor piam;- 3. There shall be NO,cant'-out privileges.NO carry-in privileges and NO spirituous beverages:alliawed. 4. Each appricant.must designate an individual to be responsible for the event and suck persomshalf sign the authority, 5. ANY andALL.persons dispensing or accepting payment for alcoholic beverages;MUSg POSSESS a vaiidATC employee permit. 6. The event must.meet.app6cable Indiana State Board of:Health requirements;parti;ctt%*/w&r.egardao Eestroom facilities. 7. If the event I&holt[in a town park,.you must.have approvat from the town board. 8. Legal Hoursofcbpensing alcoholic beverages:(Prevailing time)) Monday throughSaturday—7 AM to 3 AM the following.day Sunday-7 AM.,to 3 AM the following d'ay. 9. Applicant must file:with the district office at which the event will be held 21t:1east.f",(61 days prior to the event. 10. The aut6 ortiV.must be.posted in the most conspicuous place at the location of.the-eve:An:excise officer or commissioner„for good'cause,has the aulkidlyto reuoke.the authority during.the event: STEP 5. COMMUNITY CLEARANCE. 1.Signature:of S. ' j�nfy,<L�Chlefoli n Marshall of Jurisdiction where the even£will'be.,held! Date signed(month,day,.year) 2 Signatuue )rayon ft the.event is held in.Fort Wayne): Date signed'(month,day,.year): Note: Please post:yoeu atQproved.request in a conspicuous place where the alcoholic bevertages:are.beinp;dispensed atthe location. Iffor any reason.this request is denims,yeur.may be notified either in person or by telephone. swear oraffirrrsrJnd rt penaHies of•pe'ury-that the.information is true and accurate. Signature of permftteeIagent nature acknowledges that you have read and will abide•by-Mle ru/es:and;gpidk&es) ;;Date signed(month;day,year)) • ' I I -4i(cr FOR DISTRICT USE ONLY- District number, Date;issuedi ftontlfl;day,year), Reviewed by Beise:Pefl¢e DistfFct Representative. D. Appretvert Q;Denied: 1ARE$50.00 PER DAY. BUSINESS CHECKS OR MONEY�ORIDERS:ARE;ACCEPTED MADE OUT TO THE INDIAN�I.ALCO GLAND TOBACCO COMMISSION. 2.. SERVING PAST MIDNIGHT,.NO LATER THAN 3 AM,IS ONE I DAY.. 3. NO RAIN.CHECKS.ON ANY OF THE ABOVE EVENTS. Page 2 of 2 "•'+ Send,deliver,.or mail to: BEER I WINE AUTHORITY/TYPE 118 0 State Form 35494.(118111-15 DISTRICT i. DISTRICT 4 52422 County Road!17 651 S.Commerce Dr. �+ Approved by,State Board.of Accounts,2015 Brist ik IN 4MT Seymour,IN 47274 0"" Tetephone (574)264-9480 Telephone:(812)523.8314 INSTRUCTIONS: 1. Applicant mustcomplete all requested information:. DISTRICT 2. DISTRICT 5 2. Please type or print clearly. 1-353.South Gomnom Drlve 3650 South US Hwy 44 3. Submit appdcation.and payment to the local excise Catiernt�ia City;Ifs 467125 Vincennes,IN 47591 Tetephone::(•260);244 4285 Telephone:(812)882-1292 distdd office:. DISTRW,3DISTRICT 6 21.9West+:30D,N0cttn 6400 East 30th Street QmvbWswft,,IN-47933, Indianapolis,IN 46219 Tel¢photte::M, ;36 MIS Telephone:(317)541-4100 STEP 1. GENERAL INFORMATIM Name of applicant applyingaoi pemrit.(organnation,club,corporation,individual) iTM Permit number rissued by ATC), Carmel Clay Parks&Reamfwn Address of applicant cry,stale,'and ZIP code)' E-mail address 1235 Central Parte no, t ,CaIN 46032 :tbroman@car—eldayparks.com . Name of person making application: Fex:number: !Emergency contact telephone number Traci Broman t MT�3,7/3 ! ('317 ).573=5243• Printed name of-contact person:of event Emergency cordact telephone number Traci Broman 317 502-6330F STEP 2. EVENT INFORMATION Beginning day. Beginning date(morith,day,year) 'Ending:day Fhdmg date.