HomeMy WebLinkAbout2016-096D Indian River County Grant Contract
This Grant Contract ("Contract") entered into effective this 1st day of October 2016 by and between
Indian River County, a political subdivision of the State of Florida, 1800 27th Street, Vero Beach FL,
32960 ("County") and the Willis Sports Association, Inc.,8755 9711 Ave, Vero Beach, FL 32967.
For"Willis Sports Association's Baseball"
Background Recitals
A. The County has determined that it is in the public interest to promote healthy children in a
healthy community.
B. The County adopted Ordinance 99-1 on January 19, 1999 ("Ordinance") and established the
Children's Services Advisory Committee to promote healthy children in a healthy community
and to provide a unified system of planning and delivery within which children's needs can be
identified, targeted, evaluated and addressed.
C. The Children's Services Advisory Committee has issued a request for proposals from
individuals and entities that will assist the Children's Services Advisory Committee in fulfilling
its purpose.
D. The proposals submitted to the Children's Services Advisory Committee and the
recommendation of the Children's Services Advisory Committee have been reviewed by the
County.
E. The Recipient, by submitting a proposal to the Children's Services Advisory Committee, has
applied for a grant of money ("Grant") for the Grant Period (as such term is hereinafter
defined) on the terms and conditions set forth herein.
F. The County has agreed to provide such Grant funds to the Recipient for the Grant Period (as
such term is hereinafter defined) on the terms and conditions set forth herein.
NOW THEREFORE, in consideration of the mutual covenants and promises herein contained, and
other good and valuable consideration, the receipt and adequacy of which are hereby acknowledged,
the parties agree as follows:
1. Background Recitals The background recitals are true and correct and form a material
part of this Contract.
2. Purpose of Grant The Grant shall be used only for the purposes set forth in the
complete proposal submitted by the Recipient attached hereto as Exhibit "A" and
incorporated herein by this reference (such purposes hereinafter referenced as "Grant
Purposes").
3. Term The Recipient acknowledges and agrees that the Grant is limited to the fiscal
year 2016/17 ("Grant Period"). The Grant Period commences on October 1, 2016 and
ends on September 30, 2017.
4. Grant Funds and Payment The approved Grant for the Grant Period is (Total Dollar
Amount of $10,000.00), "Willis Sports Association's Baseball". The County
agrees to reimburse the Recipient from such Grant funds for actual documented costs
incurred for Grant Purposes provided in accordance with this Contract.
Reimbursement requests may be made no more frequently than monthly. Each
— 1 —
reimbursement request shall contain the information, at a minimum, that is set forth in
Exhibit "B" attached hereto and incorporated herein by this reference. All
reimbursement requests are subject to audit by the County. In addition, the County
may require additional documentation of expenditures, as it deems appropriate.
5. Additional Obligations of Recipient.
5.1 Records. The Recipient shall maintain adequate internal controls in order to
safeguard the Grant. In addition, the Recipient shall maintain adequate records fully
to document the use of the Grant funds for at least three (3) years after the expiration
of the Grant Period. The County shall have access to all books, records, and
documents as required in this Section for the purpose of inspection or audit during
normal business hours at the County's expense, upon five (5) days prior written
notice.
5.2 Compliance with Laws. The Recipient shall comply at all times with all applicable
federal, state, and local laws, rules, and regulations.
5.3 Quarterly Performance Reports. The Recipient shall submit quarterly, cumulative,
Performance Reports to the Human Services Department of the County within fifteen
(15) business days following: December 31, March 31, June 30, and September 30.
These reports should include but not limited to the number of unduplicated children
served during the quarter, and the progress the agency has made toward meeting
their goals and objectives as they stated in their RFP response.
5.4 Audit Requirements. If Recipient receives $100,000 or more in the aggregate from
all Indian River County government funding sources, the Recipient is required to have
an audit completed by an independent certified public accountant at the end of the
Recipient's fiscal year. Within 120 days of the end of the Recipient's fiscal year, the
Recipient shall submit the audit to the Indian River County Office of Management and
Budget. The fiscal year will be as reported on the application for funding, and the
Recipient agrees to notify the County prior to any change in the fiscal period of
Recipient. The Recipient acknowledges that the County may deny funding to any
Recipient if an audit required by this Contract for a prior fiscal year is past due and has
not been submitted by May 1.
