HomeMy WebLinkAboutCarmel Green Initiative/Facility Use Request/Chambers & Caucus Room/Award Ceremony for Earth Hour Contest; May 3rd, 2022; 4:30 PM – 6:30 PM; Linda DownerCITY OF CARMEL, INDIANA
INFORMATION
FACILITY REQUEST FORM
City Hall Caucus Room or Council Chambers
Name
Organization:
Phone Number:
Cell Number:
Email
Address
Organization Type:
Event/Use Purpose:
Event Date End Date
Number of People
Expected:
Set-Up Start time
Tear Down End Time
Event Start
time:
Event end
time:
GENERAL INFORMATION
Linda Downer-
Carmel Green Initiative
3178440495
3173322990
linda@carmelgreen.org
City
Carmel
State / Province / Region
Indiana
Postal / Zip Code
46033
Country
USA
Street Address
4490 Locker4bie Ct
Address Line 2
Non-Profit Organization
Award Ceremony for Earth Hour Art Contest
5/3/2022 5/3/2022
80
04:30:00 PM
06:30:00 PM
05:00:00 PM 06:15:00 PM
ROOM REQUESTED CAUCUS ROOM
DocuSign Envelope ID: 15E0B74B-0FAA-491E-A7BC-00BB8A086FBF
Room may be divided into sections or can be one large room. Choose the size that you need. Seating capacity: 126
chairs only. Room has an 8.5 counter area with sink.
Room Set-Up
Other seating options:
Equipment needed:
Equipment not provided:
Computers or connection cords/electrical cords
Microphones are not available in the Caucus rooms.
Projector
Other:
How many?
Equipment needed:
Equipment not provided:
Computers or connection/electrical cords.
Other:
How many?
The traditional seating arrangement is Boardroom style.
1/3 side has four, 5-foot tables with 10 chairs
2/3 side has six, 5-foot tables with 30 chairs
Classroom
Theater (chairs only)
Projection screen
Are tables and/or chairs needed around periphery of room?
Yes
No
If you selected YES - please fill out the details below.
How many additional table/chairs are needed?
Note: Extra tables/chairs available: 34 chairs, eight 4-foot tables, six 6-foot tables.
ROOM REQUESTED COUNCIL CHAMBERS
Seating capacity: 140
Microphone(s) 13 available on dais, 1 at presenter's podium, 1 at clerk's desk
Dais
1 at presenter's podium
Dais # and which ones
Projection Screen
Are tables and/or chairs needed around periphery of room?
Yes
No
If you selected YES - please fill out the details below.
How many additional table/chairs are needed?
1- four ft table, 2- six ft table
Note: Extra tables/chairs available: 34 chairs, eight 4-foot tables, six 6-foot tables.
DocuSign Envelope ID: 15E0B74B-0FAA-491E-A7BC-00BB8A086FBF
ACKNOWLEDGEMENT AND AGREEMENT
Mayor's Office
ACKNOWLEDGEMENT AND AGREEMENT
TO COMPLY WITH CITY FACILITY USE POLICY
I have read and understand the City of Carmel, Indiana ("City") Facility Use Policy and agree to be bound by all the terms
and conditions set forth therein.
I will leave the City facility I use in the same condition that it was immediately prior to my use thereof. I agree to pay for
any damage, repair or clean-up costs incurred by the City as a result of my use of a City facility.
I hereby certify that I, and the organization I represent, if applicable, agree to be bound by the City's Facility Use Policy and
by any addition conditions or restrictions placed upon my/our use of a City facility by the Board. I understand that the
Board has the right to deny, alter or revoke my request for the use of a City facility for any lawful reason. I and/or my
organization also agree to indemnify and hold harmless the City of Carmel and all of its directors, officers, employees,
agents and affiliates from any claims of whatever nature (whether foreseeable or not) arising from or in connection with this
Application for any damages, costs or expenses incurred directly or indirectly as a result of my/our use of the City-owned
facility and/or property.
*
GO TO SUBMIT TAB TO FINALIZE YOUR REQUEST
Carmel Green Initiative/Linda Downer
Name of Organization/Applicant
Signature of Authorized Agent/Applicant
Linda Downer / Board Member
Printed Name and Title (If applicable)
4490 Lockerbie Ct
Carmel, IN 46033
Address of Organization/Applicant
1/7/2022
Date
DocuSign Envelope ID: 15E0B74B-0FAA-491E-A7BC-00BB8A086FBF
CITY OF CARMEL USE ONLY
Approved this _____day of__________, 20
CITY OF CARMEL, INDIANA
By and Through its Board of Public Works and Safety
___________________________________
James Brainard, Presiding Officer
Date: ______________________________
___________________________________
Mary Ann Burke, Member
Date: ______________________________
___________________________________
Lori Watson, Member
Date: ______________________________
ATTEST:
______________________________
Sue Wolfgang, City Clerk
Date: ______________________________
Special Conditions:__________________________________________________________________
DocuSign Envelope ID: 15E0B74B-0FAA-491E-A7BC-00BB8A086FBF
January19th
1/19/2022
1/19/2022
1/19/2022
1/19/2022
SUBMIT
DocuSign Envelope ID: 15E0B74B-0FAA-491E-A7BC-00BB8A086FBF