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SPORTS AND PROGRAM CO-SPONSOR AGREEMENT (18) CITY OF CLEARWATER SPORTS AND PROGRAM CO-SPONSOR AGREEMENT THIS AGREEMENT, made and entered into this 29 day of September by and between the CITY OF CLEARWATER, FLORIDA, a municipal corporation of the State of Florida, herein referred to as "City", P.O. Box 4748, Clearwater, FL 33758 and the Countryside Jr. Cougars herein after referred to as "Co-Sponsor Group" P.O. Box 16934, Clearwater, FL 33766 (address) .................... .... . . . ................... ........ ....... ....... ................................................................... WITNESSETH: WHEREAS, the Co-Sponsor Group is an organized recreational group or program approved by the Parks and Recreation Director, which provides its own volunteer leadership and administration; and WHEREAS, the City recognizes the Co-Sponsor Group as providing a valuable service to the community, through their extensive use of volunteers and volunteer resources; and WHEREAS, the Co-Sponsor Group meets all of the criteria included in this Agreement, and WHEREAS, the Co-Sponsor Group desires to use various City-owned facilities for organized sports programs and or various other recreational related activities for the citizens of Clearwater, and WHEREAS, the City owns certain public properties and facilities that are available to be utilized by the Co-Sponsor Group for their programs; and WHEREAS, the Co-Sponsor Group may use the physical facilities owned and maintained by the City or leased to the City subject to the terms of this Agreement. NOW, THEREFORE, in consideration of the covenants herein contained' and other good and valuable consideration, the City agrees to allow the Co -Sponsor Group to utilize City facilities as described in Exhibit "J" attached hereto, as may be amended from time to time, and is hereby made a part of th,is Agreement, under the following terms and conditions- 1. Recitals. The foregoing recitals are true and correct and are incorporated in and form a part of this Agreement, i The term of the Agreement will be for a period of one (1) year commencing October 1,2020 and ending September 30, 2021 . The Co-Sponsor gaup agrees to abide by and enforce all City ordinances as they relate to Parks & Recreation. The ordinances can be found at: hftps://libraa.municode.com/fl/clearwater/codes/code of ordinances 4. This Agreement may only be amended by written amendment to this Agreement, executed by both Parties. 5, This Agreement willf remain in effect unless terminated by either party as follows: a. Upon breach of this Agreement by a party, the other party will give written notice of termination of this Agreement specifying the claimed breach and the action required to cure the breach. If the breaching party fails to cure the breach within five days from receipt of said notice, then the contract will terminate ten days from receipt of the written notice. L Either party may terminate this Agreement without cause by giving written notice to the other party that the Agreement will terminate 30 days from the receipt of said notice by the terminating party. . ;Subject to available funding, the City will provide and maintain facilities for the Co Sponsor Group for their approved program and activity. The City of Clearwater Parks and Recreation aepairtment is dedicated to improving the overall quality of sports and athletics in the City and reserves the right to close any field, at any time,, for any reason, in its sole discretion, including but not limited to, for maintenance purposes or poor field conditions. 7. Any unpermitted use of a facility or field may result in fees„ and or immediate termination of present and/or future field use. Individual teams or participants using closed facilities will be considered representatives of the Co-Sponsor Group in which they participate. 8. The Co-Sponsor Group agrees to provide recreational programs and activities to primarily benefit the residents of Clearwater. The City will actively promote the Co- Sponsor Group programs and activities utilizing City resources i.e. my Clearwater Magazine, C-View, etc. 'Promotional materials must be approved by city liaison before distribution (' e camps, Clinics, tournaments, etc ) AnV promotional materials using the City of Clearwater logo must receive written approval prior to distribution.. _........... _........... ........ .........,,, ...... . .n.,. ..e.,. .. .,... 2 1 ae 9. The City of Clearwater complies with the Americans with Disabilities Act of 1990, Public Law 101-336, July 26, 1990 (42 USCA § 12101) ("ADA"), which prohibits discrimination on the basis of disability. The ADA, as applied to cities, counties, and other local governmental entities, requires that no qualified individual with a disability shall, on the basis of a disability, be denied the benefits of local government services, programs, or activities. The Co-Sponsor Group acknowledges the importance of complying with the ADA and agrees to educate itself and its members of all requirements of the ADA and will abide by same. 10. The Co-Sponsor Group shall not discriminate on the basis of race, creed, color, age, national origin, religion, sex, disability or any other protected classin........... .... .......... --- -- ------- ............... ...... accordance with current state or federal laws. The City reserves the right to terminate this Agreement. immediately upon breach of this covenant. 11. The Co-Sponsor Group shall maintain legal status as a state or federal Internal Revenue Service approved 01(c)(3) organization, Such status shall be maintained during the term of this Agreement and proof of this status shall be submitted to the City annually. If 01(c) (3) status is rescinded, suspended, cancelled, or otherwise changed, the Organization shall notify the City within thirty (30) days. Failure by the Organization to maintain such status shall be cause for immediate termination. 1'2. The Co-Sponsor Group agrees to provide competent leadership for the program. The Board of Directors, as established by the organization's by-laws, will include at minimum, one (1) City of Clearwater resident. The Board of Directors will conduct the program in the best interest of the City of Clearwater, 13. The Co-Sponsor Group agrees to provide recreational programs and activities to primarily benefit the residents of Clearwater. The Co-Sponsor Group agrees to promote their program to the citizens of Clearwater and that a minimum of 50% of their participants will be residents of the City of Clearwater. If the 50% target is not being satisfied, the Co-Sponsor Group may submit a plan to achieve this goal or an alternative that must be approved by the City. Failure to maintain fifty percent (50%) resident participation may be cause for termination with thirty (30) days' notice, if a viable plan to increase resident participation is not approved by the City. 14. The Co-Sponsor Group agrees to submit the following as specified, and if appropriate as- a-utline-d- in correspGndiRg Exhibits. FailuFe to eernply with this ............................... ....... ... termination of present and/or future field use, or termination of current co- sponsor agreement. ------------------------------------- --------------- a. The Co-Sponsor Group will provide the following information each year as outlined in Exhibit A, • Specific range of dates for their primary season and registration dates. • Request the facilities and/or fields for their primary season • Request any special event dates such as tournaments, clinics, camps, fundraisers, etc. Charges will be determined per the agreement. ........................ b. Current roster as defined in Exhibit J. Due Date: or as defined in Exhibit J. Rosters must include the following: 0 Name of participant 0 Participant's home address 0 Participant's date of birth 0 Parent/Guardian Name 0 School Attending C. Payment for participants who do not have valid participant cards. Due Date: or as defined in Exhibit J. • Each participant is expected to possess a current City of Clearwater Recreation Card. The card must be valid for at least 50% of the Co-Sponsor Group's season as outlined in Exhibit J. A fee will be accessed to the organization for each member determined: not to have a current City of Clearwater Recreation Card, regardless of whether the individual is a City of Clearwater resident or non -resident. 0 Current fees are as follows* $128.40 for recreational Or as outlined: in Exhibit J. 4 1 11 a g e If a player does not have or purchase a Recreation Card, the fee charged to the organization will include tax. The organization is acting as a conduit for the individual and as such is responsible for the tax portion of the Recreation Card purchase. Roster payments must be accompanied' with a Participant Card Application for each person without a valid Recreation: Card. See Exhibit K. This fee is subject to change as defined in Clearwater _Code of Ordina=es, Appendix A - Schedule of Fees, Rates, and Changes, X1 Parks, Beaches, Recreation - Use of Facilities by nonresidents (ch 22). It is recommended that the Co-Sponsor Group retain a copy of the participant's recreation card or a copy of the recreation card receipt, d. An accurate facility and/or field schedule for approved season, depicting actual use. See Exhibit J. e. A complete list of current Board of Directors: Due date: 2/1/2021 f. A list of all coaches and their certifications and proof of required Level 11 or City approved equivalent background checks, See Exhibit C & J. 9. Copy of by-laws: Due date: 2/1/2021 h. Verification of non -profit status: Due date: 2/1/2021 i. A copy of Insurance Certificate naming the City of Clearwater and the Pinellas County School Board as additionally insured, and waiver, if applicable. See Section 16 for coverage requirements: Due date: 5/1/2021 or as needed See Exhibit H for Insurance, Exemption Form j. DR-14 (tax exemption form), if applicable: 2/1/2021 k. Annual financial statement, Due date- 3/1/2021 See Exhibit I for template of minimal requirements. Anngal.-Co QU;p=SjWama __ ................. Riwaft • Submitted at the end of the approved season. • See Exhibit G for template and due date, ..................................................................... ........ ..............................................................----------------------------------- ---- ---------------- ----------------------- 5-f4 M. Submit nomination for Excellence in Youth Sportsmanship Award: Due date: 12/31/2020 n. Copy of concessions manager certification, if applicable: Due date: 7/1/2021 0. Emergency Action Plan for each facility used during season: Due date: 7/1/2021 See Exhibit F for Emergency Action Plan template. 15. The Co-Sponsor Group agrees that it will indemnify and hold harmless the City, its officers and employees from liabilities, demands, damages, losses, and costs e,e entd'b cause " y, ................... t'h,' "nd li t b6i r6dkJ' ss, 6 iih midi fly' rt gfi f conduct of Co- Sponsor Group, staff, volunteers or agents, or on account of any unsafe condition that may exist as a result of the negligent operation by Co- Sponsor Group, staff, volunteers or agents of the facilities. M The Co-Sponsor Group further agrees to carry at its own cost and expense, acquire and maintain during the term with the City, sufficient insurance to adequately protect the respective interest of the parities. Specifically, the Co- Sponsor Group must carry the following minimum types and amounts of insurance on an occurrence basis, or in the case of coverage that cannot be obtain ed on an occurrence basis then coverage can be obtained on a claims- made basis with a minimum three (3) year tail following the termination or expiration of the Agreement. These insurance requirements shall not limit the liability of the Co-Sponsor Group. The City does not represent that these types or amounts of insurance to be sufficient or adequate to protect the Co -Sponsor Group's interests, or liabilities, but are merely minimums: a. Comprehensive General Liability insurance on an "occurrence" basis i including but not limited to bodily injury, personal injury, and property damage with limits not less than $1,000,0OO per occurrence, $2,000,000 aggregate. b. Automobile Liability insurance for any motor vehicle owned by, hired by, used by, or used, on behalf of the Co-Sponsor Group, providing Bodily Injury Liability and Property Damage Liability covering any injury or damage with limits no less than $1,000,,000 per occurrence, $2,000,000 aggregate. If the Co-Sponsor Group does not own any motor vehicles or u,-.e eity Propeity cis the origin for grotip travel, this insurance is not required. C. The City recommends but does not require the following coverages to protect the Co-Sponsor Group. The City is not liable and shall be ------------------------------------------------------- -------- ---------- ................................................................................. 6 g indemnified against any claims arising from any claims made against the recommended coverages provided below. i. Property Insurance ii. Crime and Employee Dishonesty Coverage iii, Sexual Abuse & Molestation Coverage iv. Workers Compensation Coverage V. Employers Liability Insurance ...............­­,""I'll".............. ................... ADDITIONAL INSURED: The City is to be specifically included as an additional insured on all liability coverage described above except for the Workers' Compensation coverage. OTHER INSURANCE PROVISIONS: The General Liability and Automobile Liability policies are to contain,, or be endorsed to contain, the following provisions: 1. PRIMARY INSURANCE COVERAGE: For any claims related to this Agreement, the Co-Sponsor Group's insurance coverage shall be primary insurance as respects the City, its officers, officials, employees, and volunteers. Any insurance or self-insurance maintained by the City, its officers, officials, employees, or volunteers shall be excess of the Co- Sponsor Group's insurance and shall not contribute to it. 2. RIGHT OF RECOVERY: Except for Workers' Compensation, the Co- Sponsor Group waives its right of recovery against the City, to the extent permitted by its insurance policies. CERTIFICATE OF INSURANCE/CERTIFIED COPIES OF POLICIES: The Co- Sponsor Group will provide the City with a Certificate or Certificates of Insurance showi:ng the existence of coverage as required by the Agreement. In addition, the Co -Sponsor Group will provide to the City, if asked lin writing, certified copies of all policies of insurance. The Co-Sponsor Group will maintain the required coverage with a current Certificate or Certificates of Insurance throughout the term of the Agreement with the City. New certificates and new certified copies of policies 51 tall be pi ovided to the City whenever any policy 19 renewed, revised, or fnine d Trorn other insurers. I he aress where such ceffificates and certified policies shall be sent or delivered is as follows, �7................................................. City of Clearwater Attention: Athletics Office 1160 Seminole Street Clearwater, FIL 33755 And City of Clearwater Attention: Risk Manager ....................................................... ...................................... ................... 