316647 9/29/2017 d G�yy
CITY OF CARMEL, INDIANA VENDOR: 371974 CHECK AMOUNT: S"""'""100.00"
ONE CIVIC SQUARE MATTHEW WORKMAN
CARMEL, INDIANA 46032 2513 SUTTON PLACE DR.S. CHECK NUMBER: 316647
CARMEL IN 46032 CHECK DATE: 09/29/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTIOTHER EXPENSESON
101 5023990 GAZEBO 100.00
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rate�s per day, number of hours, rate per hour, number of units, price per unit, etc.
_69�G 9 4 Payee
�1'1G �rvJ VWrV_O-NGi✓j Purchase Order No.
o;S) 3 &k i-�U-yq Nci Gam 'b^. r Terms
C A(-M6 y I P L4(o O 3 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Kp
Total
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.
120-
Clerk-Treasurer
20Clerk-Treasurer
AP rovals/Da �I,�
Nancy Heck
CITY OF CARMEL Lt.Joe Bickel - - -►
m Harrington CX-ISN-l-zL,-/?
FACILITY USE REQUEST FORD
je/Organization: Matthew Workman
oint of Contact: Matthew&Julia Workman&Joshua Workman
Address: 2513 Sutton Place Drive S.
City, State,Zip: Carmel IN 46032
Home Phone: (
317)888-8488 Cell Phone: (31 om_d�74 —
Email Address: to wrktnan a Qmail.com Fax Number
For Profit Organization: Nun-Profit Organization: Individual: X
Day and Date Requested: September 23th 2017
Time Requested: , 8am a.m./p.m. to: bpm a.m./p.m. (This includes set-up and clean-up time.)
Rehearsal Date: 9/22/2017 Time: Spm a.m./p.m. to 8Pm a.m./p.m.
City Facility Requested: Gazebo X Fountain Area X Japanese Garden
Palladium Center Green Caucus Room (1/3)_(2/3)_Council Chambers
Special Requests: Electricity X Fountain Restroom Other
Purpose: Wedding Number of People Expected: 100
Vendors: Yes No X (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:
Neighborhood Street Closing(Street(s),Address(es)Blocked) None
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 6_oAdav of J On 201
Mayor's Office Revised: 01/22/16