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4.12 4.12 RACES&WALKS\Reindeer Run at SUNY Adirondack-Camp Comfort—11-7-16 RESOLUTION AUTHORIZING ADIRONDACK RUNNERS' 4 MILE REINDEER RUN TO BENEFIT CINDY'S CAMP COMFORT RESOLUTION NO. ,2016 INTRODUCED BY: WHO MOVED ITS ADOPTION SECONDED BY: WHEREAS, the Adirondack Runners has requested authorization from the Queensbury Town Board to conduct its annual Reindeer Run 4 Mile Road Race/Walk to benefit Cindy's Camp Comfort as follows: SPONSOR Adirondack Runners EVENT Reindeer Run 4 Mile Road Race/Walk DATE Sunday, December 4ffi, 2016 TIME 9:00 a.m. PLACE Beginning on Haviland Road and ending at SUNY Adirondack (Email and Map delineating course are attached); NOW, THEREFORE, BE IT RESOLVED, that the Queensbury Town Board hereby acknowledges receipt of proof of insurance from the Adirondack Runners Club and therefore approves and authorizes the Reindeer Run 4 Mile Road Race/Walk within the Town of Queensbury to benefit Cindy's Camp Comfort on Sunday, December 4t', 2016, and BE IT FURTHER, RESOLVED, that the Town Board hereby approves this event subject to the Town Highway Superintendent's approval of the race, which approval may be revoked due to concern for road conditions at any time up to the date and time of the event. Duly adopted this 7ffi day of November, 2016,by the following vote: AYES NOES ABSENT: Town of Queensbury Thomas R. VanNess Highway Superintendent eittAv Highway , '=^ ` (518) 761-8212 Department P • David Duell 744 Bay Road—Queensbury,NY 12804• - �;� ' Phone: (518) 761-8211 t<7' - Deputy Highway-.i' Fax: (518) 745-4466 f Superintendent (518) 761-8210 TO: TOWN BOARD FROM: THOMAS VAN NESS DATE: OCTOBER 31, 2016 RE: ADIRONDACK RUNNERS'4 MILE REINDEER RUN I have reviewed the request by the Adirondack Runners, which will hold their 4 Mile Reindeer Run run/walk event on Sunday, December 4th to benefit Cindy's Comfort Camp and Adirondack Runners. Weather permitting, I hereby grant my approval for this event to be held on the following roadways that are under my jurisdiction: Meadowbrook Road and Cronin Road. The remaining roadways are not in my jurisdiction and may require additional authorization. — C/ft Thomas Van Ness Highway Superintendent Town of Queensbury y "° q M i Ie-Rei ndeer Mein 1- i , ilr 1 - .-- - Jr. Reindeer Run 4, Sunday,December 4th,2016 � {V� 9:00 a.m. carn SUNY Adirondack,640 Bay Road,Queensbury,NY atimere REGISTRATION: Online at Active.com (ends 12:00pm 12/3) Race Day Registration & Packet Pick-up 7:45- 8:45 in Student Center ENTRANCE FEES: $22.00-Pre-Registration (Adirondack runners $18.00) $25.00-Race Day Registration T-SHIRTS: Souvenir Long sleeve T's first 150 Entrants—sizes not guaranteed INFORMATION: Race Directors: Lance Decker& Paul Stevens Email: reindeerrun(a,adirondackrunners.org We TO BENEFIT: Adirondack Runners nd Cindy's site: ds.org Comfort Camp AWARDS: Over All: 1st-3rd Male&Female AGE GROUPS: Male & Female as follows: 14 and under, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45- 49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-99 Reindeer Run Jr: Immediately following the 4 mile (est. 10:15 am) Kids Run $5.00— 1 mile Children's fun run for ages 12 and under • RoadAa. -- -- Finish Medal to all finishers. (NO shirts) -------------------- -------------- Reindeer Run2016 - ----------_—_ LAST NAME SHIRT SIZE I I I I I FI IST I I I I I I I I I I ISMI M ILG 11 ADDRESS II I I I I I I 111111111 I PH INET I I I I I I I I I CITY STATE/PROVINCE ZIP/POSTAL CODE IIIII1111111111II I IIIIII1111 EMAIL II IIII II 1111111111111111 IIIIIIII Date of Birth AGE(Race Day) SEX(M/F) 4 Mile Run Kids Run I I I I I I I I I 1 11 I Kids Run donation suggested$5. I In consideration of the opportunity to participate in this race I hereby release and forever discharge the sponsoring agents,their members&any other persons staffing this race in any claims,costs&demands as a result of participating in this event l also certify that lam in good physical shape for the event. Further,I here by grant full permission to any and all the foregoing to use any photographs,video tapes,motion pictures,recordings,or any other record of this event for any legitimate purposes. I realize there are dangers associated with running,including but limited to street conditions,weather and traffic