Revised 05.28.2024
Youth Community Promotional Fund Policy Pxt Baseball
Youth Community Promotional Fund Check List:
Listed below is a check list of all required documents to submit an application for the Youth Community Promotional Funds. Please refer to this list as a guideline to ensure a complete application.
Document Check List
Document Details Desubmites
Current Non-Profit Status (501c) 1. Documentation showing current status. Initial: CO.
2. Latest 990 Form.
Breakdown of Services and Cost 1. Provide a detailed breakdown of what services are being provided.
2. Provide a detailed breakdown of
the cost to the Residents of
Barstow. Initial:
12,110,25
Two Year Plan 1. Provide a detailed explanation of
goals for the organization for the
next two years.
2. Provide a detailed explanation of CP.
operations for the next two years. Initial:
12,110,25
Donation Benefit Detailed explanation of how the
donation will benefit the
organization.
2. Detailed explanation of how this
do nation will cut down the cost to Ol.
the Residents of Barstow. Initial:
Include a copy of a certificate of liability 12, 12125
Certificate of Liability Insurance
insurance. Policy must be a $1,000,000
policy listing the City of Barstow as
additionaily insured Initial: CP.
Provide a detailed explanation of what 12,110,25
Background Checks Procedures
procedures are being used to conduct
backgrounds checks for members of the Initiat: CP.
organization.
12, 140,25
Evidence or Proof of Funds Show evidence and proof of funds demonstrating that the City is not the only
funding source, by presenting additional Initial: CP.
funding contributions.
Verified By:
CITY OF BARSTOW
BARSTOW
YOUTH COMMUNITY PROMOTIONAL FUND
IN-KIND DONATION APPLICATION
APPLICANT INFORMATION
Name of Applicant: Name of Organization:
Hope Surprenant PF Premier Baseball CA
Mailing Address: 420 Emerald St
City: Barstow State: CA Zip: 92311
Telephone: (xe0.883cc) 760-963-0542 Email: [email protected] 760-963-0542 [email protected]
Non-Profit: Yes E No O
501(cX3) #: 99-1078957 profit? Yes O
EVENT DESCRIPTION
Name of Event:
Practice / Game Facility Rental
Date(s) of Event: Location:
See attached Robert A. Sessions Memorial Sportspark
# of Participants:
WAIVER OF FEES DESCRIPTION
Park/Facility: Date(s):
Robert A. Sessions Memorial Sportspark See attached
Fees: Total:
$
Rental Fee: $. /hr x hrs
$
Lights: $. /hr x hrs
Total Fees Waived: § See attached
IN-KIND DONATION DESCRIPTION
Quantity Unit Cost Total
None
Total:
Youth Community Promotional Fund Application Page 1
•
1. Why is your organization requesting an in-kind donation? Receiving a donation from Measure Q will allow us to practice at a safe and clean facility while our team grows and develops. (See attached)
2. How will this in-kind donation benefit your organization and the youth population of Barstow?
These donations will help alleviate cost for practice / game fees while we provide a competitive team for hard working and motivated youth.
With this application, please attach the following:
1. A detailed description stating the total cost of the activity or event, all sources and amounts of funding, and all expenses;
2. A description of the organization's or group's purpose or objective;
3. A five-year operating plan outlining the goals and objectives for their organization;
4. A copy of the organization's non-profit determination.
By signing below, I declare that I have read the Youth Community Promotional Fund Policy and agree to all its terms and conditions. I agree that there is a formal process in place to conduct background checks on all employees and volunteers who work with persons under the age of 18 years and senior citizens. I understand that an incomplete application will not be accepted an that the organization or applicant will not be considered for funding. (If the application is being submitted on behalf of an organization or school, an additional signature is required.) Hopsmarenant HOpe Surprehant
Applicant Signature Applicant Name (printed)
12/16/2025
Organization President/Director Signature Date
(if applicable)
Youth Community Promotional Fund Application Page 2
Deparment of the Treasury Dese
i internal Revie Sovie June 20 2024
Tax Exempt and Goverment Entities Eingloyer I number
IRS PO Bos 2 B9-1078957
(in minati, O|| 45301 Pursan is contact
Name Customer Service
ID number: 31954
Telephone: 877-829,500
PXE PREMIER BASEBALD CA CORPORAGION Accenteg pered ending 11225 MIONEER RD November 30
APPLE VALLEY: CA 92108 Public charty atatus
fem 190/ 210 22 1300 м горочно
Yes
Effective data ef saample
April B, 2024
Contrihution deductibility
Yes
Addendum applies
No
DEN
26053576008064
Dear Applicant:
We're pleased to tell you we determined you're camps from federal income tax under Inseral Revenuc Code (IRC) Section 501(cx(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax doductible bogusts, devises, transfers or gifts under Section 2053. 2106, or 2522. This letter could help resolve questions on your excmpt status. Please keep it for your records.
Orgunizations sxempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations We determined youre a public charity under the IRC Section listed at the top of this letter.
If we indicated at the top of this letter that you're required to file Form 990 990-EZ/990-N, our records show you're required to file an annual information relum (Form 990 or Form 990-EZ) or clectronic notice (Form 990-N, the c-Postcard). If you don't file a required retum or notice for three consecutive years, your exempt status will be auromatically revoled.
IF we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral pan of this letter.
For important information about your responsibilities as a tax-exempt organization, go to www.in.gov/charities.
Enter "4221-PC" in the search bar to view Pubitication 4221-PC, Compliance Guide For 501(cX(3) Public Charities, which describes your recondkeeping reporting, and disclosure requirements.
