3.1 3.1
RACES&WALKS\Tackett Cluropractic Rim for the Ages-5-18-15
RESOLUTION AUTHORIZING TACKETT CHIROPRACTIC'S
"RUN FOR THE AGES" 5K RUN/WALK
RESOLUTION NO. ,2015
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 13th, 2015
TIME: Approximately 9:30 a.m.
PLACE: Beginning and ending at Homer Avenue
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 18t`day of May, 2015, by the following vote:
AYES
NOES
ABSENT:
Town of Queensbury Thomas R. VanNess
✓ Highway Superintendent
y
Hi g hwa (518) 761-8212
Department David Dues
F
742 Bay Road—Queensbury, NY 12804 Deputy Highway Superintendent
Phone: (518) 761-8211 (518) 761-8210
Fax: (518) 745-4466
TO: TOWN BOARD
FROM: THOMAS VAN NESS
DATE: MAY 07, 2015
RE: TACKETT CHIROPRACTIC RUN FOR THE AGES
I have reviewed the request for the Run for the Ages 5K race to be held June 13th, 2015,
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.
Thomas Van Ness
Highway Superintendent
Town of Queensbury
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,Bridging generations _ __' e age
Sdtu r aye June 130 2C1
Proceeds benefit Big Brothers Big Sisters
and Glens Falls Senior Center
Registration: 8 to 9 a.m. Race Day at Tackett Chiropractic, 19 Homer Ave. Queensbury,NY
Entrance Fee: $20 Pre-Registration Online (Active.com till 6/11)or Mail-In ,
$25 Race Day Registration RUNNERS/WALKERS WELCOME!!! 9 fp
Information: Dr.Tackett and Dr. Sawyer,t(518)798-4322 �rUnn 'lit' 1 , pe
Awards: Top 3 Overall Males/Females&Top 3 males/females in 10 year age groups. 'Iii t
This is an Adirondack Runners Grand Prix Race
Thank vcu to our corporate sponsors:
Adirondack Regional
Ol: Cottrell Dental
d JEFFREY D. HOWARD
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r )IC Glen' al * .1,e,, - co
I1 s,,,,,i11„Lms t'.1= o 11.
lw
z7-7r":-----:=."--- FitzGerald Morris Baker Firth
Detach Here
Name M F
Street Address
City State Zip
Age on Race Day Email
Shirt size(Please circle) S M L XL
Checks can be made payable to: "Big Brothers Big Sisters" (will be shared 50/50 with the GF senior center)
Mail entry slip to: Tackett Chiropractic, 19 Homer Ave. Queensbury,NY 12804 or sign up on ACTIVE.COM
Waiver:In consideration of the acceptance of this entry,I waive all claims for myself and my heirs against the sponsors and cooperating and coordinating groups and
any individuals associated with this event and will hold them harmless for any and all injuries which may result from my participation.I hereby give my permission to
the media to use my name and photograph in the newspaper,broadcast and telecast of this event without limitation or obligation.I certify that I am physically fit for this
event and understand the risks involved by participating in this event.
Signature: Date:
r DATE:,4/24/2015
CERTIFICATE OF INSURANCE
CERTIFICATE NUMBER !20150420330293
:AGENCY:
ESIX 3 LLC I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
d/b/a Entertainment&Sports Insurance eXperts(ESIX) I CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES
d/b/a Entertainment and Sports Insurance Agency(California) i NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
2727 Paces Ferry Road,Building Two,Suite 1500 ; BELOW.
1 Atlanta,GA 30339 i '
678-324-3300(Telephone)
i 678-324-3303(Facsimile)
NAMED INSURED: INSURERS AFFORDING COVERAGE:
USA Track&Field,Inc. Tackett chiropractic . INSURER A: Philadelphia Indemnity Ins.Co.
132 East Washington Street,Suite 800 Indianapolis IN 46204 INSURER B: Philadelphia Indemnity Ins.Co.
!EVENT INFORMATION:
Run For The Ages(6/13/2015-6/14/2015)
POLICY/COVERAGE INFORMATION:
' THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY s:
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.