I hereby for myself,heirs,executors,or assigns waive&release any and all claims 1 may have against Road Runners,the sponsors,SUNY Adirondack,Town of Queensbury, Warren County,Adirondack Runners,as officers and any ace official for any injury,illness or property loss which might occur to me while competing in,traveling to,or returning from the events on December,4th 2016. ENTRY $ SIGNATURE DATE SIGNATURE OF PARENT(if under 18) ADDITIONAL DONATION $ Make Checks Payable To:THE ADIRONDACK RUNNERS AMOUNT ENCLOSED $ Mail Entries To: Adirondack Runners/Lance Decker, 1 Castle Road,South Glens Falls, NY 12803 Reindeer Run2016 "----•-•\re----\'\..1) V.",".',.:to,4 Sr r k '04 " y r ' r•'�1y �� Tp [( N' NI /� ,J� v'Wavntl}a • .. ''h 1 '""� it . .os i;4 P � �✓ f l: ,_. " • �TJt to `� h' C { .. .. enol { • 7+3 i, I, �,� 4t. . • iv e -"J! 5 :'ulNwgp :W % E C r) • 011111. ''''':' : . '''. ... ; C4 No I ^,-.5.1' IS , -1 tax, g may■' I Cd Y E `/ p� " 'delft • ;. ' ` ,1 r'� ` s�1 �r1'I �J } x'il 115. ,1 t Y iil� L I /}:' I,r r,A, o- .'11 t ` 1•{ \' i1 l Illy �1t +l4od i' �rlp,,, "r^"_"ter. T . .•'. 1 4 � e I " • ,���' l f 1{'11 u ,l, r• ',',`E 111`I'f ���if�� 1��'' , .i1.11.1! ..: �1'tl y1M/y,"'� rti�,��=J 1 1t,' 4..1,3 1, r l 1141u 'K rF �1,,�rryy-'qq, '4r •7'. LA <v 1 Ia ly#itr '�,FF 'II �� GI i<II '�•'1''°,A CSY`t11 jlmlzo}'� <4 + ; ' �ti••'�'1y1 rrl'"" xG''; I1,, h+��'viF�w��i t^wrI 1 yr!{Hh� • I4) t <I `�▪ ' s+ r 1 +� 1 '.1 tir1.'( �'�.',r,� I e,'Py A Q�{{niR ht I�� >^�ti t, r• • ,t'YI`�y ,,I r<lilk hJ,, �d 14' rY*A: '.µ71'u F..S ,. l r,H i t r e p l7F + ', , t 1 I e114 ,t5} 'r / �vtf a"'k rI r � ' i ,er (� r" tv h 'r; ' , 1 ti 1 :"; • • ACORO CERTIFICATE OF LIABILITY INSURANCE DATE IMM DDIYYYY) 10/27/2016 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 INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must 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 endorsement(s). PRODUCERNC:MEACT MdrgBret M. Mayers STAR Insurance - Fort Wayne Office fnrc°.No.Exp: (260)467-5669 WC Ne),(260)467-5691 2130 East Dupont Road DDRlEss:margaret.mayers@starfinancial.com INSURER(S)AFFORDING COVERAGE NAIC tl Fort Wayne IN 46825 INSURER A National Casualty Company 11991 INSURED INSURER Nationwide Life Insurance Co. 66869 _ Road Runners Club of America/2016 and Its INSURER C: _ Member Clubs INSURERD: 1501 Lee Highway, Suite 140 INSURERE: Arlington VA 22209 INSURERF: COVERAGES CERTIFICATE NUMBER:2016 $1M A.I. 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. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP WM/ LIMITSLTR INS] VD POLICY NUMBER (MDDIYYYY) IMMIDD/YYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 5 500,000 A CLAIMS-MADE as OCCUR PREMISES X Legal Liability to KR00000005887400 12/31/2015 12/31/2016 MED EXP(Any one person) S 5,000 Participant $1,000,000 12:01 AM 12:01 AM PERSONAL B AOV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S Unlimited X POLICY f EJECT LOC Abuse & Molestation PRODUCTS-COMP/OP AGG S 1,000,000 OTHER Aggregate $5,000,000 Abuse&Molestation $ 500,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea nutle t° A ANY AUTO BODILY INJURY(Per person) S AL OWNED SCHEDULED XR000000058E/7400 12/31/2015 12/31/2016 BODILY INJURY(Per accident) S AUTOS AUTOS X HIRED AUTOS X NON-OWNED 12:01 AM 12:01 AM PROPERTY))RTY AGE AUTOS (Per accident) S UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E L DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S B Excess Medical & Accident SPX0000027201500 12/31/2015 12/31/2016 Excess Medical $10,000 ($250 Deductible/Claim) 12:01 AM 12:01 AM AD&Specific Loss $2,500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 1D1,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED AS RESPECTS TO THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED. DATE OF EVENT(S) : 12/04/16 4 Mile Reindeer Run-4 Mile Road Race & Jr. Reindeer Run-1 Mile Rids Run INSURED RRCA CLUB/EVENT MEMBER: The Adirondack Runners, Att'n: William Venner, PO Box 2245, Glens Falls, NY 12801 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 12/04/16 Town of Queensbury THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 742 Bay Road ACCORDANCE WITH THE POLICY PROVISIONS. Queensbury, NY 12804 AUTHORIZED REPRESENTATIVE Terry Diller/MMA "'_05 -q R - 3 PG U ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 OD14nn