334639 01/18/19 CITY OF CARMEL, INDIANA VENDOR: 372930
® Vie,• ONE CIVIC SQUARE NORTHVIEW CHURCH CHECK AMOUNT: $*******"75.00"
?� CARMEL, INDIANA 46032 12900 HAZEL DELL PARKWAY CHECK NUMBER: 334639
C/O AUDRA KELLY CHECK DATE: 01/18/19
aroN CARMEL IN 46033
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4359029 RENTAL 75.00 HISTORIC PRESERVATON
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
Vendor# 372930 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
NORTHVIEW CHURCH IN SUM OF$ CITY OF CARMEL
12900 HAZEL DELL PARKWAY An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
C/O AU DRA KELLY rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
CARMEL, IN 46033
Payee
$75.00
ON ACCOUNT OF APPROPRIATION FOR
Purchase Order#
Dept of Community Service Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
Rental 43-590.29 $75.00 1 hereby certify that the attached invoice(s),or 12/18/18 Rental Facility rental agreement for Carmel Hist. $75.00
1192 101 Prior Year 1192 101 Preservation Comm.
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
Monday,January 14, 2019
Mike Hollibaugh
Director
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Motz, Lisa
From: Sam Burgess <sburgess@indianalandmarks.org>
Sent: Friday,January 11, 2019 2:53 PM
To: Motz, Lisa
Subject: Additional invoice
Attachments: Facility_Property_Use_Agreement_Northview_January_24.pdf
Thank you, Lisa. I am also sending a signed facility use agreement for rental of space at Northview Church on January 24 for the
Carmel Historic Preservation Commission's second informational session regarding the designation of the Plum Creek Corn Crib
as a local conservation district. The document is intended to serve as an invoice,and-the payment should be made from the
Commission's 2019 budget. Please specify that the check be sent to:
Northview Church,c/o Audra Kelly
12900 Hazel Dell Parkway
Carmel, IN 46033
I appreciate you processing the request.
Best,
Sam
From: Motz, Lisa <Imotz@carmel.in.eov>
Sent: Friday,January 11,2019 2:35 PM
To:Sam Burgess<sbureess@indianalandmarks.ore>
Subject: RE:CHPC facade grant payout documents for Plum Creek Corn Crib
Thank you Sam. I will process immediately.
From: Sam Burgess [mailto:sburgess(&indianalandmarks.org]
Sent: Friday, January 11, 2019 2:31 PM
To: Motz, Lisa
Subject: CHPC facade grant payout documents for Plum Creek Corn Crib
Lisa,
Attached are a cover letter, invoice, and proof of payment to initiate the disbursement of a Carmel Historic Preservation
Commission facade grant to the Plum Creek Farms Homeowners Association for restoration work on the Plum Creek Corn
Crib. The W-9 should already be.on file. If you need any additional information, please let me know.
Thanks,
Sam
........................................
Sam Burgess
Carmel Historic Preservation Commission Staff
....................................
1
northviewchurch
FACILITIES/PROPERTY USE AGREEMENT
campus: L OAA yy_k
PURPOSE: This Agreementgives permission'to groups,organizations and individuals("User")not directly overseen by
Northview Church to use specified facilities and property owned by the church. Users with the permission of Northview
Church do so with full knowledge that losses or liabilities incurred by the Userare not covered by the church. The User
wil l be totally responsible for any/al l damages/injuries that may occur d uri ng the!rt!me using the facilities/properties,
ThisAgreementis entered into onthis day of Acom b P of the year _ 02 D by and
between Northview Church and
Name of Use r/co nta ct pe rso n 5"�7, <5Ar- I•.iiYroN rR.gs-!~F.ywribP] MPAIYF)o,N5,rAFF-
Address of User/contactperson 126� GN7hz ,�V ,sNi�1�N✓al'a�tN l-(G2,�2 _
E-mail of User/contact person bu•v eSS WG.v,�� v l�W�rGZS av^
Phone#of User/contact person Z
Facility area desired {�
Date(s)Requested ran uak,/
Anticipated Attendance
Building Space Requested:
Auditorium
Classroom(s)
Common Space,Kitchen&Cafe
Kids/Student Center
Outside Amenities
Other:
WHEREAS Northview Church is the ownerof building and property located atthe address printed above;
AND WHEREAS the Userdesiresto use church facilities/propertyon the terms and conditions setforth.
NOW,THEREFORE,inconsideration of the mutual promises contained herein(and!n separate Agreement-if
applicable),It is agreed by and between the parties to the following:
1. User agrees to release and hold NorthvlewChurch harmlessfrom any and al I injury and liability including attorney's
-fees arising out of the User's use of the above premises orthe building(s)of which the facilities area part, and or any
parking facilities on or adjacentthereto.
2. The user understands that the responsibility to obtain liability and property insurance is upon the User. Itisnotthe
duty or responsibility of Northview Church to insure the User's use of facilities. Insurance. User agrees to list Northview
Church as an Additional Insured(AI)on its General Liability Policy,providing the church with a Certificate of Insurance
showing this status,and a General Liability limit of no less than$1,000,000 per Occurrence for bodily injury and property
damage,and if Userhas employees,proof of Workers Compensation on said Certificate.
These insurance requirements do not apply if NorthviewChurch Representative initials so here: .
3. The User agrees to abide by and obey all laws,ordinances,and regulations promulgated by any government unit
havingjurisdiction in the locale of Northview Church and will not engage in any activities in violation of such laws,
ordinances,rules and regulations.
4. User agrees to abide by any rules or regulations forthe use of the premises.
5. The User takes on the responsibility of every and all actions of any and all ages of the participants of the
event/activity.
PRICING:
Building Fees(Mark the left box for the appropriate fees,if no charge,please enterN/C)
$ Auditorium/Sanctuary $
$ Classroom(s) $50
$ Common Space,Kitchen,Cafe $50
$ Kids/Student Center $50
$ Outside Amenities $50
$_ Other: $ ()
Owner and User agree that the use of the
facilities/property is at NO charge.
Custodial Fees(Mark the box at the leftforthe appropriate fees)
This is a non-refundable fee to be returned Withthis signed agreementand the reservation is officially made.
$ 3 hours or less($25/hour)
$ $75 Half day(up to 4 hours)
$ $125 Full Day
6. Billing: We understand NorthviewChurch will invoice the Userforthe $ 3. 00 in building and custodial
fees.
6&' az a 6�" 19
(Signature ofNorthviewChurc epresentative) Date
(Signatureof User/Contactperson) Date
(Printname of User/Contact Person) rev. 7-25-2018
4
i