H--TYPE OF INSURANCE: !POLICY NUMBER(S): EFFECTIVE: ? EXPIRES: LIMITS:
A !GENERAL LIABILITY
1PHPK1241556 111/1/2014 ;11/1/2015__ --
X Occurrence ) (12:01 AM ;12:01 AM 1 GENERAL AGGREGATE(Applies Per Event) $3,000,000
---- ---- ---
X Participant Legal Liability 1 1 EACH OCCURRENCE ,
DAMAGE TO RENTED PREMISES(Each Occ.) $1,000,000
MEDICAL EXPENSE(Any one person) EXCLUDED
PERSONAL&ADV INJURY $1,000,000
1 PRODUCTS-COMP/OP AGG $3,000,000
B 'UMBRELLA/EXCESS LIABILITY
PHUB476653 111/1/2014 i 11/1/2015
X Occurrence AGGREGATE(Applies Per Event) $10,000 000
---– i i 12:01 AM ;12:01 AM – ——--. _�
S EACH OCCURRENCE $10,000,000
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.
k
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).
}
CERTIFICATE HOLDER: NOTICE OF CANCELLATION:
Town of Queensbury Should any of the above described policies be cancelled before the expiration date thereof, i
742 Bay Road notice will be delivered in accordance with the policy provisions.
= Queensbury NY 12804 AUTHORIZED REPRESENTATIVE:
• USA Track & Field, Inc.
Effective 11/1/2014 - 11/1/2015
Policy #PHPK1241556 PI-AM-002 (12/08)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - CERTIFICATE HOLDERS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SECTION II—WHO IS AN INSURED is amended to include any Certificate Holder, identified as an
additional insured, on a Certificate of Insurance issued by Philadelphia Indemnity Insurance Company or
our authorized representative, but only for liability arising out of the negligence of the named insured.
The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those
limits specified in a contract or agreement. These limits are inclusive of and not in addition to the limits of
insurance shown in the declarations.
Page 1 of 1
DATE:1 4/24/2015
CERTIFICATE OF INSURANCE
CERTIFICATE NUMBER:120150420330294
AGENCY:
ESIX 3 LLC i 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)
. ,. _.._ _ r. .. a _— _
NAMED INSURED: INSURERS AFFORDING COVERAGE:
j USA Track&Field,Inc. Tackett chiropractic
132 East Washington Street,Suite 800 INSURER A: Philadelphia Indemnity Ins.Co.
Indianapolis IN 46204 1 INSURER B: Philadelphia Indemnity Ins.Co.
3 EVENT INFORMATION:
Run For The Ages(6/13/2015-6/14/2015)
POLICY/COVERAGE INFORMATION:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY i
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: j LIMITS_
A GENERAL LIABILITY
X Occurrence PHPK1241556 '11/1/2014 `11/1/2015�� _ _____
i GENERAL AGGREGATE(Applies Per Event) $3,000 000
— -- ;12:01 AM ;12:01 AM # --— __
X Participant Legal Liability i ; EACH OCCURRENCE $1,000,000
I
I 1 DAMAGE TO RENTED PREMISES(Each Occ.) $1,000,000
MEDICAL EXPENSE(Any one person) EXCLUDED
i
PERSONAL&ADV INJURY $1,000,000
, ! PRODUCTS-COMP/OP AGG $3,000,000
B !UMBRELLAJEXCESS LIABILITY 1�
IPHUB476653 ;11!1/2014 1
X Occurrence 1/1/2015 , AGGREGATE(Applies Per Event) $10,000,000
�_..� ;12:01 AM 112:01 AM 1_
s EACH OCCURRENCE $10,000,000
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,µ
participant check-in and award ceremonies. i
1
•
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 I
24 04).
r
j CERTIFICATE HOLDER I NOTICE OF CANCELLATION
Warren County I Should any of the above described policies be cancelled before the expiration date thereof,
CIO Warren County Attorney's Office I notice will be delivered in accordance with the policy provisions.
1640 State Route 9 1 AUTHORIZED REPRESENTATIVE:
Lake George NY 12845 — :