5.4.1 The Recipient further acknowledges that, promptly upon receipt of a qualified
opinion from it's independent auditor, such qualified opinion shall immediately be
provided to the Indian River County Office of Management and Budget. The qualified
opinion shall thereupon be reported to the Board of County Commissioners and
funding under this Contract will cease immediately. The foregoing termination right is
in addition to any other right of the County to terminate this Contract.
5.4.2 The Indian River County Office of Management and Budget reserves the right
at any time to send a letter to the Recipient requesting clarification if there are any
questions regarding a part of the financial statements, audit comments, or notes.
5.5 Insurance Requirements. Recipient shall, no later than October 1, 2016, provide
to the Indian River County Risk Management Division a certificate or certificates
issued by an insurer or insurers authorized to conduct business in Florida that is rated
not less than category A-: VII by A.M. Best, subject to approval by Indian River
County's risk manager, of the following types and amounts of insurance:
(i) Commercial General Liability Insurance in an amount not less than
$1,000,000 combined single limit for bodily injury and property damage,
— 2 —
including coverage for premises/operations, products/completed operations,
contractual liability, and independent contractors;
(ii) Business Auto Liability Insurance in an amount not less than $1,000,000
per occurrence combined single limit for bodily injury and property damage,
including coverage for owned autos and other vehicles, hired autos and other
vehicles, non-owned autos and other vehicles; and
(iii) Workers' Compensation and Employer's Liability (current Florida statutory
limit)
(iv) In the event that children are supervised, Sexual Molestation Liability
Insurance in an amount not less than $1,000,000 each occurrence/claim.
5.6 Insurance Administration. The insurance certificates, evidencing all required
insurance coverages shall be fully acceptable to County in both form and content,
and shall provide and specify that the related insurance coverage shall not be
cancelled without at least thirty (30) calendar days prior written notice having been
given to the County. In addition, the County may request such other proofs and
assurances as it may reasonably require that the insurance is and at all times
remains in full force and effect. Recipient agrees that it is the Recipient's sole
responsibility to coordinate activities among itself, the County, and the Recipient's
insurer(s) so that the insurance certificates are acceptable to and accepted by
County within the time limits set forth in this Contract. The County shall be listed as
an additional insured on all insurance coverage required by this Contract, except
Workers' Compensation insurance. The Recipient shall, upon ten (10) days' prior
written request from the County, deliver copies to the County, or make copies
available for the County's inspection at Recipient's place of business, of any and all
insurance policies that are required in this Contract. If the Recipient fails to deliver or
make copies of the policies available to the County; fails to obtain replacement
insurance or have previous insurance policies reinstated or renewed upon
termination or cancellation of existing required coverages; or fails in any other regard
to obtain coverages sufficient to meet the terms and conditions of this Contract, then
the County may, at its sole option, terminate this Contract.
5.7 Indemnification. The Recipient shall indemnify and save harmless the County, its
agents, officials, and employees from and against any and all claims, liabilities,
losses, damage, or causes of action which may arise from any misconduct, negligent
act, or omissions of the Recipient, its agents, officers, or employees in connection
with the performance of this Contract.
5.8 Public Records. The Recipient agrees to comply with the provisions of Chapter
119, Florida Statutes (Public Records Law).. The Recipient shall comply with
Florida's Public Records Law. Specifically, the Recipient shall:
(1) Keep and maintain public records that ordinarily and necessarily would be
required by the County in
order to perform the service.
(2) Provide the public with access to public records on the same terms and conditions
that the County
would provide the records and at a cost that does not exceed the cost provided in
chapter 119 or as
otherwise provided by law.
(3) Ensure that public records that are exempt or confidential and exempt from public
records disclosure
requirements are not disclosed except as authorized by law.
