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4.01 4.1 RACES&WALKS\Reindeer Rim at SUNY Adirondack-Ca nip Contort 5k—11-2-15 RESOLUTION AUTHORIZING ADIRONDACK RUNNERS' 5K REINDEER RUN TO BENEFIT CINDY'S CAMP COMFORT RESOLUTION NO. ,2015 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 5k Road Race/Walk to benefit Cindy's Camp Comfort as follows: SPONSOR Adirondack Runners EVENT Reindeer Run 5k Road Race/Walk DATE Sunday, December 6h, 2015 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 5k Road Race/Walk within the Town of Queensbury to benefit Cindy's Camp Comfort on Sunday, December 6t`, 2015, 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 2nd day of November, 2015, by the following vote: AYES NOES ABSENT: 4.1 RACES&WALKS\Reindeer Run at SUNY Adirondack-Camp Comfort 5k-11-2-15 RESOLUTION AUTHORIZING ADIRONDACK RUNNERS' 5K REINDEER RUN TO BENEFIT CINDY'S CAMP COMFORT RESOLUTION NO. ,2015 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 5k Road Race/Walk to benefit Cindy's Camp Comfort as follows: SPONSOR Adirondack Runners EVENT • Reindeer Run 5k Road Race/Walk DATE Sunday,December 6th,2015 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 5k Road Race/Walk within the Town of Queensbury to benefit Cindy's Camp Comfort on Sunday,December 6th, 2015,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 2nd day of November,2015,by the following vote: AYES : NOES : ABSENT: Town Of Queensbury Thomas R. VanNess Highway Superintendent Highway Home(518) 745-0929 Department 742 Bay Road—Queensbury,NY 12804 David Duell Phone: (518) 761-8211 Deputy Highway Fax: (518) 745-4466 Superintendent Home(518) 743-0938 TO: TOWN BOARD FROM: THOMAS VAN NESS DATE: OCTOBER 19, 2015 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 6th 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 • e roadw' roadways are not in my jurisdiction and may require additional..authorization. Thomas Van Ness Highway Superintendent Town of Queensbury N q MiIe 'RindeerRun j Sunday,December 6h,2015 jt, 9:00 a.m. sigimitigirimccArn SUNY Adirondack,Queensbury,NY REGISTRATION: Online at Active.com (ends midnight 12/3) Race day&Packet Pick-up 7:45- 8:45 at SUNY Adirondack, 640 Bay Rd , Queensbury ENTRANCE FEES: $23.00-Pre-Registration (Adirondack runners $20.00) $25.00-Race Day Registration T-SHIRTS: Souvenir Long sleeve T's first 125 Entrants—sizes not guaranteed INFORMATION: Race Directors: Lance Decker&Mary Meagher Email:reindeerrun(21adirondackrunners.org Website: www.adirondackrunners.org TO BENEFIT: Adirondack Runners and Cindy's Comfort Camp AWARDS: Over All: lst-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+ Reindeer Run Jr: Immediately following the 4 mile(est. 10:15 am) RoadlD' Kids Run $5.00—1 mile Children's fun run for ages 12 and under is wr,.I Ak Finish Medal to all finishers. (NO shirts) Reindeer Run2015 SHIRT SIZE LAST NAME FIRST SM M LG XL A IDREI 5 I I I I I I I I I I 1 1 1 1 1 I PH INE 1 1 1 1 1 1 I IIIIIII IIIIIIII I1 i1 111 CITY STATE/PROVINCE ZIP/POSTAL CODE IIIIIIIIIIIIIII I IIIIIIII EMAIL I I I I 1111111111111 1 1 1 111 1 1 1 1 1 1 Date of Birth AGE(Race Day) SEX(M/F) 5k Run 5k Walk Kids Run I I I II 1 1 I Kids Run donation suggested$5. 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. I also certify that I am 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 I may have against Road Runners,the above listed sponsors,SUNY Adirondack,Town of s � ` Queensbury,Warren County,Adirondack Runners,its officers and any race official for any injury,illness or property loss s` 5� r ENTRY which might occur to me while competing in,traveling to,or returning from the events on December 6,2015. SIGNATURE DATE • , Kr ADDI'fIOI�AL DONATION; $ t om SIGNATURE OF PARENT(if under 18) z, AMOUNT ENCLOSED? $ Make Checks Payable To:THE ADIRONDACK RUNNERS Mail Entries To: Reindeer Run2015 Adirondack Runners/Lance Decker, 1 Castle Road,South Glens Falls, NY 12803 - AC CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `� 10/13/2015 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). PRODUCER COME CT Margaret M. Mayers STAR Insurance — Fort Wayne Office PHONE (260)467-5689 FAX (260)467-5691 IA/G.No.Ext): um.No): 2130 East Dupont Road mx mEss:margaret.mayers @starfinancial.com INSURER(S)AFFORDING COVERAGE NAIC 0 Fort Wayne IN 46825 INSURERANational Casualty Company 11991 INSURED INSURER B Nationwide Life Insurance Co. 66869 Road Runners Club of America/2015 and Its INSURERC: Member Clubs INSURER D: 1501 Lee Highway, Suite 140 INSURERE: Arlington VA 22209 INSURER F: COVERAGES CERTIFICATE NUMBER:2015 - $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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD o p_ POLICY NUMBER JMM/DD/YYYYUMMIDD/YYYY)- LIMITS X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $ 1,000,000 A CLAIMS MADE X OCCUR DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ X Legal Liability to XR00000004913200 12/31/2014 12/31/2015 MED EXP(Any one person) $ 5,000 participant $1,000,000 12:01 AM 12:01 AM PERSONAL A ADV INJURY_ $ 1,000,000 GEN).AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Unlimited X POLICY JET LOC Abuse 6 Molestation PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: Aggregate $5,000,000 Abuse and Molestation $ 500,000 AUTOMOBILE UABIUTY (EeM COMBINED LIMIT $ 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED OR 00000004913200 12/31/2014 12/31/2015 BODILY INJURY(Per accident) $ AUTOS AUTOS ON-O PROPERTY DAMAGE X R NON-OWNED 12:01 AM 12:01 AM $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE _ $ DED RETENTION$ $ WORKERS COMPENSATION I PERTUTE I I W- AND EMPLOYERS'UABIUTY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $• OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ ti es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Excess Medical 6 Accident SPX0000026656100 12/31/2014 12/31/2015 Excess Medical $10,000 ($250 deductible/claim) 12:01 AM 12:01 AM ADA Specific Loss $2,500 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Addhional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED. DATE OF EVENT(S) : 12/06/15 4 Mile Reindeer Run & 1 Mile Jr. Reindeer Run INSURED 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 12/06/15 Town of Queensbury THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 742 Bay Rd. ACCORDANCE WITH THE POLICY PROVISIONS. Queensbury, NY 12804 AUTHORIZED REPRESENTATIVE John Lefever/LIO ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(?014011 w 4 Mile W indeer Ron 1 Course Map ... ) 1"H -f Start Student Q. Center t T. tC • Finish,. I' " "'"' "" -. i 4 i,i,7, ; r it ch...;...riThe,pram., i IL CP i t�C fanueudowt"'��99�� ■ 723LL� 64a,. : _boot i , . a tydero ,� 1 �. W . F - ` iR'4 - pT •• * t'" 0,61' t '' Os AV - .a.. }+ 5 r r IE c \ 7 yy� r t %NrlbAprinrri0t i f ?i l