Volunteer Coverage

STATEMENT OF NON-COVERAGE FOR VOLUNTEERS

City of Sodaville hereby elects not to provide Workers; Compensation coverage for its volunteer workforce under the Workers' Compensation coverage agreement with City County Insurance Services.

City of Sodaville hereby acknowledges its understanding that no Workers' Compensation coverage exists for volunteer workers under the City County Insurance Services coverage agreement in the vent a claim is filed.

Date: November 15, 2012

Name of Entity: City of Sodaville

Name of authorized representative: Judy K. Smith

Title: City Administrator

Signature: Judy K. Smith