(mdnth,day,year) Thursday "August 14,2016 Tom/ August 11,2016 Time of event Start time stmo 0 AM R'PM' Eiad,time: ptn3G E]AM. 2:PM Type or description:of event. Monon Mixer-A&M.ww2 .event at The.Waterpark. Exact address of event(number•and•'stioet,city,state,and Z1P code) 1195'Central Par&M-Msk Camel,IN 46032 STEP 3. FL�ta P41:6t4(j Ste 4;,lttaaerl er 2) Alcohol e x Zone i jI Entrance.lsdlers. y{ par-O' Page 1 of 2 STEP 4. ACKNOWLEDGEMENT In order to qualify,for-this authority to serve beer and wine,the following guidelines must be met: 1. There must:be a,well defined premises,i.e.building,tent,enclosure,or fenced4n,or designated:area. 2. You must have a.defined floor plan or diagram. This is to be drawn on Page 1,Step.3 of this:application. If minors are to be present,you must have a defined:separetibn between the bar area and family area. (Must be on floor plan}, 3. There.shalD be.NO,taffy-out privileges,NO carry-in privileges and NO spirituous beverages allowed.. 4. Each applicant.most-designate an individual to be responsible for.the event and such persoat shalf sign the authority. 5. ANY and:ALL.peasonsdispensing or accepting payment for alcoholic beverages MUST POSSESS_a,valid ATC employee permit. 6. The event.must.meet.applicable Indiana State Board of Health requirements,particufarl5 with,regard to restroom facilities. 7. if the event:is;held ihatown park,you must have approval4rom the town board. 8. Legal Hours ot'dislperpsing alcoholic beverages:(Prevailing time): Monday thmu gift Saturday—7 AM to 3 AM the following day' Sunday-7 APA to 3AM the following day 9. Applicant.must file.with the district office at which the event will be held at.least:five(5j days prior to the event. 10. The authatityt mmit,to posted in the most conspicuous place at the location of the eveptll-An,excise,of iiceror commissioner,for good'cause,has the.authorityta Revakiathe authority during the event. STEP 5. COMMUNITY CLEARANCE: 1.Signature of'Sherili'ot' ma Chief of!�qlice,or]Bkvin Marshall of jurisdiction where the eventw8l:be:hetd; Date signed(m th1ay,.year), 2. Signature oL' yor(ffi'q&event is held in Fort Wayne), Date sig onth,day,year)r i Note: Please post.yoyr appreved.request in a conspicuous place where the alcoholic beveragesafe,being dispensed'at the location,. If for any:reason this request.is der ied•„yeo may.be notified either in person or by telephone'. I swear or,affiim.undbri penalties of perjury that the information is true and accurate.. Signature,of,permitree:/lagant.(pt'mur ature acknowledges that you have read and will abide by the!Adies;and,'gpideGnes)' I Date signed(rnonth;day-year); 2--t L. FOR DISTRICT USE ONLY District number, Date issued'(Month;.day<yea� j Reviewed byEkefse.Polite Distdct Representative D Appoved< Denied j i 1 ALL EVrrNi SARE$50.U0 ER DAY. BUSINESS CHECKS OR MONEY'ORDL=RSAREACCEPTED MADE OUT TO THE INDIA FCA EOHOLAND TOBACCO COMMISSION. 2.. SERVING FAST MIDNIGHT NO LATER THAN 3 AM,IS ONE 1 DAY.. 3- NO RAIN CHECKS ON ANY OF THE ABOVE EVENTS. Page 2 of 2