— 3 —
(4) Meet all requirements for retaining public records and transfer, at no cost, to the
County all public
records in possession of the Recipient upon termination of the Agreement and
destroy any duplicate
public records that are exempt or confidential and exempt from public records
disclosure requirements.
All records stored electronically must be provided to the County in a format that is
compatible with the
information technology systems of the County.
Failure of the Recipient to comply with these requirements shall be a material breach
of this Agreement.
6. Termination. This Contract may be terminated by either party, without cause, upon
thirty (30) days prior written notice to the other party. In addition, the County may
terminate this Contract for convenience upon ten (10) days prior written notice to the
Recipient if the County determines that such termination is in the public interest.
7. Availability of Funds. The obligations of the County under this Contract are subject
to the availability of funds lawfully appropriated for its purpose by the Board of
County Commissioners of Indian River County.
8. Standard Terms. This Contract is subject to the standard terms attached hereto as
Exhibit C and incorporated herein in its entirety by this reference.
9. Sovereign Immunity. Nothing herein shall constitute a waiver of the County's
sovereign immunity.
IN WITNESS WHEREOF, County and Recipient have entered into this Contract on the gote•
first above written. INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONEFSSID&Fq.•.,
,• s
Dated: June 21, 2016 By:� �.. ��` %���~, 4`%
Commissioner Bob Solari, Chairman ;o:
Attest: Je re y ith, Clerk of Co u mafrgller ro
By' • ...... '�� :
u er CO
Approved:
J son rown
C"Administrator
Approved as to form and legal suffici
Dyl eingold, County Attorney
RECIPI
B :
AGENCY NAME
4 -
Willis Sports Association,Inc._WSA's Florida Dodgers Baseball Program-CSAC
PROGRAM COVER PAGE
Organization Name: Willis Sports Association, Inc.
Executive Director: James Willis E-mail:willissportsinc@wmail.com
Address: 8755 97th Ave Telephone: 772-360-9804
Vero Beach, FL 32967 Fax: 772-226-2685
Program Director: April Willis E-mail:willissportsincggmail.com
Address: 8755 97th Ave Telephone: 772-370-5858
Vero Beach, FL 32967 Fax: Fax: 772-226-2685
Program Title: Willis Sports Association's Florida Dodgers Baseball Program
Priority Need Area Addressed: Out of school recreational activities and enrichment programs
Brief Description of the Program: This program is designed to engage minorities and
disadvantaged youth in the game of baseball. The program provides opportunities for physical
activity, social and emotional growth and development, character development, civic
engagement, and puts a focus on academic achievement and personal responsibility on and off
the field
SUMMARY REPORT—(Enter Information In The Black Cells Only)
Amount Requested from Funder for 2016/17: $ 20,000.00
Total Proposed Program Budget for 2016/17: $ 96,783.80
Percent of Total Program Budget: 20.7%
Current Program Funding (2016/17): $ -
Dollar increase/(decrease) in request: $ 20,000
Percent increase/(decrease) in request **: #DIV/0!
Unduplicated Number of Children to be served Individually: 153
Unduplicated Number of Adults to be served Individually: -
Unduplicated Number to be served via Group settings: -
Total Program Cost per Client: 632.57
**If request increased 5%or more, briefly explain why: N/A
If these funds are being used to match another source, name the source and the $ amount: N/A
The Organization's Board of Directors has approved this appVationn(date,.
r(t�s -,IY 'lName of President/Chair of the Board re
Name of Executive Director/CPO Sig tore
2
I
l
EXHIBIT B
[From policy adopted by Indian River County Board Of County Commissioners on February 19,
2002]
"D. Nonprofit Agency Responsibilities After Award of Funding
Indian River County provides funding to all nonprofit agencies on a reimbursement basis
only.
All reimbursable expenses must be documented by an invoice and/or a copy of the canceled
check. Any expense not documented properly to the satisfaction of the Office of Management &
Budget and/or the County Administrator may not be reimbursed.