100 S. Myrtle Ave, Clearwater, FL 33756 17. The Co-Sponsor Group will maintain a positive relationship with the City and Parks and Recreation Department by: a. Obtaining prior approval for any activities. b. Obtaining prior approval for any field or facility improvements. C. Providing all requested information and paying all fees on time. d. Informing Parks and, Recreation staff of field problems or schedule change requests in a timely manner. e. Enforcing and abiding by all applicable laws, rules, policies and procedures. f. The Co-Sponsor Group President will be the liaison with the City unless the President appoints another representative, 9. The City and the Co-Sponsor Group will make a good faith effort to reply to all communications (phone, e-mail, etc.) within two (2) business days. 18. The Co-Sponsor Group will act as a good caretaker and custodian of all City of Clearwater property by avoiding any activity that may damage the facilities, by cleaning up trash after each use, by enforcing the "no smoking" policy, by 1 ifilizing lights only when needed and tUrning theM Off 240 r use. 19. The Co-Sponsor Group will assume all responsibility to monitor storm conditions and evacuate playing fields of participants and spectators when the threat of lightning or dangerous conditions approaches. Co-Sponsor Group will cancel .... ....... ...... .. .. .. — --- ----- --- --- ----- ..... ....... ----------------------------- . ..... ...... ......................................... .. .. ................. ........... .. .. ....... ............................................................................................................................................................................................................................. F1 a g games when field or playing conditions could cause harm or damage to participants or to the facilities i.e. flooded fields, 20. The Co-Sponsor Group will validate the quality of adult leadership by conducting and authorizing annual Level Ul or City approved equivalent criminal background checks, on all persons acting as a coach, and any person acting in an official capacity with any organization directly overseeing the Co-Sponsor Group's youth activities. These checks shall be conducted and completed prior to the beginning of each playing season or involvement with children and shall remain valid for the -duration-of this aqreementT­he jCo-Sponsor Group shall emptoy a reputable company to conduct such checks. A statement confirming the completion of the background checks is due to the Athletics Office prior to the first day of utilization of any City facility hereunder. Co-Sponsor Group is responsible to notify the City of any persons acting in an official capacity with the organization added during the season or after initial form was provided. Said individuals shall undergo the criminal background check and a notarized form must be provided for each individual added. The Co-Sponsor Group shall also adopt and publish a criminal background check policy to be used for determining an individual's eligibility to coach. Should an individual be disqualified as a result of the check, the Co -Sponsor Group will prohibit that individual from, serving in any official capacity with the Co-Sponsor Group's activities, disqualify that individual from providing any services or participating in any activities contemplated under this Agreement, and notify the City of said applicant disqualification. The Co-Sponsor Group shall establish a policy as to how its criminal background checks will be processed and will pay for the cost of each background check. Exhibit "C" — Criminal Background Investigation Policy is shown as a base required for the Co-Sponsor Group. The Co-Sponsor Group shall furnish to the City a listing of the persons that have successfully undergone a Level 11 or City approved equivalent criminal background check prior to the beginning of any individual's involvement with any youth related activities. A Co-Sponsor Group Board member and Notary Public shall sign this listing for final verification of the actions taken by the Co-Sponsor Group 21. Volunteers under thea a of 18 must be approved by the Co -Sponsored Group in advance. A written list of all qualified volunteers under the age of 18 must be submitted to the City prior to use of volunteer. ................... ............. ................................... ............... ...............-,""I'll,............. .... ......-,"''I'll,.............-,""I'll,. ..........1111111"I",...............-,""I'll,...............­­­­­­­­,­...............-,""I'll,............... ............... ................ .... ........... ..... a. Minors may access the facility but only in the presence of an approved coach. b. Minors cannot supervise other minor participants of the program. 22. The Co-Sponsor Group will recognize and support City public/private partnerships, The Co-Sponsor Group will be given ample notice of such partnerships and their responsibility if any. 23. The Co-Sponsor Group must receive prior written approval from Parks and Recreation to make any alterations, changes or additions to the existing facilities. pon or ..........­­­ -","", -15fi-1......`­"-b-....fff........ f5­'­lity­­`­­­,t roup is7fes,ponst e- or-su, mi ing-a ct i Imp request form for review/approval. 24. The Co-Sponsor Group is not permitted to operate a concession stand when an outstanding City agreement is in place. The Co-Sponsor Group will not engage in private third-party operations of the concession stand. In the absence of an outstanding City agreement, the Co-Sponsor Group is permitted to operate a concession stand. The Co-Sponsor Group will also be responsible to maintain the concession stands to the standards established by the State of Florida Department of Health and the City of Clearwater as outlined in Exhibit B. Any Co-Sponsor Group that operates a concession stand will be required to have their concession manager become a Certified Professional Food Manager. As regulated by the Florida Department of Health, food service operations must provide annual training for employees. It is the responsibility of the certified manager or person in charge to train or ensure, the training of all employees under their supervision and control who engages in the storage, preparation, or serving of food, or cleaning of equipment, utensils, or food contact and non -food contact surfaces, and to do so in accordance with acceptable sanitary practices. The trainings must be annual and provided to employees by March 31 of each year. Employees hired after the annual training has been provided for that calendar year must receive training within 30 days of being hired. The certified manager or person in charge must also maintain a copy of the establishment's most recent regular food service inspection form provided by the department. Employees shall present this inspection form to guests or patrons for their review upom request. 25. Facilities constructed by the Co-Sponsor Group i.e. press boxes, concession stand, batting, tunnels etc., will, be maintained by the Co-Sponsor Group, Failure to maintain these facilities in a manner acceptable to the City shall be a material ----------------------------------------------------- -- ----------- ------------------------------- —------------------- ---- ---------------------------- ................................................... ........ ...............___...... --—------------ ...... ........... 10 breach of this Agreement and may result in the termination for cause of this Agreement. 26. Schedules submitted by the Co-Sponsor Group must accurately depict field/facility use and any changes must be approved before they are implemented. The City reserves the right to revise or revoke schedules of facilities based on inappropriate use or non -use by the Co-Sponsor Group. The City also has the sole right to assign fields or facilities to others if use by the Co Sponsor Group is not substantiated. 27. The Co-Sponsored Group will be responsible for all tournament fees for any _Aoumament-Any other events induding,-furtdraising-events-or activfties-wHt-be charged' per the Athletics Office fee schedule, The Co-Sponsored Group will be responsible for all facility fees for any non -sponsored seasons. Th e Co- Sponsored Group will be responsible for all facility fees for any camps/clinics when registration fees are required to participate. The Co-Sponsored Group will be responsible for direct City costs for any camps/clinics open to the public and free to participate. 