4.04 4.4
RACES&WALKSUeffAurelia 5k—12-21-15
RESOLUTION AUTHORIZING JEFF AURELIA
SCHOLARSHIP FUND 5K ROAD RACE
RESOLUTION NO. ,2015
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 Friday, January 14, 2016
TIME 10:00 a.m. — 11:30 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 proof of
insurance from the Jeff Aurelia Scholarship Fund and authorizes 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 Friday, January 1St, 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 21St day of November, 2015, by the following vote:
AYES
NOES
ABSENT:
• Town of Queensbury Thomas R. VanNess
Highway Highway Superintendent
Department
-742 Bay Road—Queensbury, NY
David Duell
12804 Deputy Highway
Phone: (518) 761-8211 Superintendent
Fax: (518) 745-4466
TO: TOWN BOARD
FROM: THOMAS VAN NESS
DATE: DECMEMBER 8, 2015
RE: JEFF AURELIA SCHOLARSHIP FUND I BIG A'S 5K
I have reviewed the request of the Jeff Aurelia Scholarship Fund to hold their 5K road
race on Friday,January 1st, 2016. Weather permitting, I hereby grant my approval for
the race to be held on the following roadways: Farr Lane, Fox Farm Road, Fox Hollow
Lane,'and Dartmore Drive. Any additional roadways are not within my jurisdiction and
may need further.approval -This approval is also contingent upon the receipt of a
certificate of insurance.
Sincerely,
Thomas R. Van Ness
Highway Superintendent
�' R.E
cn
DEC . 4 2015 The Jeff Aurelia Scholarship Fund
QUEENSSURY P
CLERK'S OFFICE , 7G Finch Way
` • `� Queensbury, New York 12804
Town Clerk Darleen Dougher,
On behalf of the Jeff Aurelia Scholarship Fund I am requesting permission
to conduct a 5k road race in the Town of Queensbury on January 1, 2016. The
race is named in memory of Jeff Aurelia, a former Glens Falls High School student
and Queensbury Middle School teacher. The race is called Big A's 5k and
scholarships have been created and they benefit several local graduating seniors.
The start time of the race is 10:OOam and a children's short course race will
follow, with activities ending at approximately 1p:30am. Lieutenant Lee Corsones
of the Warren County Sheriff's Department contacCted and he has no concerns as
this race is in it's 6th year. The run will begin and end at the Queensbury High
School Campus.
I have included a copy of the course map and insurance certificate along
with this written request. If your office or anyone has questions feel free to
contact me.
Respectfully:
Peter D. Casertino
518-361-7689
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DATE: 12/8/2015
CERTIFICATE OF INSURANCE
CERTIFICATE NUMBER: 20151125389595
AGENCY:
ESIX 3 LLC CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS MCERTIFIC CERTIFICATE DOES
d/b/a Entertainment&Sports Insurance a eXperts
Agency(ESIX) NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
d/b/a Entertainment and Sports Insurance Agency(California)
2727 Paces Ferry Road,Building Two,Suite 1500 BELOW.
Atlanta,GA 30339
678-324-3300(Telephone)
678-324-3303(Facsimile)
NAMED INSURED: 1 INSURERS AFFORDING COVERAGE:
USA Track&Field,Inc. Jeff Aurelia Scholarship Fund Assoc INSURER A: Philadelphia Indemnity Ins.Co.
132 East Washington Street,Suite 800 p
Indianapolis IN 46204 INSURER B: Philadelphia Indemnity Ins.Co.
EVENT INFORMATION:
6th Annual Big As 5k(1/1/2016-1/2/2016)
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 I
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 11/1/2015 11/1/2016
12:01 AM 12:01 AM GENERAL AGGREGATE(Applies Per Event) $3,000,000
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
X Occurrence PHUB517449 11/1!2015 11/1/2016 EACH OCCURRENCE $10,000,000
12:01 AM 12:01 AM — -- --
AGGREGATE(Applies Per Event) $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.
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:
y
Town of Queensbury Should any of the above described policies be cancelled before the expiration date thereof,
742 Bay Rd notice will be delivered in accordance with the policy provisions.
do Big A's 5k AUTHORIZED REPRESENTATIVE: --
Queensbury NY 12804 —_,