If an agency repeatedly fails to provide adequate documentation, this may be reported to the
Board of Commissioners. In the event an agency provides inadequate documentation on a
consistent basis, funding may be discontinued immediately. Additionally, this may adversely
affect future funding requests.
Expenditures may only be reimbursed from the fiscal year for which funding was awarded. For
example, no expenditures prior to October 1=' may be reimbursed with funds from the following
year. Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not
carried over to the next year unless expressly authorized by the Board of Commissioners.
All requests for reimbursement at fiscal year end (September 30'") must be submitted on a timely
basis. Each year, the Office of Management & Budget will send a letter to all nonprofit agencies
advising of the deadline for reimbursement requests for the fiscal year. This deadline is typically early
to mid October, since the Finance Department does not process checks for the prior fiscal year
beyond that point.
Each reimbursement request must include a summary of expenses by type. These summaries
should be broken down into salaries, benefits, supplies, contractual services, etc. If Indian River
County is reimbursing an agency for only a portion of an expense (e.g. salary of an employee), then
the method for this portion should be disclosed on the summary. The Office of Management &
Budget has summary forms available.
Indian River County will not reimburse certain types of expenditures. These expenditure types are
listed below.
a. Travel expenses for travel outside the County including but not limited to; mileage reimbursement,
hotel rooms, meals, meal allowances, per Diem, and tolls. Mileage reimbursement for local travel
(within Indian River County) is allowable.
b. Sick or Vacation payments for employees. Since agencies may have various sick and vacation
pay policies, these must be provided from other sources.
c. Any expenses not associated with the provision of the program for which the County has awarded
funding.
d. Any expense not outlined in the agency's funding application.
The County reserves the right to decline reimbursement for any expense as deemed necessary."
— EXHIBIT B -
EXHIBIT C
STANDARD TERMS FOR GRANT CONTRACT
1. Notices: Any notice, request, demand, consent, approval or other communication required or
permitted by this Contract shall be given or made in writing, by any of the following methods:
facsimile transmission; hand delivery to the other party; delivery by commercial overnight courier
service; or mailed by registered or certified mail (postage prepaid), return receipt requested at the
addresses of the parties shown below:
County: Brad E. Bernauer, Director
Indian River County Human Services
1800 2711 Street
Vero Beach, Florida 32960-3365
Recipient: ' jI
&W), TL-
2. Venue; Choice of Law: The validity, interpretation, construction, and effect of this Contract shall
be in accordance with and governed by the laws of the State of Florida, only. The location for
settlement of any and all claims, controversies, or disputes, arising out of or relating to any part of
this Contract, or any breach hereof, as well as any litigation between the parties, shall be Indian
River County, Florida for claims brought in state court, and the Southern District of Florida for
those claims justifiable in federal court.
3. Entirety of Agreement: This Contract incorporates and includes all prior and contemporaneous
negotiations, correspondence, conversations, agreements, and understandings applicable to the
matters contained herein and the parties agree that there are no commitments, agreements, or
understandings concerning the subject matter of this Contract that are not contained herein.
Accordingly, it is agreed that no deviation from the terms hereof shall be predicated upon any prior
representations or agreements, whether oral or written. It is further agreed that no modification,
amendment or alteration in the terms and conditions contained herein shall be effective unless
contained in a written document signed by both parties.
4. Severability: In the event any provision of this Contract is determined to be unenforceable or
invalid, such unenforceability or invalidity shall not affect the remaining provisions of this Contract,
and every other term and provision of this Contract shall be deemed valid and enforceable to the
extent permitted by law. To that extent, this Contract is deemed severable.
5. Captions and Interpretations: Captions in this Contract are included for convenience only and are
not to be considered in any construction or interpretation of this Contract or any of its provisions.
Unless the context indicates otherwise, words importing the singular number include the plural
number, and vice versa. Words of any gender include the correlative words of the other genders,
unless the sense indicates otherwise.
6. Independent Contractor. The Recipient is and shall be an independent contractor for all purposes
under this Contract. The Recipient is not an agent or employee of the County, and any and all
persons engaged in any of the services or activities funded in whole or in part performed pursuant
to this Contract shall at all times and in all places be subject to the Recipient's sole direction,
supervision, and control.
7. Assignment. This Contract may not be assigned by the Recipient without the prior written consent
of the County.
- EXHIBIT C -
ACORO- CERTIFICATE OF LIABILITY INSURANCE DATE:02/03/2016
PRODUCER: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE
DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
Chappell Insurance Agency, Inc. POLICIES BELOW.
25807-A Cox Road
Petersburg, VA 23803
(804) 733-2020
INSURED: INSURERS AFFORDING COVERAGE
INSURER A: Nationwide Mutual Insurance Company
Nations Baseball Tournament Association, Inc.
216 Statesville Blvd. INSURER B: Hartford Life and Accident Company
Salisbury, NC 28144 USA INSURER C:
rINSURER
:
TEAM NAME: Florida Dodgers Blue
COVERAGE'S
THE POLICIES OF INSURANCE-LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY
EFFECTIVE
INSR ADDL POLICY DATE POLICY EXPIRATION
LTR INSD TYPE OF INSURANCE NUMBER (MM/DD/YYY`) DATE(MM/DD/YYYY) LIMITS
A GENERAL LIABILITY EACH OCCURRENCE $2,000,000.00
DAMAGE TO RENTED
X X COMMERCIAL GENERAL LIABILITY RPG272375 01/01/2016 01/01/2017 PREMISES(EA OCC) $300,000.00
CLAIMS MADE MED EXP(Any one person) EXCLUDED
X OCCUR PERSONAL&ADV INJURY $2,000,000.00
AGGREGATE PER TEAM $5,000,000.00
PRODUCTS-COMP/OP AGG $2,000,000.00
PARTICIPANT LEGAL LIAR. $2,000,000.00
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $
BODILY INJURY
ALL OWNED AUTOS (Per Person) $
BODILY INJURY
SCHEDULED AUTOS (Per Accident) $
PROPERTY DAMAGE
HIRED AUTOS (Per Accident) $
NON-OWNED AUTOS
GARAGE LIABILITY AUTO PNLY-EA ACC $
ANY AUTO OTHER THAN EA ACC $B
AUTO ONLY AGG $
B SECONDARY PARTICIPANT ACCIDENT 36-SB-206418 1/1/2016 1/1/2017 AD&D $5,000.00
Excess Accident Medical Expense $100,000.00
Deductible $250.00
Benefit Period 52 Weeks
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The association shown as a certificateholder is an additional insured as respects the insureds negligence resulting from the insureds'participation in
events sanctioned and operated by the certificateholder.The additional insured status only applies during such times that the insured participates in
these events.
Coverage effective from: 02/03/2016 - 01/01/2017
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
Willis Sports Association, Inc. BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER VNLL
8755 97th Avenue ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE
HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL IMPOSE NO
Vero Beach, FL 32967 OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS
OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Certificate Number: Nations-BB-50-051855
i
ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE:10/17/2016
PRODUCER: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE
DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
Chappell Insurance Agency, Inc. POLICIES BELOW.