28. Any revenue collected by the Co-Sponsor Group on City property must be used to promote and support the Co-Sponsor Group's activities. Use of funds for other purposes could result in termination of this Agreement. 29. The Co-Sponsored Group agrees that all staff, coaches, volunteers and agents of the Co-Sponsored Group shall conduct themselves as good role models exemplifying good sportsmanship, cooperation and appropriate behavior, The City reserves the right to require removal of any person associated with the Co- Sponsored Group if he/she is deemed to be exhibiting behavior detrimental to overall success of the organization or City. M The Co-Sponsor Group and all its invitees will abide by all applicable law s and all City policies when using City facilities, including those policies which state that the consumption of tobacco products or alcoholic beverages on City or School property is prohibited. 31. The Co-Sponsor Group further agrees to make no unlawful, improper, or offensive use of the facilities. 32. If either party terminates the Agreement, any improvements made to the property by the CO-SPOAsor Group will remain the PFOpefty ef the Gity, 33. The Co-Sponsor Group may not assign this Agreement or any of its rights hereunder, nor permit others to use the facilities or any part thereof without the written consent of the City. The Co-Sponsor Group shall not permit any third- ....................... party usage. This Agreement is a privilege for the benefit of the Co-Sponsor Group only and may not be assigned in whole or in part by the Co-Sponsor Group to any other person or entity. Any attempt to assign the rights or obligations of this Agreement shall render this Agreement null and void in tot ll. The Co-Sponsor Group understands that the Co- Sponsor Group's use of the facilities is nonexclusive. 34. Use of facilities by the Co-Sponsor Group is intended solely for the purpose of training and competition for the Co-Sponsor Group's rostered participants. Any personal use by volunteers is prohibited ........ ....... ........ 35. Any vendor sales (merchandise or concessions) must be approved in writing by the City of Clearwater Athletics Office prior to the event, 36. Co-Sponsor Groups are responsible for informing their members of current guidelines and rules as outlined in this Agreement. Organizations are expected to take reasonable measures to ensure compliance during their events. Violations may result in the suspension or cancellation of this Agreement. 37, Any questions arising out of the use of the facilities or otherwise arising under this Agreement must be submitted in writing. 38. Special conditions or other issues (i.e. maintenance issues, payment of fees, special needs) will be covered in Exhibit(s) and attached hereto and made a part hereof. ...................... ........................................... .............................................................----........................................................................ .................. .......... .......... 12 1 Page IN WITNESS WHEREOF, the parties hereto have executed this Agreement the day and year first written, Witnesses: As to City Manager or Designee As to Co -Sponsor Group Designee/City Liaison By: CITY OF CLEARWATER, FLORIDA City Manager or Designee -t Co -Sponsor Group President or Designee I Page EXHIBIT A City of Clearwater Co-Sponsor Group Primary Season Use Request DUE DATE: Co-Sponsor Group: .................... Requested Facility/Field Primary Season: Requested Special Event Dates (Tournaments, Clinics,Camps, Etc.), Charges will be determined per agreement, Submitted-BY: Date: -------------------------------------------- ------- ------------------------ ---------------------------------------------------- m_....._.._............................ ....................................................................................................................................................................................................................................__._._......_..__..._m.. .. . M......................................................................................... 14 1 Pad' e EXHIBIT B City of Clearwater Concession Stand & Office Building Policies & Procedures City of Clearwater Parks and Recreation Department permits various organizations, groups, and agencies to use the concession/storage/office building on property owned by the City of Clearwater. Permission to use City of Clearwater property and/or facilities shall be based on the following conditions. A. The use of the property and/or facilities shall be on a seasonal: basis rather than a permanent one. For ex-ampJe, a baseball organ izatiGn may-be permitted to use the facilities and/or property during the baseball/softball season and a soccer organization may be permitted to use the facilities during the soccer season. B. All groups who use the concession will be responsible to maintain the concession stands to the standards established by the State of Florida Department of Health. Any Co-Sponsored Group that operates a concession stand will be required to have their concession manager become a Certified Professional Food' Manager. Concession cooking and sales are only permitted with a valid license from the Department of Health. With prior written approval from the Athletics Office, concession stands without a valid license from the Department of Health can only sell prepackaged foods that do not require preparation (chips, pretzels, etc.). Bringing foods to sell from home or grilling on site is not permitted. C. The City will retain the rights to program any facility and associated amenities (concession, press box, conference rooms, storage rooms, etc.) it deems appropriate at anytime during the year. All due diligence will betaken to minimize the impact on a Co- Sponsor Group during their season. The City of Clearwater reserves the right to open, and staff the concession stand for any City sponsored event, regardless of the time of year of the event, The City will make every effort to work with the organization if the event is held during the organization's "traditional"season. D. The City of Clearwater shall have the right to enter and remain upon its property for the purpose of examining and inspecting the space and' determining whether the Co- Sponsor Group is in compliance with Department policies with respect to cai e ar rd rnai n ten an ce. Access to th e con cessi on stan d gljdjqj[ .:pff ors an 87 o r Keys wi 11 5 e i ss ued on an as needed basis through the City of Clearwater Parks & Recreation Department. The Co- Sponsor Group is prohibited from making copies of said issued keys. The organization may not change out any locks on any of the buildings, An!yrequest ------------- ------- ----------------------------------------------- for a changing of the locks must be submitted to the Athletics Office in writing. Additionally, no improvements (painting, signs, etc.) can be made at any building without prior written approval by the Parks and Recreation Athletics Office. Any unauthorized hanging of signs will result in their removal and the organization will be billed for the tabor and any resulting damage. The Co -Sponsor Group shall provide keys/access to any shed or equipment stored at or on city property. E. The Co -Sponsor Group may be required by the City of Clearwater Parks & Recreation Department to remove all stored materials following the completion of the season so another user group may use the area. The user is responsible applicable regutation. ViOlati rib at -Me -Mies may tesult in the user losing the use of the storage area. F. The Co -Sponsor Group is required to maintain the cleanliness of the office and common conference room area and any storage room assigned to