3.01 3.1
RACES&WALKS\Tackett Chiropractic Run for the Ages-6-16-16
RESOLUTION AUTHORIZING TACKETT CHIROPRACTIC'S
"RUN FOR THE AGES" 5K RUNIWALK
RESOLUTION NO. ,2016
INTRODUCED BY:
WHO MOVED ITS ADOPTION
SECONDED BY:
WHEREAS, Tackett Chiropractic has requested permission to conduct its "Run for the Ages"
5k Run/Walk to benefit Big Brothers Big Sisters of the Southern Adirondacks and the Glens Falls
Senior Center as follows:
SPONSOR: Tackett Chiropractic
EVENT: 5k Run/Walk
DATE: Saturday, June 18t'', 2016
TIME: Approximately 9:30 a.m.
PLACE: Beginning and ending at 19 Homer Avenue, Queensbury
NOW, THEREFORE, BE IT
RESOLVED, that the Queensbury Town Board hereby acknowledges receipt of proof of
insurance from Tackett Chiropractic to conduct its "Run for the Ages" 5k Run/Walk within the Town
of Queensbury as set forth in the preambles of this Resolution, and
BE IT FURTHER,
RESOLVED, that the Town Board approves this event subject to approval by the Town
Highway Superintendent which approval may be revoked due to concern for road conditions at any
time up to the date and time of the event, and
BE IT FURTHER,
RESOLVED, that this event shall also be subject to the approval of the Warren County
Superintendent of Public Works.
Duly adopted this 6ffi day of June, 2016,by the following vote:
AYES
NOES
ABSENT:
nwn of Queensbury
Thomas R. VanNess
Highway Superintendent
Highway (518) 761-8212
Department t i David Duell
74.2 ry>
Bay Road—Queensbu NY 1280.1
� Deputy Highway Superintendent
Phone: (518) 761-8211 (518) 761-8210
Fax: (518) 745-44.66
TO: TOWN BOARD
FROM: THOMAS VAN NESS
DATE: MAY 18, 2016
RE: TACKETT CHIROPRAL 11C RUN FOR THE AGES
I have reviewed the request for the Run for the Ages 5K race to be held June 18th, 2016,
beginning at 9:30 AM. Weather permitting, I hereby grant my approval for the event to be held
on the following roadways: Homer Avenue, Woodvale Avenue, and Everts Avenue.
P �
Thomas Van Ness
Highway Superintendent
Town of Queensbury
Pamela Hunsinger
From: drsawyer@tackettchiropractic.com
Sent: Wednesday, May 11, 2016 10:28 AM
To: Pamela Hunsinger
Subject: Run For the Ages
Attachments: Town of QBY INs.pdf; ROAD COURSE.zip
Pam-
Run for the ages is a 5K run/walk for all ages and athletic levels. The proceeds from the race benefit big borthers big
sisters of the southern adks and the glens falls senior center. The race is June 18th 2016 and it starts at 9:30am.
Please find the attached Certificate of insurance and map of the course.
Thank you and let me know if you need anything else.
Dr. Jeff Sawyer
Tackett Chiropractic Center
19 Homer Ave.
Queensbury, NY, 12804
(518)798-4322
www.tackettch i roDractic.corn
1
DATE: 5/11/2016
CERTIFICATE OF INSURANCE -
CERTIFICATE NUMBER: 20160422413151
AGENCY:
ESIX 3 LLC ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
d/b/a Entertainment&Sports Insurance eXperts(ESIX) CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES
d/b/a Entertainment and Sports Insurance Agency(California) NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
2727 Paces Ferry Road,Building Two,Suite 1500 BELOW.
Atlanta,GA 30339
678-324-3300(Telephone)
678-324-3303(Facsimile)
NAMED INSURED: INSURERS AFFORDING COVERAGE:
USA Track&Field,Inc. Tackett chiropractic INSURER A: Philadelphia Indemnity Ins.Co. NAIC#:
132 East Washington Street,Suite 800 18058
Indianapolis IN 46204
INSURER B: Philadelphia Indemnity Ins.Co. NAIC#:
18058
_.
EVENT INFORMATION:
Run For The Ages(6/18/2016-6/19/2016)
POLICY/COVERAGE INFORMATION:
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.
INS TYPE OF INSURANCE: POLICY NUMBER(S): EFFECTIVE: EXPIRES: LIMITS:
A GENERAL LIABILITY
X Occurrence PHPK1403938 1111/2015 11/1/2016 GENERAL AGGREGATE(Applies Per Event) $3,000,000
12:01 AM 12:01 AM
X Participant Legal Liability EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED PREMISES(Each Occ.) $1,000,000
MEDICAL EXPENSE(Any one person) EXCLUDED
PERSONAL&ADV INJURY $1,000,000
PRODUCTS-COMP/OP AGG $3,000,000
B UMBRELLA/EXCESS LIABILITY
PHUB517449 111/1/2015 11/1/2016
X Occurrence EACH OCCURRENCE $10,000,000
12:01 AM 12:01 AM
AGGREGATE(Applies Per Event) $10,000,000
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS:
Coverage applies to USA Track& Field sanctioned events and registered practices, including any directly related activities, such as event set-up and tear-down,
participant check-in and award ceremonies.
The certificate holder is an additional insured as required by written contract or written agreement, but only for liability arising out of the negligence of the Named
Insureds per the following endorsement:Additional Insured-Certificate Holders(Form PI-AM-002)
The General Liability policy is primary and non-contributory with respect to the negligence of the Named Insureds(Form CG 00 01).
The General Liability policy contains a blanket Waiver of Subrogation as required by contract per Waiver of Transfer of Rights of Recovery Against Others(Form CG
24 04).
Excess policy follows form of underlying General Liability.
CERTIFICATE HOLDER: NOTICE OF CANCELLATION:
Town of Queensbury Should any of the above described policies be cancelled before the expiration date thereof,
742 Bay Road notice will be delivered in accordance with the policy provisions.
queensbury NY 12804 AUTHORIZED REPRESENTATIVE:
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