2.11 2.11
RACES&WALKS\Rotary 5k—1-22-18
RESOLUTION AUTHORIZING ROTARY 5K ROAD RACE/WALK
RESOLUTION NO. ,2018
INTRODUCED BY:
WHO MOVED ITS ADOPTION
SECONDED BY:
WHEREAS, the Glens Falls Rotary Foundation, Inc., has requested authorization from the
Queensbury Town Board to conduct its annual 5k road race/walk to benefit the Family Service
Association of Glens Falls, Inc., and SUNY Adirondack Summer Enrichment Scholarship Program as
follows:
SPONSOR Glens Falls Rotary Foundation, Inc.
EVENT 5k Road Race/Walk
DATE Saturday, April 21St, 2018
TIME Approximately 10:00 a.m.
PLACE Beginning and ending at SUNY Adirondack
(Copy of course attached);
NOW, THEREFORE, BE IT
RESOLVED, that the Queensbury Town Board hereby acknowledges receipt of proof of
insurance from the Glens Falls Rotary Foundation, Inc., to conduct a 5k Road Race/Walk within the
Town of Queensbury, and
BE IT FURTHER,
RESOLVED, that the Town Board hereby approves the Glens Falls Rotary to conduct a 5k
Road Race/Walk within the Town of Queensbury on Saturday, April 21", 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 22nd day of January, 2018,by the following vote:
AYES
NOES
ABSENT:
Town of Oiiee,sl>r vThomas R.VanNess
Highway /� Highway Superintendent
Department
7.1.4 Bay Road—Queensbury,NY 1480+ �Et , :.v
�'�< —�-' David Duell
Phone(5 s)76 I-S41 I C
Fax:(518 7.15-1 66 l Deputy l lighway Superintendent
intendent
TO: QUEENSBURY TOWN BOARD
FROM: THOMAS VAN NESS
DATE: January 11, 2018
RE: April 21, 2018 The Rotary 5K Race
I have reviewed the request of The Rotary 5K Race being held by Glens
Falls Rotary on Saturday April 21, 2018 at loam.
I hereby grant my approval for the race to be held on the following roadway
that is under my jurisdiction: Meadowbrook Road. All other roads that are not
under my jurisdiction my need further approval from the County.
Sincerely,
61Aluot iet'arg°444.
Thomas R. Van Ness
Highway Superintendent
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Saturday, April 21, 2018
Proceeds benefit Family Service Association mE:of Glens Falls,Inc., E SUNY Adirondack START TIo•O 0Am
Summer Enrichment Scholarship Program at SUNY Adirondack Student Center
Pro-registration:On or before April 12th,2018-mail to Glens Falls Rotary,PO Box 2702,Glens Falls NYt 12801 or register
online at wwwactive com Entry Fee':ADULT S25 AGE 12 ft UNDER S17 Race Day Registration:8AM to 915AM ADULT
$30 AGE 12&UNDER S22 Course:One small hill start,then flat and fast!T-shirts:Available for the first 300 entrants
[sizes not guaranteed]Awards:Male and Female overall,age groups 1st,2nd,3rd,Team Awards[see page 2]
z
NAME M F
STREET ADDRESS
CITY STATE ZIP
AGE ON RACE DAY PHONE SIL
SHIRT SIZE S M L XL 'Checks payable to:The Rotary Club of Glens Falls Foundation,Inc.
I know that runninglwalking a road race is a potentially hazardous activity 1 hereby attest I am medically able and properly trained to run(walk I agree fo abide by
any decision of a race official relative 10 my ability to safely Clete the runlwalk.t assume[email
risks associated with runnmg(walking in chis event including,but
not limited to fall contact with other participants,the effect of the weather including high or low terrrperatures.wind traffic and the conditions of the road ell
such
risks are being known and appreciated by me.For safety reasons headphones should not be used and strollers.roller skates.etc.are prohibited unless to
accommodate the disabled.Having read the waiver and knowing these facts and consideration of your accepting my entry.l for myself and anyone entitled to
act on my behalf.waive and release the Glens Falls Rotary Club.SUNY Adirondack,Town of Queensbury Warren County Washington County sponsors volunteers and
officials their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event Further I consent and give
permission to use my likeness antler voice in photographs,motion pictun records andlor other record of the Rotary 5K for any legitimate purpose Tho Glens
Falls Rotary Club reserves the right to cancel this event without the return of fees due to unforeseen circumstances,such as dangerous weather.
1 k I
SIGNATURE DATE 7�C
SIGNATURE OF PARENT OR GUARDIAN IF RUNNER IS UNDER 18 YEARS OLD USA
.
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SUNYADIRONDACK
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PRINT DATE:112/11/2017
CERTIFICATE OF INSURANCE
-
! CERTIFICATE NUMBER:;20171211576547
_
;AGENCY: .._.._. __.-_-_... ., = _ --:. ,.�,.�,�_ .:.-_:._.„
? Integro USA Inc. I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
d/b/a Integro Insurance Brokers I CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES
i 2727 Paces Ferry Road,Building Two,Suite 1500 I NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
I Atlanta,GA 30339 I BELOW.
1678-324-3300(Phone),678-324-3303(Fax) ;
iNAMEDINSURED: !INSURERS AFFORDINGCOVERAGE:T ~,w• _„.R�_ .�_-_y _�
; USA Track&Field,Inc. Glens Falls Rotary i INSURER A:Philadelphia Indemnity Ins.Co.NAIC#.18058
! 130 East Washington Street,Suite 800
F Indianapolis IN 46204 1 INSURER B:Philadelphia Indemnity Ins.Co.NAIC#.18058
EVENT INFORMATION:..x.x-. ..,-,_ �_r w ,- . 2
!Rotary 5K and Corporate Challenge(4/21/2018-4/22/2018)
I POLICY/COVERAGE INFORMATION: ._, ®d _�_. -. .=w�a.. ._ �._., _r., _.s ...... ,__..__..:.. ._
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 I TYPE OF INSURANCE: !POLICY NUMBER(S):I EFFECTIVE: j EXPIRES: 1 LIMITS:
A GENERAL LIABILITY
_
X Occurrence PHPK1721333 {11/1/2017 111/1/2018
GENERAL AGGREGATE(Applies Per Event) $3,000,000
i 12:01 AM 12:01 AM
X Participant Legal Liability EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED PREMISES(Each Occ.) $1,000,000
i1 MEDICAL EXPENSE(Any one person) EXCLUDED
i ' - PERSONAL&ADV INJURY $1,000,000
I ` t PRODUCTS-COMP/OP AGG $3,000,000
B I UMBRELLA/EXCESS LIABILITY
fPHUB602873 ;11/1/2017 r 11/1/2018
, X Occurrence i EACH OCCURRENCE
1 ;12:01 AM ,12:01 AM $10,000,000
I AGGREGATE(Applies Per Event) $10,000,000
(DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: —w _—---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 per the following endorsement:Additional Insured-Certificate Holders(Form PI-AM-002)
IThe General Liability policy is primary and non-contributory with respect to the negligence of the Named Insureds(Form CG 00 01)
jThe 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).
i I
Excess policy follows form of underlying General Liability.
CERTIFICATE HOLDER: M »� — R F N NOTICE OF CANCELLATION: _-------. ._ _
Town of Queensbury I Should any of the above described policies be cancelled before the expiration date thereof,
1 742 Bay Road ;notice will be delivered in accordance with the policy provisions.
Queensbury NY 12804 (AUTHORIZED REPRESENTATIVE:
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