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221096 06/18/2013 CITY OF CARMEL, INDIANA VENDOR: 355486 Page 1 of 1 4J� ONE CIVIC SQUARE INDIANA ALCOHOL&TOBACCO COMM CARMEL, INDIANA 46032 302 W WASHINGTON ST ROOM E114 CHECK AMOUNT: $50.00 INDIANAPOLIS IN 46204 CHECK NUMBER: 221096 CHECK DATE: 6118/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1096 4239039 APP 50 . 00 GENERAL PROGRAM SUPPL Carmel • Clay Parks&Recreation CHECK REQUEST Date: Wednesday, May 22, 2013 Check payable to: Name: Indiana Alcohol &Tobacco Commission Address: Indiana Government Center South, Room E-114; 302 W. Washington Street City, State, Zip Indianapolis, IN 46204 Mail check to payee X Return check to requestor Check Amount: $ 50.00 Date Required: June 25Th, 2013 Check needed for: Temporary Beer/Wine Permit for the Monon Mixer at The Waterpark To be paid from: PO#(if applicable) Requisition#: MC004180 Budget account-GL# 1096.60.4239039 Budget Line Description General Program Supplies Invoice(s)MUST be attached. Requested by(print):Traci Pettigrew Requested by(signature): 0, Approved by(signature of Division Manager):on this date Form revised 7-7-08 Shared/Forms/Business Services/Check Request Form/Check Request(rev 7-7-08) ��s r APPLICATION FOR TEMPORARY BEER/WINE PERMIT ° /►�• p / State Form 35494(R6 110-06) Type of permit :' :�,�.�,,,�; Approved by Slate Board of Accounts 1996 118 I 1 � Amount received INSTRUCTIONS: 1.You must attach floor plan 2. You must obtain authority from local officials. Permit number TM ..3;; � ?��rH� •�.��rS�EP111�MM�AI�INGINS�R�C7'1_2NS�1.:�°ta-. fir. Return permit to Carmel Clay Parks & Recreation Address(number and street) 1411 E. 116th Street City,ZIP code Carmel, IN 46032 Telephone number 317.843.3875 _ T.T;.�' yx �' }�STEF2.GENERA ;INFORM TA ON rte": r ? �r �; WPM ti Name of applicant(organization,club,corporation,individual Carmel Clay Parks & Recreation Name of person making application Traci Pettigrew Address of applicant(number and street,city,state,ZIP code) 1235 Central Park Drive East, Carmel, IN 46032 County of event Telephone number of person making application Hamilton 317.573.5243 Date(s)(month,day,year) HFrom: August 8, 2013 To and including:August 8, 2013 ours of event From: 8.30 ❑AM O PM To: 11:00 ❑AM ✓❑PM Exact address of event(number and street,city, state,ZIP code) Jurisdiction(town,city,county name) 1195 Central Park Drive West,Carmel, IN 46032 Carmel a ", '�� as :•;� ` ',STEP3(EVfNT';INFQRM_ J Y. ,-r, — AT 1.State the name of person in charge Qn case of emergency) Telephone number 1 Telephone number 2 Traci Pettigrew 317.573.5243 317.502.6330 71s the event open to the public? El Yes ❑No 3.Has the applicant or any partner or any officer ever been convicted of a felony,misdemeanor,or a violation of the ATC laws? []Yes 2]No If yes,explain: 4.How many persons can you expect in daily attendance? 100-500 Security provided ❑ Yes El No If yes,name of security 5.Name of event: Monon Mixer at The Waterpark ❑✓ Not-for-profit ❑For profit 6.Is the applicant,partnership,or corporation the holder of any kind of Indiana alcoholic beverage permit? If Yes,state: ❑Yes No a.type of permit b.permit number c.name on permit IR In order to qualify for a temporary permit,the following guidelines must be met: 1.There must be a well defined premises,i.e.building,tent,enclosure,or fenced-in or designated area. 2.You must submit a floor flan or diagram(8 112 x 11)showing either a beer garden/bar room(for adults only)or beer garden/bar room and family area (for families to consume food). All alcoholic beverages must be dispensed from the beer garden/bar room. Minors will be allowed in the family area with a parent or guardian to consume food. 3.There shall be NO carry-out privileges,NO carry-in privileges,and NO spirituous beverages allowed. 