PXF
Youth Community Promotional Fund Policy
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
Details Date Submitted
Document 1. Documentation showing current 317126-
Current Non-Profit Status (501c)
status
2. Latest 990 Form
1. Provide a detailed breakdown of 7 17 12ie
Breakdown of Services and Cost what services are being provided
2. Provide a detailed breakdown of
the cost to the Residents of
Barstow
1. Provide a detailed explanation of 7712
Two Year Plan goals for the organization for the
next two years
2. Provide a detailed explanation of
operations for the next two years
1. Detailed explanation of how the 717124
Donation Benefit donation will beneft organization.
2. Detailed explanation of how this
donation will cut down the cost to
the Residents of Barstow
Include a copy of a certificate of liability TT7126
Certificate of Liability Insurance insurance. Policy must be a $1,000,000 policy listing the City of Barstow as
additionally insured.
Provide a detailed explanation of what 117126
Background Checks Procedures procedures are being used to conduct backgrounds checks for individuals
Provide evidence and proof of funds 717126
Evidence or Proof of Funds showing that the City is not the sole source of funding.
PXF
CITY OF BARSTOW
BARSTOW
YOUTH COMMUNITY PROMOTIONAL FUND
IN-KIND DONATION APPLICATION
APPLICANT INFORMATION
Name of Applicant: Name of Organization:
Hope Surprenant PXF Premier Baseball CA
Mailing Address: 420 Emerald St
State: CA Zip: 92311
City: Barstow
Telephone: (20030) 760-963-0542 Email: [email protected] 760-963-0542 [email protected]
Non-Profit: Yes E No DI If No, are you planning on partnering with a non- profit? Yes D No O
501(c)(3) #: 99-1078957
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 Hope sweart Hope Surprenant
Applicant Signature Applicant Name (printed)
7.60260
Organization President/Director Signature Date
(if applicable)
Youth Community Promotional Fund Application Page 2
PXF Premier Baseball CA Corporation
420 Emerald St.
Barstow, CA 92311
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 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 x 3 hours = $60 per practice; $120 per week; $6,240 per year Field Rental Tournament Fees:
Two-day tournament hosted at Robert A. Sessions Memorial Sportspark three times a year:
$500 per day x 6 days = $3,000
FACILITY FEE TOTALS: $9,240.00
FISCAL YEAR 2027-2028
Plan: Compete in competitive travel baseball tournaments as 14 and under then move to 15 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 Field Rental Tournament Fees:
Two-day tournament hosted at Robert A. Sessions Memorial Sportspark three times a year:
$500 per day x 6 days = $3,000
FACILITY FEE TOTALS: $9,240.00
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.
Department of the Treasury Date
Internal Revenue Servicel June 26, 2024
Tax Exempt and Government Entities Employer ID number
IRS P.O. Box 2508 99-1078957
Cincinnati, OH 45201
Persan to comtact.
Name: Customer Service
ID number 31954
Telephone: 877-829-500
PXF PREMIER BASEBALL CA CORPORATION Accounting period ending 11225 PIONEER RD November 30
APPLE VALLEY. CA 92308 Public charity status:
170(bX(1)A)(vi)
Form 100 / 990-EZ / 990-N required
Yes
Ellective date of examption
Aptl 8, 2024
Centrihution deductibility!
Yes
Addendum applies!
No
DLN:
28053576008064
Dear Applicant:
We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records.
Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're 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 return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked.
If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter.
For important information about your responsibilities as a tax cxempt organization, go to www.ir.gov/charities.
Enter "4221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)3) Public Charities, which describes your record coping, reporting, and disclosure requirements.
Sincerely.
elin a matter
Stephen A. Martin
Director, Exempt Organizations
Rulings and Agreements
Letter 947 (Rev. 2-2020)
Catalog Number 35152P
DATE (MM/DDIYYYY)
ACORDi 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.
MPORTANT: 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 NAME: Daryl Chappell
4335 Cox Rd, Ste 4335 PHONE 804-733-2020 FAX
(A/C, No. Ext): (AC. No): 804-591-1603
Glen Allen, VA, 23060
E-MAIL
ADDRESS: [email protected]
INSURERS AFFORDING COVERAGE NAIC *
INSURED
INSURER A: SiriusPoint America Insurance Company 38776
PXF Premier Baseball Ca
420 Emerald St INSURER B. Axis Insurance Company 37273
Barstow, CA 92311 INSURER C:
INSURER D:
(1)Team Name(s): PXF Premier Baseball Ca INSURER E:
Age Group: 12U INSURER F:
COVERAGES CERTIFICATE NUMBER: NS-BB-807-001306 REVISION NUMBER:
THIS IS TO CERTIFY THAT 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
ADDLSUBR POLICY EFF POLICY EXP
INSR LIMITS
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER
COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 2,000,000 X
CLAIMS-MADE x OCCUR DAMAGE TO RENTED $ 1,000,000
PREMISES (Ea occurrence)
A x 08/01/2025 08/01/2026 MED EXP (Any one person)
PLH02GL00001951
PERSONAL & ADV INJURY $ 1,000,000
12:01 AM 12:01 AM
GENERAL AGGREGATE $ 5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
PRODUCTS COMPION AGG $ 2,000,000
POLICY PROJECT LOC
Participant Legal Liability $ 1,000,000
OTHER
UMBRELLA LIAB OCCUR EACHOCCURRENCE
EXCESS LIAB CLAIMS MADE AGGREGATE
DED _ 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. Actionel Remarka Schecute, may be attached if 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 220 E Mountain View St STE A BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
Barstow, CA 92311
AUTHORIZED REPRESENTATIVE
Pars 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 Notice to Texas Insureds: The insurer for the purchasing group may not be covered by an insurance insolvency guarantee fund or similar mechanism and the insurer of the group is not subject to all the insurance laws and regulations of this state