the organization. All records relating to the organization (registration forms, medical releases, etc.) shall be kept in a secure office or secure cabinet, notthe general conference room. The common room must be cleared of all organizational paperwork, equipment, etc. at the end of the season. Rooms designated to Co - Sponsor Grou p during approved season: Room/Space Duration of use Office/Storage Space at the Plex October 2020 - September 2021, as needed Concession stand and press box at the Plex FaU 2020 Season, Fall 2021 Season, as needed Press Box at the Plex Out of season based on avalabihty for board meetings The undersigned admowledges receipt of this document Contact/Representative: Date: (.1, 16 1Page EXHIBIT C.1 Criminal Background investigation!Policy For Adult Volunteer Coaches in Youth Sports The City of Clearwater, Florida h as a desire to protect the safety and welfare of its youth during their participation in all sports or athletic activities that are Co-Sponsored by the City. Recognizing the nation-wide incidence of crimes against children requires pro- active steps to provide protection to children participating in organizations involving sports a n d athletic competition. The_C ity-requ jfes�that-alUcoaches--(m-ust- oat as"--- -8-years of olden-that utaize-th e, City ath letic facilities,or the facilities secu red by the City, as a part of any City sponsored youth sports or athletic activities shall be required to submit themselves to undergo a Level 11 or City approved equivalent criminal background investigation prior to their participation. One such example of a City approved equivalent is a NCSI criminal background: investigation. After initial compliance and every twelve (12) months thereafter, all volunteer coaches as stated above must undergo criminal background investigation. Criminal background investigations must be performed 2ror to the volunteer being assigned any duties or responsibilities at any City sports or athletic facilities. The City may determine the time of year the investigations are to be conducted depending on the beginning of their practice season(s)or events. An individual convicted of any of the following criminal offenses shall be disqualified' from participation as a volunteer in any City sponsored sports or athletic activities utilizing City sports or athletic facilities. Ag gravated kidnapping Indecent exposure Injury to elderly or Aggravated robbery disabled. Agqravated sexual assault Intoxication offenses* Arson Kidnapping Assault* Marijuana possession* Any violation of the law intendedto control Murder the possession or distribution of any Obscenity Prohibited sexual conduct controlled substance or Illegal drug Prostitution (including promotion of, C ri mes a2a i n st ch i Id ren agg[ayateg gq�qntinn of solicifntinn� —Cli Deadly conduct Sexualabuse Del'iveryof marijuana Theft* I DUI- of into Manslau titer ---------- *NOTE: Assault/ DUI / Intoxication offenses/ Marijuana possession / Theft— Eligibility depends on the severity and length of time passed since the offense occurred. In misdemeanor convictions for these offenses, the disqualification wi 11 occur with a second misdemeanor conviction. Depending on the time frame of the DUII, driving while representing the organization isnot recommended. This list of offenses is not intended to be all inclusive and in no way sets limits on the offenses that are deemed grounds for disqualifying an individual f rom affiliation with the Co-Sponsor Group. Decisions on all other crimes or offenses not otherwise described -bl , 11-1111111111" " ............... -ma,-6�4,I e-so :�iscre,,ton b, A` --..........ti "I'l-'-f-th' ................ e....I.................d.............. t th -Ponsofl- fou with the law. If a volunteer or other agent of the Co-Sponsor Group is determined eligible for affiliation and is later arrested or convicted of any of the above crimes, he/she is required to notify the Co-Sponsor Group immediately. He/she will be removed immediately from his/her volunteer position until the case has been finally adjudicated. Failure to notify the Co- Sponsor Group of any arrests or convictions from the listabove will result in the volunteer being immediately removed from all Co-Sponsor Group volunteerduties for a minimum of twelve (12) months beginning on the date the failure to notify was discovered, or for such othertime as required by law. In the event the Co-Sponsor Group is notified that a volunteer has been determined ineligible to volunteer for the organization, it is the responsibility of the organization to supply the Athletics Office with a revised volunteer list. INDEPENDENT SANCTIONING AUTHORITY COACHES,ASSISTANT COACHES, AND REFEREE BACKGROUND SCREENING The City requires that an "independent sanctioning authority", defined therein as, "a private, non-governmental entity that organizes, operates, or coordinates a youth athletic team in this state if the team includes one or more minors, and is not affiliated with a private school as defined in s. 1002.01" (Florida Statutes), conduct Level 11 (2) background screening p u rsu a nt to s. 435.04, F.S., or City approved equivalent, of each cu rren t a n d prospective athletic coach. Athletic Coach is defined for these purposes as 1) "a coach, assistant coach, or referee working for 20 or more hours within a calendar year, whether for compensation or as a volunteer, for a youth athletic team based in Florida; and 2) has direct contact with oneormore minors on the youth athieticteam," Thig response I5l1ity7 may no be deiego fe-d 16- an rndividual feam. 1he independent sanctioning authority may not authorize any person to act as an athleticcoach unlessa Level 11 (2) or City approved equivalent screening is conducted which does not result in disqualification as provided for in s. 435, F.S. Level 11 (2) or City approved equivalent background screenings must be conducted an,nually for each coach. The backarou-n-011,11sc-r-een-0a shall include a search of the__athJetjc_-QQ other............................................ ............................................................... ................................................................................................................................................................... .................................................................. 18 1 P a g e identifying information against state and federal registries of sexual predators and sexual offenders, which are available to the public on Internet sites provided by the Florida Department of Law Enforcement unders. 943.043, F.S. and the Attorney General of the United States under42 U.S.C. s. 16020. An independent sanctioning authority shall disqualify any person from acting as an athletic coach as providedfor in s. 435.04 or if he or she is identified on a registry as described above, must notify a disqualified person within seven (7) days of the background screening, advising of the results; and maintain for at least five (5) years, a copy of the results and written notice. -------------------- -------------------------------------- -------- --------------- ------------------------------ ------------------------------ ------------------ - ------------............................ EXHIBIT C.2 AFFIDAVIT OF CRIMINAL BACKGROUND SCREENING INDEPENDENT SANCTIONIING AUTHORITiY ("I.a. .") NAME, DATE- . ATE ';tl -= H d id"", I C . .. volunteering as a Coach, Assistant Coach, or Referee within my organization ("I.S.A.") providing services to City under this Agreement, or conducting activities on City property, have completed the background screening requirements set forth above and as required by law, and been deemed eligible by N.S.A. to provide services as a. Coach, Assistant Coach or Referee underthis Agreement. The information contained in this Affidavit is up to date as of the date th is Affidavit is dated and fu m ished to the City of Clearwater barks and Recreation Department per the requirements of Sections 14(f), 20, and 30 of this Agreement. All individuals providing services u nderth is Agreement are listed below. Each individual shall be identified by name, birth date and date deemed eligible. This affidavit must b provided to the City on the annual anniversary of the date above, for as long as this Agreement is effective. [please attach additional sheet(s) if needed]. (List of Individuals) Name Birth Date Date Deemed Eligible ............. ...... ......._........