4.Each applicant must designate an individual to be responsible for the event and such person must sign the application. 5.ANY and ALL persons dispensing or selling,or accepting payment for alcoholic beverages MUST POSSESS a valid ATC employee permit. 6.The event must meet applicable Board of Health requirements,particularly with regard to restroom facilities. 7.Legal hours of dispensing alcoholic beverages(Prevailing time) Monday through Saturday--7a.m.to 3 a.m.the following day Sunday--10:00 a.m.to 12:30 a.m.the following day 8.Applicant must file with the ATC at least 15 days prior to the event. Failure to comply is grounds for denial. 9.The temporary permit must be posted in the most conspicuous place at the location of the event. An excise officer or commissioner,for good cause, has the authority to revoke a temporary permit during the event. The applicant,swears or affirms under penalties of perjury that the information in this application is true and accurate. The applicant also acknowledges the following: Initial It is a crime to drive with a blood-alcohol content of.08. It is a class 6 Misdemeanor,punishable by up to 6 months in jail and a$1,000 fine for knowingly serving an intoxicated person. /� That an excise officer may enter,inspect,and search your premises without a warrant and you must produce your permit on demand. /111 That an excise officer may,for good cause,revoke a temporary permit during the event. Signature te-(month,day,year) •' MR "�� ".> ._ ;Y STEP S�COMMUNI31(�CLEAi2%�NCEr`r , i - ��a SIGNATURES MUST BE RECEIVED IN ORDER LISTED Before the Commission will consider the issuance of such temporary alcoholic beverage permit,the following signatures of the law enforcement officials of the community shall be obtained: We,the undersigned,hereby do not object to the issuance of a temporary alcoholic beverage permit to: 1.Signature of Sheriff of county,Chief of Police,or Town Marshall of jurisdiction where event will be held Date signed 2.Signature of the mayor(if the event is held in Ft.Wayne) Date signed 3.Signature of Excise Police representative Date signed 3, ��r 'S;�'1�:•�:Y"i Y �',_gUytry+i^,My:.�i.�^�_ A� _ -G{D r1F:t wY �i��rcT' �c� ��f'zY�' II ( 1. ALL EVENTS ARE$50.00 PER DAY. �. 'I i.The fee must be paid by business check,money order,certified check or. 2. SERVING PAST MIDNIGHT,NO LATER THAN 3 A.M.,IS ONE DAY. cashiers check. Cash will only be accepted if the application is hand- - - 3. NO RAIN CHECKS ON ANY OF THE ABOVE EVENTS. delivered to the'ATC inllndianapolis: RETURN COMPLETED APPLICATION AND PROPER FEE TO THE LOCAL EXCISE OFFICE AT LEAST 15 DAYS PRIOR TO EVENT INFORMATION ON HOW TO CONTACT YOUR LOCAL EXCISE OFFICE CAN BE FOUND AT http://www.in.gov/isep Page 2 - �;�Y ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Indiana Alcohol &Tobacco Commission Terms IN Government Center South, Room E114 302 W. Washington Street Indianapolis, IN 46204 Invoice Invoice Description Amjj50 t or note attached invoice(s) or bill(s)) PO# Date Number ( g .00 5/22/13 Application Temporary Alcohol permit for the Monon Mixer Total $ 50.00 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_ Clerk-Treasurer Voucher No. Warrant No. Indiana Alcohol & Tobacco Commission Allowed 20 IN Government Center South, Room E114 302 W. Washington Street Indianapolis, IN 46204 In Sum of$ $ 50.00 ON ACCOUNT OF APPROPRIATION FOR 109 - Monon Center PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1096-60 Application 4239039 $ 50.00 1 hereby certify that the attached invoice(s), or bills) is (are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 13-Jun 2013 P& rx-&U Signature $ 50.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund