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RACES&WALKS\.1effAurelia 5k—12-18-17
RESOLUTION AUTHORIZING JEFF AURELIA
SCHOLARSHIP FUND 5K ROAD RACE
RESOLUTION NO. ,2017
INTRODUCED BY:
WHO MOVED ITS ADOPTION
SECONDED BY:
WHEREAS, the Jeff Aurelia Scholarship Fund has requested authorization from the
Queensbury Town Board to conduct a 5k road race to benefit the Jeff Aurelia Scholarship Fund as
follows:
SPONSOR Jeff Aurelia Scholarship Fund
EVENT 5k Road Race
DATE Monday, January 1St, 2018
TIME 10:00 a.m. — 11:00 a.m. (approximately)
PLACE Beginning and ending at Queensbury High School
Campus (Letter and map delineating course are attached)
NOW, THEREFORE, BE IT
RESOLVED, that the Queensbury Town Board hereby acknowledges receipt of proper proof
of insurance from the Jeff Aurelia Scholarship Fund to conduct a 5k Road Race partially within the
Town of Queensbury to benefit the Jeff Aurelia Scholarship Fund on Monday, January 1St, 2018, 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 18ffi day of December, 2017,by the following vote:
AYES
NOES
ABSENT:
The Jeff Aurelia Scholarship Fund
10 Northup Ln .
Queensbury, NY 12804
Town of Queensbury Clerk,
The Jeff Aurelia Scholarship Fund is requesting to run the Big A's 5K race
in the Town of Queensbury on January 1, 2018 at 10:00am and end around
1 1:OOam. The race was established several years ago when Jeff Aurelia, a
Queensbury High School teacher suddenly passed away on New Years Eve. The
proceeds from the race and other donations go to college scholarships for
Queensbury and Glens Falls High School Graduates.
The race begins and ends at the Queensbury High School. Again this year
we have all the traffic intersections manned by race volunteers. A copy of the
race map is included with this written request. We are awaiting the insurance
certificate and as soon as it is received a copy will be forwarded to the Town of
Queensbury.
If there are any questions please do not hesitate to call.
Respectfully ubmitted:
tit Eq
��y RECEIVED
Peter D. Casertino Town of Queensbury
Y
DEC 0 5 2017
Highway Department
Town of Queensbury Thomas R.VanNess
Highway Highway Superintendent
Department •
742 Bay Road—Queensbury,NY 12804 ` �� °. David Duell
Phone:(518)761-8211 j Deputy Highway Superintendent
Fax: (518)745-4466
TO: QUEENSBURY TOWN BOARD
FROM: THOMAS VAN NESS
DATE: DECEMBER 6, 2017
RE: January 1, 2018 Big A's 5K Race
I have reviewed the request for the Jeff Aurelia Scholarship Big A's 5k Road Race being
held on January 1, 2018 from loam to 11am to benefit college scholarships for Queensbury
and Glens Falls High School Graduates.
Weather permitting, I hereby grant my approval for the race to be held on the following
roadways that are under my jurisdiction: Farr Lane, Fox Farm Road, Fox Hollow Road and
Dartmore Drive.
Sincerely,
f .
e
Thomas R. Van Ness
Highway Superintendent
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DEC 0 5 2017
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PRINT DATE:;12/4/2017
CERTIFICATE OF INSURANCE -
CERTIFICATE NUMBER:120171204573260 I
!AGENCY: 1
i._. __..__.___.___ ____
Integra USA Inc. ;THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
1 d/b/a Integro Insurance Brokers CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES
2727 Paces Ferry Road,Building Two,Suite 1500 NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
Atlanta,GA 30339 BELOW.
678-324-3300(Phone),678-324-3303(Fax)
NAMED INSURED: INSURERS AFFORDING COVERAGE:
! USA Track&Field,Inc. The Jeff Aurelia Scholarship Fund INSURER A:Philadelphia Indemnity Ins.Co.NAIC#:18058
130 East Washington Street,Suite 800
Indianapolis IN 46204 INSURER B:Philadelphia Indemnity Ins.Co.NAIC#:18058
EVENT INFORMATION:
Big A's 5K(1/1/2018-1/2/2018)
i POLICY/COVERAGE INFORMATION:
,THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING AN-Y-1
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.
I INS jTYPE OF INSURANCE: I POLICY NUMBER(S):E EFFECTIVE: , EXPIRES: (LIMITS
A `GENERAL LIABILITY
I X Occurrence PHPK1721333 11/1/2017 11!1/2018 i GENERAL AGGREGATE(Applies Per Event) $3,000,000
i— ._ 12:01 AM 12:01 AM
i X Participant Legal Liability EACH OCCURRENCE $1,000,000
E i j DAMAGE TO RENTED PREMISES(Each Occ.) $1,000,000
j --
MEDICAL EXPENSE(Any one person) EXCLUDED
j j I PERSONAL&ADV INJURY $1,000,000
I [ PRODUCTS-COMP/OP AGG $3,000,000
j B UMBRELLA/EXCESS LIABILITY
PHUB60287311/1/2017 111/1/2018
X Occurrence ! EACH OCCURRENCE $10,000,000
12:01 AM i12:01AM
` AGGREGATE(Applies Per Event) $10,000,000
1 DESCRIPTION OF OPERATIONS/
LOCATIONSNEHICLES/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.
Excess policy follows form of underlying General Liability. RECEIVED
Town of Queensbury
Evidence of coverage only DEC 0 5 2017
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CERTIFICATE HOLDER:
" OTIC' 0 ��'�
The Jeff Aurelia Scholarship Fund Should any of the above described policies be cancelled before the expiration date thereof,
19 Northup Drive notice will be delivered in accordance with the policy provisions.
Queensbury NY 12804 AUTHORIZED REPRESENTATIVE:
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