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1 city of Clearwater . Pi,nellas CountySchool Board
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CANCELLATION
AN, t ,191 8. c u EFa�t�L �
THE r-`XPIR ,r a L,'jAI k E F I t ? rte GGE aJPL.I.GE#`EL IVF.FR 0IN ACCORDANCE
Little League Baseball Risk Purchasing Group, Inc, 'a°'11H I i F, .1,.
539 U.S. RT. 15 Highway I
South Williamsport, ISA 17702
PQ Box 14955
Clearwater,FL 33766
�# (777)474-2787
a 11 r r r r u r www.coun"sidell.com
September 20,2018
City of Clearwater,Athletics
c/o Emily Frazer,Youth Sports Specialist
Re: Countryside Little League
Dear Ms.Frazer:
Please accept this letter as Countryside Little League's insurance exemption requests as it relates to the
Co-Sponsor agreement with the City of Clearwater:
EXEMPTION FOR REQUIRED INSURANCES:
(check if applicable)
X Automobile Liability Insurance
On behalf of the Countryside Little League,I submit our organization does rust own any vehicles nor does
the organization provide or arrange for any transportation/carpooling for any members,participants,
employees,or volunteers of the organization to any practices,games,or organization sponsored
activities. Thus,our organization is requesting exemption from providing auto liability insurance per the
Co-Sponsorship agreement.
Workers Compensation/Employers Liability Insurance
On behalf of the CountrvSide Little Leu,I submit our organization does not have paid
employees/volunteers attend any practices,games,or organization sponsored activities. Our workers
compensation coverage also dues not provide coverage for volunteers„
Property Insurance
On behalf of the Countryside Little League,I submit our organization is exempt from providing property
insurance due to the value of the property.Unless it`s damaged as a result of City negligence while in our
care,custody and control,our organization will be responsible for covering any losses.
Name of Organization: Countryside Iattl+ League
Title: President
Name of Representative.. Matthew Werner
Signature:
Dater September2il,21178
If you should have any questions,please do not hesitate to contact me directly..
Sincerely,
/I---
Matthew Werner, President.
Countryside Little League