_ ..... .. . .... ........._. ...... ..... ...._ 20lr> a gs. Signature of Affiant Sworn to and subscribed before me this day of a Notary Public My Commission Expires: Personally known 01IR Produced Identification Type of Identification Produced .'.r"" EXHIBIT C.3 ATTESTATION OF COACHES' CERTIFICATIONS By my signature, I attest that the coaches listed below have completed the following certifications/classes and are eligible to coach with the Organization. Name Certification EXHIBIT D PARKING RESTRICTIONS During the Co -Sponsor Groups season, the Co -Sponsor Group is responsible for assigning members of their organization to manage and control parking, and to keep fire Ian es and access for emergencyveh ides dea r. The Co -Spon sorGrou ps will en su re that all vehicles on ly park in designated legal parking lots or stalls Parking or driving on fields, medians, sidewalks, bike lanes, paths, or other unauthorized areas inside the park are strictly prohibited. The City ultimately retains the right to prohibit parking at any location. The Co -Sponsor Groups will control the parking at the thcilifies they =time to frInfifir* sto.itprcgrarns ror warp - a. Countryside Sports Complex: Parking is not permitted along the right-of-way on McMullen Booth Road. Additionally, vehicles may not park in the swale between the sidewalkand the right-of-way. Co-SponsorGroups using th is ven ue will help promote good neighbor cooperation with Chi Chi's Golf Course by ensuring that Chi Chi's parking is not encroached upon. b. David Martin Fields at Gien Oaks Park: Parking is not permitted along South Hillcrest Ave., South Turner St, or South Evergreen Ave. c, ECM 8 and 9 Fields: Parking is not permitted in the Eisen howerSchool parking lot during school hours. d. Frank Tack Fields: Parking is not permitted in the grass along Montclair Road. e. Joe DiMaggio Baseball Fields: The Co -Sponsor Group will ensure that vehicle traffic associated with their activities will not drive on the maintenance/emergency access road between the turf multi-purpose fields. Additionally, no vehicles are permitted to park nextto the baseball fields. f. Sid Lickton Park: Parking is not permitted along the roadside of Saturn Ave. g. Vehicles/trailers are not permitted inside any of the facilities nor on any turf surface with prior written approval from the Athletes Office. h. Long Center: No field parking unless approved and responsible to reserve spaces for Long Center patrons as directed by staff. Failure of the Co -Sponsor Group to control the parking at any of these facilities during their activities will result in the Athletics Office reassigning the number of games, game start times, and/or the number of fields that can be in use at each facility to ensure compliance with the parking restrictions at each site. In addition, the City reserves the right to schedule staff at the Co -Sponsor Group's expense to assist with EXHIBIT E CO-SPONSOR GROUPS RESPONSIBIIJTIES The Co -Sponsor Group agrees that during the term of this Agreement, the Co -Sponsor Group will at no cost or expense to the City, provide the following maintenance and/or repair: a. Stripe each turf field as needed. b. Pick up all paper, cigarette remnants and debris and place in trash receptacles, including the breakdown of all boxes. 111 • * • e 1 7 • i• al • rote se *In • Pet's Ordinance, and all other posted rules. d. The Co-SponsorGroup, any league, team, group, or person, using a City park under this section and failing to leave it clean of litter to the satisfaction of the City, will reimburse the City for city worker time used to clean the facility. e. Provide for any special needs or services such as secu city or traffic control devices or officers needed as a result of Co -Sponsor Grou p's use of the Facility. f. Light cleaning of the restroom facilities on a daily basis when in use. g. The Co -Sponsor Group shall not store any items outside the storage room nor dispense of any trash outside the facility area other than in containers provided by th e City. h. The Co -Sponsor Group will issue to the City three keys to any Co -Sponsor Group initiated lock used at any City facility as well as anytime the locks are changed. i. As noted earlier, while the Co -Sponsor Group's use of the facility is nonexclusive, subleasing of the facility or assigning use of the facility by the Co - Sponsor Group is not permitted. Such activity by the Co-SponsorGroup could result in termination of th is agreement. j. The press box, multi-purpose areas, office space, concession areas and storage rooms must be cleaned and organized on a nightly basis. The Co -Sponsor Group shall receive an invoice from the City, as applicable, if the Co - Sponsor Group does not follow through with these responsibilities. Failure to make such a payment will be grounds to bar the Co -Sponsor Grou p from use of the facility until the fee is paid or acceptable re • ial ction is taken. Contact/Representative: .4( Date: 24 Page EXHIBIT F EMERGENCY ACTION PLAN EMERGENCYACTION PLAN for Facility Name: Facility Address: Facility Phone Number: Date Prepared- .............. ....................................................................................................................................................................................................................................................................................................................................................... .................................................................. . ........ . ... ..... . EMERGENCY PERSONEL NAMES AND NUMBERS Designated Emergency Contact Name: Phone: 'Rack-up Emergency Contact: Name: Phone: EVACUATION ROUTES ,Site personnel should knew at least two evacuation routes, Evacuation route plan. The following information is to be marked clearly on an evacuation plan that is readily accessibleto the Emergency Contacts on-site. 0 Emergency exits 0 Primary and secondary evacuation routes 0 Locations of fire extinguishers 0 Fire alarm pull stations' location 0 Assembly points EMERGENCY PHONE NUMBERS: 9-1-1 UTILITY COMPANY EMERGENCY PHONE NUMBERS Electric Company: Gas Company: EMERGENCY REPORTING AND EVACUATION PROCEDURES Types of emergencies to be reported to site personnel are: 0 Medical, Severe Weather, Fire & Other, Terrorist attack, bomb threat, hostage, etc. MEDICAL EMERGENCY Call medical emergency phone number: 9-1-1 Provide the following information: • Nature of medical emergency, . ........ . .......... ....... ........................... ........ • Your name and phone number from which you are calling. Do not move victim unless absolutely necessary, The following personnel are trained in CPR and First Aid to provide the required assistance prior to the arrival of the professional medical help- 1. 2. 3, Attempt first aid ONLY if trained and qualified, FIRE EMERGENCY When fire is discovered: • Activate the nearest fire alarm (if installed) • Notify the local Fire Department by dialing 9-1-1 • If a fire alarm is not available, dial 9-1-1 and notify everyone at the facility to evacu ate to the i r closest exit. Fight the fire ONLY if, 0 The Fire Department has been notified. 