25807-A Cox Road
Petersburg, VA 23803
(804) 733-2020
INSURED: INSURERS AFFORDING COVERAGE
Nations Baseball Tournament Association, Inc. INSURER A: Nationwide Mutual Insurance Company
216 Statesville Blvd. INSURER B: Hartford Life and Accident Company
Salisbury, NC 28144 USA INSURER C:
INSURER D:
TEAM NAME: Florida Dodgers Blue INSURER E
COVERAGE'S
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY
EFFECTIVE
INSR ADDL POLICY DATE POLICY EXPIRATION
LTR INSD TYPE OF INSURANCE NUMBER (MM/DD/YYYY) DATE(MM/DD/YYYY) LIMITS
A GENERAL LIABILITY EACH OCCURRENCE $2,000,000.00
DAMAGE TO RENTED
X X COMMERCIAL GENERAL LIABILITY RPG272375 01/01/2016 01/01/2017 PREMISES(EA OCC) $300,000.00
CLAIMS MADE MED EXP(Any one person) EXCLUDED
X OCCUR PERSONAL&ADV INJURY $2,000,000.00
AGGREGATE PER TEAM $5.000,000.00
PRODUCTS-COMP/OP AGG $2,000,000.00
PARTICIPANT LEGAL LIAR. $2,000,000.00
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $
BODILY INJURY
ALL OWNED AUTOS (Per Person) $
BODILY INJURY
SCHEDULED AUTOS (Per Accident) $
PROPERTY DAMAGE
HIRED AUTOS (Per Accident) $
NON-OWNED AUTOS
GARAGE LIABILITY AUTO PNLY-EA ACC $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY AGG $
B SECONDARY PARTICIPANT ACCIDENT 36-SB-206418 1/1/2016 1/1/2017 AD&D $5,000.00
Excess Accident Medical Expense $100,000.00
Deductible $250.00
Benefit Period 52 Weeks
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The county shown as a certificateholder is an additional insured as respects the insureds negligence resulting from the insureds' usage of owned or
controlled premises of the certificateholder.The additional insured status only applies during such times that the insured is utilizing said premises.
Coverage effective from: 10/17/2016 - 01/01/2017
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
Indian River County Commissioners BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL
1801 27th Street ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE
HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL IMPOSE NO
Vero Beach, FL 32960 OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS
OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Certificate Number: Nations-BB-50-051855 iT'
ACORD- CERTIFICATE OF LIABILITY INSURANCE I
DATE.02/03/2016
PRODUCER: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE
DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
Chappell Insurance Agency, Inc. POLICIES BELOW.
25807-A Cox Road
Petersburg, VA 23803
(804) 733-2020
INSURED: INSURERS AFFORDING COVERAGE
Nations Baseball Tournament Association, Inc. INSURER A Nationwide Mutual Insurance Company
216 Statesville Blvd. INSURER B: Hartford Life and Accident Company
Salisbury, NC 28144 USA INSURER C:
INSURER D:
TEAM NAME: Florida Dodgers Blue INSURER E:
COVERAGE'S
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY,REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY
EFFECTIVE
INSR ADDL POLICY DATE POLICY EXPIRATION
LTR INSD TYPE OF INSURANCE NUMBER (MM/DD/YYYY) DATE(MM/DD/YYYY) LIMITS
A GENERAL LIABILITY EACH OCCURRENCE $2,000,000.00
DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY RPG272375 01/01/2016 01/01/2017 PREMISES(EA OCC) $300,000.00
CLAIMS MADE MED EXP(Any one person) EXCLUDED
X OCCUR PERSONAL&ADV INJURY $2,000,000.00
AGGREGATE PER TEAM $5,000,000.00
PRODUCTS-COMP/OP AGG $2,000,000.00
PARTICIPANT LEGAL LIAR. $2,000,000.00
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $
BODILY INJURY
ALL OWNED AUTOS (Per Person) $
BODILY INJURY
SCHEDULED AUTOS (Per Accident) $
PROPERTY DAMAGE
HIRED AUTOS (Per Accident) $
NON-OWNED AUTOS
GARAGE LIABILITY AUTO PNLY-EA ACC $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY AGG $
B SECONDARY PARTICIPANT ACCIDENT 36SB-206418 1/1/2016 1/1/2017 AD&D $5,000.00
Excess Accident Medical Expense $100,000.00
Deductible $250.00
Benefit Period 52 Weeks
DESCRIPTION OF OPERATIONS/LOCATIONSAtEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The team or league listed below as a Certificateholder is a named insured within the above referenced policies for any Nations activities,practices,
and any organized and sanctioned activities of any other amateur baseball association.
Coverage effective from: 01/26/2016 - 01101/2017
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
Florida Dodgers Blue BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL
8755 97th Avenue ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE
HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL IMPOSE NO
y Vero Beach, FL 32967 OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS
OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Certificate Number: Nations-1313-50-051855 ^"