316645 9/29/2017-VOIDED CITY OF CARMEL, INDIANA VENDOR: 371975
ONE CIVIC SQUARE WATERSTONE MORTGAGE CHECK AMOUNT: $'*'"*"100.00*
CARMEL, INDIANA 46032 12 W.MAIN STREET CHECK NUMBER: 316645
* ATT:MICHELE SMITH CHECK DATE: 09/29/17
CARMEL IN 46032
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GAZEBO 100.00 OTHER EXPENSES
VOUCHER NO. WARRANT NO.
ALLOWED 20
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$
ON ACCOUNT OF APPROPRIATION FOR
4 101 Gtr
Board Members
PO#or INVOICE NO. ACCT#!TITLE AMOUNT I hereby certify that the attached invoice(s), or
DEPT.#
D f 50�3��p /w — 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
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Sign_ L re
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Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Approvals/Date
Nancy Heck 6V,
CITY OF CARMEL Charlie Driver as la
Adam Harrington 7 ot6''�1
FACILITY USE REQUEST FO;
Name/Organization: 8'
Point of Contact:
Address: ` W , /kA(L(a
City, State,Zip:
"me Phone: Cell Phone: "jam' q 06
Email Address: `��l��L•S�t�c1��y�c�kr�-Cgf_&bft%mber Oil
For Profit Organization: Non-Profit Organization: Individual:
Day and Date Requested: �e aO fl�
Time Requested: _91a.m.& to: joa.m./o(This includes set-up and clean-up time.)
Rehearsal Date: Time: / a.m./p.m. to a.m./p.m.
City Facility Requested: Gazebo V Fountain Area Japanese Garden
Palladium Center Green Caucus Room (1/3)_(2/3)_Council Chambers
Special Requests: Electricity Fountain Restroom Other
Purpose: II T 1 Number of People Expected: /oo
MP(OY7P -eciaf - eUeAf-
Vendors: Yes_ No_(See Item 5, City of Carmel Facility Use Policy attached) _
City Street Closing: (See Item 9,City of Carmel Facility Use Policy attached)
Large or Race Events: U),p W -
�ue , ,, rat . 7k
"A -W A Pree e0%tCrf- -to t Ad C4A,"
Neighborhood Street Closing (Street(s),Address(es) Blocked) �► �� f M
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