0 The fire is small and is not spreading to other areas, 0 Escaping the area is possible by backing up to the nearest exit. 0 The fire extinguisher is in working condition and personnel are trained to use it. Upon being notified about the fire emergency, occuaants must: 0 Leave the building using the designated escape routes, 0 Assemble in the designated area (specify location): .. ......... ......... ... .....1--1 ....................................... ..................................................... ................................................ .......................................... 2 6 1 P a g, 10 Remain outside until the competent authority (Designated Officialor designee) announces that it is safe to reenter. Designated Emergency Contact should.- * Coordinate an orderly evacuation of personnel.. . Perform an accurate head cou n t of personnel reported to the design ated area. 0 Determine method to locate missing personnel. 0 Provide the Fire Department personnel with the necessary information about the incident. CHEMICAL SPILL: ............... ............... .... .... ........ . ............ ................ ... ....... . • Do not attempt to clean the spill unless trained to do so. Call 9-1-1 and attend to any injured persons. • Evacuate building as necessary. The following,are the locations of: Spill Containment and Security Equipment: Personal Protective Equipment(PPE): MSDS: When Chemical Spill has occumed.- a Secure the area and alert other site personnel, 0 Call the Fire Department if site personnel are unavailable, SEVERE WEATHER AND NATURAL DISASTERS Hu cane: If Pinellas County is under a Hurricane Watch or Warning, all activities will be cancelled, and no one will be allowed to enter our facilities. Please instruct all parents, coaches, athletes to stay home and seek shelter. Lightningll-hundersbm (www.lightningsafety.noaa.gov) & No place OUTSIDE issafe duringathunderstorm! A house,orotherfu 111yen closed building with wiring and plumbing offers your best protection against lightning. A car with a metal roof and sides is yoursecond-best protection against lightning, 0 The "30-30 Rule"offers easy to followlightning safety guidance. When you see lightging,eeuntthet'meuitt'Iyutii-ivaitliaiidei. ifthattimels3usecon 1Ubt: t:"[UUYh__:t5__bV d9affligiveirmus!­ SeeK shelter. IT you cin t see the li:ghtning,just hearing the thunder is a good back-up rule. Wait at least 341 minutes after the lightning flash before leaving shelter. Tomado: • When a warning is issued by sirens or other means, seek inside shelter. • Consider the fol I owing: Small interior rooms on the lowest floor and without windows, Hallways on the lowest floor away from doors and windows, and Rooms constructed with reinforced concrete, brick, or block with no windows, • Stay away from outside walls and windows. • Use arms to protect head and neck. • Remain sheltered until the tornado threat is announced to be over, ............................................ ....... ............ , ..................................................................................................................................................... 2 8 EXHIBIT G CO-SPONSOR ORGANIZATION ANNUAL REPORT This documentation provides a breakdown of the organization. The document is an overview of the (year, season) City of Clearwater Co-Sponsoiship Agreement. This report is due Organization Description: (Brief description of organization's mission, history, and programs offered) Participation Numbers: (Number of participants per session and/or program; include participants info for each division/age bracket) Volunteer Numbers: (Number of volunteers and hours volunteered) Accomplishments/Highlights: (Awards, clinics, camps, championships) Requested Facility Improvements: (Add-ons or renovations which may benefit organization/other facility users) Contact/Representative: Da EXHIBIT H Certificate of Insurance Sample SAMPLE Aii LIABILITY INSURANCE f TUVVWkVV "kMTRMK'M7N 15 1 AM,M WATUR 15r N AMTMIVMNr.*(1,WY MM G6 ;°M iFfRM uCi MrH!;Wt Mrk ' uN[r 4 I NMTIIl i NftlM.... J r,IIM(MYNr-.M'iNT AM Md oy 0NVMRJM6m miNl% (;%k'r O MMkIN:91LY AN=IX"NV MYM F,Yk PMMa MRMN aWWO'CuNli ftY TUNN M ✓4 Wj, ME1&& MI CMM'MM.MMM Imo.RRWM'IJN.wMW1,rpljFM4 My u°MtNraMkVNKF M.. S TMiM41 N Hfh'F':N!4 IRMF N%*14 WA." 1qu,*VlRNMYMP.0,N67N°.e530fu dk6R^M1iSkIN uNTaNVaM'iPMo r0d6VMT7 M.MMk 1#4t'roti101014MANN4Ntmkf4NM. MMM'M.,FPnVTMM'"S'NT @M kMu;Tbuk'2NAAL7vLc TM�vMNbMk 11MGIMu m' NV'1Ma1FnPb�AMor M6/flW NR 6'&uNd W@ Mn bti wW MSI MJ$n ivIPM4 G..CMN N6 M'�.�Y pryrom 411wMdittrW wu`ly aF M�'A4�NtiV"m�.'NM M,�. F NV 4wfin`dM b'�Cti.MuM'P4^%1d.7rMW iN S.NF4'440 MraaMw ail w Y1 w taFT twA—4 r�warmmlPorNuawamw: �M Mi�x i�'r"c°'M.r,rs t wru IyrmMrwk wrva"W+wal;uwiu, wmo.v.ndff..'mavnn�wf 6M m�cV,n M,�mm�w�w,nrR n� Nfl'%mww mhCM'ar rere�Ms�,x�re unwnu�ti rbw�,m9�4w um UY-mM.„uwo6M�.�HwN Nm�NmNi�ww awo-Mwa��^u9'�, rPon�wruuMma:m,� «wrvdJ�b y... ,m.._,...... _...... ........ .. ........,.,, �......, �, , ,,,,y M .,.. ... . _ __._w..,.,. i INSURANCE d.'�.u�FAM IRR TION mmwitrwamk r6�F M,°M4 r1Mr 6 aur•o (A41AM'N BZw'' W K)'NW rMrv'M(WW"PV4 ....... .. ,.,,..........„ f 'NMdkVhCiM�' ,....,.,.,".,, T 'Prw;s la�,S kb`7 Nr 7 P mM r,'6W.A,. k r6drt Nr&r N�1°,i` MIFF Ir.e vmi b+'A pop W�,6 M.a� '!m.r4 T t ,qTv,Amv„E fF%tD bwMOOU)MiNC,4,6.41, ,,E roM7al i MI,MU7,.R1�,�mm, 1 Ffi4w 7Tp wrA M6.arwu d'MMr lMk.r ANY MT MMl. TV""rii 7"AWMTCM'11Nd 0V r6 C NMI"RACT DAO rA "G»"rN7 kNr liq d'1ESWIF77 Tlk 6ik,MRb THil* I UM7N4cm Mu 9E ll'SI1'M.:=IAll MAV 'Mw Ei 7,4E�„M,N;�<7 MP,1m1nd"P+6kF m,rg uIMk.M, 7G k.L �T "FMPa66a £iM YL."4A AM,M" I"'.Y9'J /)Vl � 1'C MJ fi M'Md WY'IOM10 kM�MJ 10 'Mr.NN!"r'h1 LBd I�'J4G U<tM'H , �.� 'rar�+Mw�a ;u�w,�E d�ldUG y�ruuT"w�TtM ^"':wM"9 '.�Kvr'rr"l,llll.. aNrpRM rrr,NMMrtW. MMN fA.W.:"A Ldww;fAluvW M,aP1^h'!IreErrrJM M sgFPJ R,PW lY # X mmmm F M1 QAC ;" ....,� .....�.,� ��Mv��mnz�wFM an�M�awMmum 6 >� �i Yrmlb T kmMM'rY.mN�'!r murt��¢u o' -J � �rta6 M,w;,wMu,ru�r M M"^�'�MaM°S� ,;M�µr�mrrry IC ,a�vw � � � W,+I"> �rrw av✓,M�iC„m.NtrP' N r ,,.�.�., wr.Mn'a El El .rl _ NM armor ". a [am.ruNIMti61o�w � �rS�." cmwsT t7 r or r 1 M'MTa� wmdiuwwr WoRMM rl;kuw wMk wM Frt' ( M'MUMr ut n k. rlra 171I _. .. _a ww6arrAIIu>4N �m r�sm aw W rrNaa�w o. _u_ ...,, .. ,,..e .a ., w �w b MP D uEmzr Rn1M,aC�.r.NN17 "" h uruwi a (m'rM,mNluk N kMrm'mo ra M @ a ww r M�rum e m, � 7 �Tm .d� U ,.ewM rDR du w n�i.vb T m 1 j I�NMd�T�^��R�rNNmNN;I�MIMM6+�E, � � �rk�r �m�M��r +�o�M� � �m.�ara�rawM� �ara��wror�uaMu �mrrc�wmirr�n4a.%YiOW01A*Mbuwui Md*dfta�� ra�rrnww�r SPOMi,OR04GORGANZA71spk TEAM Of I Ehu orTEAVSt 0700F OF w:;:1..'E,M,R"46kM.7'E ,nh:ND PI NN .N,LAS Ck:1UNN7a SCH,00L KARO ARE ADDa:T06'b'gNMk.4f4''M RZ- 1 N,�NNR; u x�Na�'tNRw I T dM of c a,ea%r'N iter lM IN;Rk,�GAM OF'Y}#M-.ABli EEKWED M+NUE..M;, M NMF S,NMWA'i1L ED M M�N2M E w 7 7 W MC6.. aMM F ruRTl rRMF aMna RMF 7 „ i Clearwater,� FL �� m'�!„F..�+,ys� ........ � _ r MU/M1�MMNN'T1!Nh MM':M�M�Md:MYPa.WrMMs r r ......�........�.s .� ................�.... ..__�.�.... ....., — .,......m._.. �.r,Y�!IVVk'6_i°rJ'9"vdW@.�'sN;4�N'6tl.w.iMY�a^":d'MI.'A,'Sld'.AI—AJhrTVtM �1 N,bN4rF���N.ry,��11�+�V'M} NRS NM,;I„W'M�11L'"ti aN; mrec,ua�rtt nFevMmsu�u a RwyMM�2e�r�c1 rTM�FMc�rrd�,fmu.6N'kNM ................................................................................................................................................................................................................................ ....................................................................................................,........ ....................................................................................................... 0 1 P EXHIBIT I ANNUAL FINANCIAL STATEMENT ANNUAL FINANCIAL STATEMENT FISCAL YEAR ENDING NAME OF OGANIZATION Amount Item Registration CP(Grants Clinics Tournaments Sponsorships Concessions Fundraisers Donations Miscellaneous $0.00 Total Revenue Amount Item Marketing Uniforms Awards Dues OpeningDay Concessions Benefits Salaries Miscellaneous $0.00 Total Expenses • Date: 1 I age EXHIBIT J — Countryside Jr. Cougars Special Conditions • The organization's president or authorized representative must attend the co - sponsor president's meetings conducted by the Athletics Section. • Rosters O (Season): Fall, August 15, 2021 to November 30, 2021 • Roster due: 8/1/2021 or prior to first scheduled use •••••• MN, •• +TM' • re, orair...e.v.w. toiroo. 