315767 9/6/2017 r u•coq*
CITY OF CARMEL, INDIANA VENDOR: 371905 CHECK AMOUNT: S""""100.00'
® ONE CIVIC SQUARE CARMEL MUSIC ACADEMY
43 ?� CARMEL, INDIANA 46032 CARMEL
ILLINOIS ST#117 CHECK NUMBER: 09/0 67
s CARMEL IN asosz CHECK DATE: 09/06/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GAZEBO 100.00 OTHER EXPENSES
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Approvals/uate
Nancy Heck 00, k� P &-Zd 'j-7
CITY OF CARMEL Charlie Driver—L-u—i1
FACILITY USE REQUEST FOR11 Adam Harrington -.14 -1�
Name/Organization: Carmel
Point of Contact: , . 520dYU -61) L,
Address: /u'tOS 4?.5
City,State,Zip: JYV `/I Opp Q9Z
Home Phone: ol? � /Cell Phone:
Email Address: ep—e. Czc.rmekm"Sac 0,C CZ v11A
d Numbet
For Profit Organization: n Non-Profit Organization: Individual:
Day and Date Requested: J l
Time Requested: a. ./p.m. to: 2_a.m�m. this includes set-up and clean-up time.)
Rehearsal Date:. Time: a.m./p.m, to a,mJp.m.
City Facility Requested: Gazebo Fountain Area Japanese Garden
Palladium Center Green Caucus Room (1/3)_(2/3),_Council Chambers
Special Requests: Electricity Fountain Restroom-K— Other
Purpose: rlVumber of People Expected: �n Imit"J*
lU
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Vendors: Yes No (See Item 5,City of Carmel Facility Use Policy ftachW
City Street Closing: (See tem 9,City of Carmel Facility Use Policy attached)
Large or Race Events: 1V
Neighborhood Street Closing(Street(s),Address(es)Blocked)
The Carmel Board of Public Works and Safety reserves the right,in its sole discretion,to deny
any facility use request and/or revoke any previously granted request to use a City facility for
any lawful reason.
Received this day of 201
Mayor's Office
Revised: 01/22/16