Sincerely,
Ale a matter
Stephen A. Martin
Director, Exempi Organizations
Rulings and Agreements
Letter 947 (Rev 22020)
Celalog Number 151528)
PXF Premier Baseball CA Corporation
420 Emerald St.
Barstow, CA 923117
EIN: 99-1078956
Primary contact:
Hope Surprenant
(760) 963-0542
[email protected]
About our team:
We are a Barstow based travel baseball team called PXF Premier CA. Our team is highly competitive and relies solely on fundraising and donations. We are seeking support from the City of Barstow with facility rentals, Now that we are officially a non-profit organization, your support will be helping us grow and maintain a healthy life-style focused on sportsmanship and exercise.
Services to provide:
We are a team that provides baseball at a competitive level for the youth who practice hard to perform at the next level. We teach sportsmanship, positive attitudes and hard work ethics that the youth will take with them into adulthood.
FISCAL YEAR 2025-2026
Plan: Compete in competitive travel baseball tournaments as 12 and under then move to 13 and under while representing Barstow and the High Desert. Tournaments will be played throughout Southern California and nearby states. We will also travel to Cooperstown NY in the summer of 2026 to complete in the "Cooperstown All Star Village" tournament against teams all around the county. We hope to host our own tournament within the City of Barstow as well, bringing revenue to the City of Barstow through the snack bar, dining, gas, and transient occupancy taxes.
Field Rental Practices Fees:
Practices at Robert A. Sessions Memorial Sportspark with lights, twice a week for three hours:
$20 x 3 hours = $60 per practice; $120 per week; $6,240 per year FACILITY FEE TOTALS: $6,240.00
Tournament/Clinic 2x 500 $1000 Total Request $7240.00
FISCAL YEAR 2026-2027
Plan: Compete in competitive travel baseball tournaments as 13 and under then move to 14 and under while representing Barstow and the High Desert. Tournaments will be played FISCAL YEAR 2026-2027
Plan: Compete in competitive travel baseball tournaments as 13 and under then move to 14 and under while representing Barstow and the High Desert. Tournaments will be played throughout Southern California and nearby states. We hope to host our own tournament within the City of Barstow as well, bringing revenue to the City of Barstow through the snack bar, dining, gas, and transient occupancy taxes.
Field Rental Practices Fees:
Practices at Robert A. Sessions Memorial Sportspark with lights, twice a week for three hours:
$20 × 3 hours = $60 per practice; $120 per week; $6,240 per year Donation Benefit:
Receiving a donation from Measure Q will allow us to practice at a safe and clean facility while our team grows and develops. Not having to pay for practice fees will allow us to allocate other funds to travel and represent our community.
Background Check Procedures:
Each year, background checks are conducted on all coaches through the following baseball tournament sanctions: USSSA Baseball; Triple Crown, Perfect Game and NCS.
Funding Sources:
The team will do occasional fundraiser but the majority of tournament entry fees are paid out of pocket by the players. We will also receive a few donations from local businesses to assist with tournament entry fees.
DATE (MM/DD/YYYY)
ACORD' CERTIFICATE OF LIABILITY INSURANCE 01/27/2026
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements).
PRODUCER
CONTACT
Chappell Insurance Daryl Chappell
NAME:
4335 Cox Rd, Ste 4335 PHONE 804-733-2020 FAX
(ASC, No. Ext): (AC. No): 804-591-1603
Glen Allen, VA, 23060
E-MAIL
ADDRESS: [email protected]
INSURERS) AFFORDING COVERAGE NAIC #
INSURED
PXF Premier Baseball Ca INSURER A: SirlusPoint America Insurance Company 38776 420 Emerald St INSURER B: Axis Insurance Company 37273
Barstow, CA 92311 INSURER C:
INSURER D:
HSURER E
(1)Team Name(s): PXF Premier Baseball Ca
Age Group: 12U NSURER F:
INDICATED. NOTWITHSTANDING ANY REQUIREMEN TEA OR CONDITION OF A CONTRACT ON THERE AN EAT A SU (MM/DD/YYYY (AM/DD/MY)
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE [X] OCCUR DAMAGE TO RENTED $ 1,000,000
PREMISES (Ea occurrence)
x PLH02GL00001951 08/01/2025 08/01/2026 MED EXP (Any one person) PERSONAL & ADV INJURY $ 1,000,000
12:01 AM 12:01 AM
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY PROJECT LOC PRODUCTS COMP/OP AGG $ 2,000,000
OTHER: Participant Legal Liability $ 1,000,000
UMBRELLA LIAB OCCUR EACHOCCURRENCE
EXCESS LIAB CLAIMS MADE AGGREGATE :
DED I RETENTION
SRPO188416-00 08/01/2025 08/01/2026 EXCESS MEDICAL $ 100,000 PARTICIPANT ACCIDENT 12:01 AM 12:01 AM DEDUCTIBLE $ $500.00 DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (ACORD 101, Adional Remarks Schedule, may be aleched more space is required The certificate holder listed below is an additional insured with respect to the operations of the named insured. This insurance covers one (1) team only with maximum of 20 players per team for Baseball.
Coverage Effective From 03:41 PM on 01/27/2026 TO 08/01/2026
CERTIFICATE HOLDER CANCELLATION
City of Barstow
220 E Mountain View SI STE A
Barstow, CA 92311
AUTHORIZEDREPRESENTATVE
Pare Chappell
Certificate Number: NS-BB-807-001306
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD otice to Texas Insureds: The insurer for the purchasing group may not be covered by an insurance insolvency guarantee fund or simil echanism and the insurer of the group is not subject to all the insurance laws and regulations of this stat