1•11 F &maw a., 00 4 IS • 11.3.11-4t "` • i..1.11C.A.11011{2.1111b, • Roster Payments o (Season): Fall, August 2021 to November 2021 • Roster payment due: 8/15/2021 • An accurate facility and/or field schedule, depicting actual use i.e. games, practices, meets, tournaments, and events. Blanket schedules will not be accepted as firm schedules. The following dates apply: o Fall Pracfice schedule due: 8/15/2021 o Fall Game schedule due: 9/1/2021 • A list of all coaches and their certifications and proof of required Level 11 or City approved equivalent background check. o Fall 2021 coaches Level 11 or City approved equivalent • Due: 8/1/2021 or prior to first scheduled use o Fall 2021 coaches' certifications • Due: 8/1/2021 or prior to first scheduled use • Co -Sponsored Usage Dates: O This agreement covers the requested dates for recreational tackle/flag/cheer games and practices based on availability: • Cougar Camp, June 14, 2021 -June 18, 2021 • Fall 2021, August 1, 2021- November 30, 2021 • Additional Considerations: N/A EXHIBIT Participant Card Application CLEatitWATERPARKS fkRECREATION DEPARTMENT RECREATION APPLICATION rvA"'J" AV,1)1M,,1 um1nA 40;rp;aorU�arm "�rp��,-s��"rts�"t:a�r^�nr` AUN"G"P.S A170,WMQUIREAk�,IDP1r"N'N70� rtoN mmuesx m safe��NAa ~h d. esdd ce/R%z.a arkddressa Cage Stader Zi N"dadimmp.address: uCit'"' State. zipm E-asvad,fid dt es.sar Telephone*t Call Emverppemmtyr'Fe$eprfmone,�. 'WAMR.O RELFAU OF LMIUTY NPS rwm�¢�6imrma,pwwo*ipru PVawr INH.R'�akrt wr;l auvmaau.eakwwVrc]Yer o eurw,rrwa"aadwml iul w�ylHrw?�.a:w�;wa »q",Nwaur�r°�rr�tl4vrwaa�a"0±breiw'x'k„��wa'✓asi�u�r�r,Nu;.�,�nuw,�r^r�ae -awGuwl,�r�u�, wark�rel;o prjg%,'w9"nii awmd am o'ema rf"Lw atiro~wi yuww ;vmw Pae Wr 41N, w'u Yawui,'�a w.hv4wm rruw aerahaw wsr Since tle OtIr of 0ewetter a»not aware ed mm a or S^d*" 2kemsV's�physir.e.4 evadrdan Or arAi0itag fmm Ta1i&Us 4ct'rines and W conzideration of the dsrmefmas and cppetnwrairies afforded to My depemd*ZV's6 or me by part6cdpyatvema uta arrmMttrvees epwmm wed bY the City of Cdearwwrater,p Me As follotwt; If d or t"dr y*ademmtas t srouW sufferam inpury or Mnasa as a.partariparst d ammtdmeraae Carr repxresemwxataawo. to azo their cdi rat^iorm tamp isav^a m!se ter mmap dependerotti.0 tramms�po ted to a.rmmedwad faud'arp for tmreamatuaart and f take fag mspoz,idaffitp"far dtiti artasmm..and.apree to pap Any erdpeurs�e M&Urread for W1 troatment, i hu ther a"to tzdvmammand sattv,and Eaapd harnfieis the City,of CleArwater,Al eiampl"es aralwau for any Personal mrAry My depe m; rt s f or d might mtarmr during panlapalton ut recrearremr.acirrmtmesw M,SE D RACK Of PtpRM FOR DIPORTANT PARTICIPANT INFORMATION CCEFO E SpiGNIN 4, Nrpap hcaask,t Signature or Legal Guardian dtitm-adprphcaaut Date Cl CE USE ONLY If Resident Proof of resmdarwry verification trmrIDmded(trmanut umsm efrwrm)a I E at'Uderut duam reurt amavm tEade statement did day s car'pess i bf adMmcpe re' trar mu Property 0tetmemr : Florida Photo W.card M Voter LM iamdicati . , 'murisdiadfmpa Nan- esfdent Cuillest tmtditS bilks,)fess d amrm vditi days,olda Tyrpe of utility Actrv*Duty Military 01 WitAry LD. Saver S I ors C:,' Property Appraiser"s Offrrwm �; a htfinea z City Employ", C ddayr LM City ID# Dept.Nam* Npasas-dtesiadent Disabled vetier^ala(w,4l need to pramrade documseutatian 6'oos the Veteran's,a pdmwaraasrrration) Nom-Resadetut Youth Spowu Card'itrenfy criteria&program are applicafmle,jk 1W-1 Eses RaidI (CmrcNuwmlamrttawletar_ ___ _ _ _____ _ ........ _ Information vMerifted by,., i q e'JkrCYSfV a"t";tMdrA Ym:LA I"mmEYlb'`PMPo rk"BtieradiNG Apmb"mW"Nk"WiYb'kad.nn!haiaNzme9 Y"dtlah r"aa ti'S`;"I'A"V"V'U'40L MIS Ntaf 5 Arm^uao�9^ua'�,MMr��,�Nw,�'L^maw aei!�uww^aD" 'Y�l+t,�;ra�'m A�uar,;W�"r"mr WOtNrwrum�l�hr,ek^war�"mlw;�m�,d�fe Y'�ra�a w�fwu"tlx vw wive°aN,�l;md,"h�Ad b'tsS,�rmn�V�uS PSsrrc rrv 'uWrl��uS�'r�r��a��mrw��re kGar jVw"rgdw and rteamrt,Am M AwwwOmmirow r rq),alai Sl'aamu"mowNaAeop,ds a �wnarwe�uuw�wu�u�riurukuuurve..wu..'::,..,,,auuuuewrvw&i;.vxvcwwuv�uurriuui�uwrurw�uuiwwreuvr..� ,...�uuuwwmrwivrweuemuawuuu.uvuuuuwr¢rrrrumuvvuuauruirruliuuu�uuuuuw'wwuwiw�uwixa'.,,- „vruuuwwiuuevuvuuwefi.-wawiiwu�uwwwr '�� rvuuuruuuwrvu.uuu.�uru�uuc..uwuuuwumwmwrr,�i i. fij J�N>'r"h"�'ffwex 41arlb,quai(,ted xth'0'9g'1806' 'V,Rer�,n'4 Nei r,Ap T'j? CLER PARKS&RECREATION DEPARTMENT RESIDENCY GUIDELINES RESIDENT& A, Frwnde proof of residonc7 It is up to the apphcazt to prove deet he or:be is a current resident of the rCityr of Cleariwater.Any two V 21 afth*followrngonti,n#nt,:wt,Lbe,-uffide,r,t, Phat000psesnie Trot acooptabie, Froof of depLmder xy-Birth mridticate or otffije,r proof of d8pcidonjcy may be required, I A mrrentState of FloMa photo adenndranoz cAwl or,curremvehide rerztranon- 21 A curTent,ontimal vo%r idem ficanon card thoutzg the City a�:"'ICAr% 31 Any M4 utffit)?hall lett than 9,0rw da ,old that shos applicAnt's name and a City of Clearwater rn edental address as the seance address. 'Uthrip'Licludez electric telephone,water,nid/ar ca sire bUL7, 4. A mrrent year, properry tax bill torr notice W m your name dare Nin'l a Oty of Clearwater proptrry address, ..... ...... ...... .............................. ......... ——--------- ".n11zVr1r:�' � 6, An anti meal rwtarized statement from azngdglt jt1gtyg that yon are a tall rm*refiftew car hzs ar her how aa td athuar two pr oalr listed Above shy mg that home W a Ciryr of ClearwAzer addres-- E. FAMILY: Huslsmd and wife or twopferionzimt1t, lir Farmverinp with the City dGearwater or Pinellas County,MmU or a legai guardian amd thew chadmi who live hi the same lwusehahl,who are 19 years of age Or nader,or Isn than 23 years of age and a Rall-tme caUege siftdeat Ver dIcation of any ap or Wnfly VaU3 nuy be reqtdred. C Complete anjd.rpthe R*avacian UrdApplicatoia, 0Pay the appropriate regutration fee, Note 1z Termanent,Clay'of cearwater eaxploveez their immediate fa=Lt7 memben City of Clearwater retirees and active duty nwm,hers of the'U.&Coazt Guard ar militavy and r1eir immedtate ftarlies,r,proof rtqu"d p are exempt ftvm the other proof of resid*nsr reqWrenwn= Note 2z Fahified WbrniAtan-FaWfirAtwn of appbcadoa infortawdon,nuy dizqualft the appliemt ftm f=re pamcipatm an City of Clearmoer reoreanan prograsns and sem spa nsor sports pan scipatim U. RETIREE'S:(Rec CardlPlus Free) A. Imvide,prmfefrunvnt peasion pay stub roan vieAxAl insuranv*6 Irl, NON-RESMENTS,-Programs that typisagy reach capaiciry mayhare registration,promdures that ghre Clearwater resWents priatity, rV. NOX-RESTOENT=T AE LM VET ERW&WiH need to provide documentation from the Veterans Administration.whicki rriH be=,ach*d to the Rec.Card Applitabon. UV ALL PARTMIYAN"FS PUASE NOTE: k Personal training is prohbited at my of farlties,unless the indiiAdual Ls a contract instructor with the City o(clearwaur, & Lost CArds-A repWvtaent card,for residents and non-rendents cost SS plus team C. Refund palicie'- dill iefund mcgie,=are,subpect to advarustration apprwraL A11aw fmir to sit week,for reftmdl to blo proirw5red. Rerream5cm C",s Rtfunds cagd;W.dIR 4,04 IM,zj&zded aftax tan ba;ivazz d4z fzaa%dal.Qi lzuw A"042"'Ous ioz V-'64UA'4s;4VA;A 44 vnth the card ar pass attached. A SIOAX pro zap fee wig be deducted tramaii refunds, Open Swim/Open Skate,Refund If,the dry must dase a pooil orskate park unmpecte'0y,pArtkipams who have b*,eT4 at the facility for less that arm hour mov be,rven a rain cheek foranother vta m ............ ...... ....... .......... .................. ............. ........................................................................................................................................................................................................