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RACES&WALKS\Rotary 5k for 2019—12-3-18
RESOLUTION AUTHORIZING ROTARY 5K ROAD RACE/WALK
RESOLUTION NO. ,2018
INTRODUCED BY:
WHO MOVED ITS ADOPTION
SECONDED BY:
WHEREAS, the Rotary Club of Glens Falls Foundation, Inc.,has requested authorization from
the Queensbury Town Board to conduct its annual 5k road race/walk to benefit the Conkling Center
and Prospect Center as follows:
SPONSOR The Rotary Club of Glens Falls Foundation, Inc.
EVENT 5k Road Race/Walk
DATE Saturday, April 13ffi, 2019
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 Rotary Club of Glens Falls 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 Rotary Club of Glens Falls
Foundation, Inc., to conduct a 5k Road Race/Walk within the Town of Queensbury on Saturday, April
13d', 2019, 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 3rd day of December, 2018,by the following vote:
AYES
NOES
ABSENT:
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TO: TOWN BOARD
FROM: DAVIDOUELL
DATE: NOVEp\BER37, 2018
RE: GLENS FALLS R[DARY5K RUN
I have reviewed the request by the Glens Falls Rotary Club,` which will hold their 5k Run run/walk
event on Saturday, April 13, 2O1Sto benefit The Conk|ing Centar & Prospect Center.
Weather permitting, I hereby grant my approval for this event to be held on the following roadway
that is under my jurisdiction: Meadovvbnook Road. The remaining roadways are not in my
jurisdiction and may require additional authorization.
OavidDueU
Highway Superintendent
Town OfOueensbury
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Saturday, ril 13, 20
. , STTIME: 10:OOAM
at SUHY Adirondack Student Center
Pre-registration:On or before April 4th,2019-mail to Glens Falls Rotary,PO Box 27OZ Glens Falls NY 12801 or register
online at wwwactive.com Entry Fee':ADULT S26,AGE 12 h UNDER S17 Race Day Registration:8AM to 9:15AM ADULT SR AGE AGE 12 R 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 21
NAME M F
f
STREET ADDRESS
CITY STATE ZIP
AGE ON RACE DAY PHONE EMAIL
SHIRT SIZE S M L XL Checks payable to:The Rotary Club of Glens Falls Foundation,Inc.
I know that running/walking a road race is a potentially hazardous activity,1 hereby attest I am medically able and properly trained to run/walk I agree to abide by
any decision of a race official relative to my ability to safely complete the run/walk 1 assume all risks associated with running/walking in this event including,but
not limited to,fall,contact with other participants,the effect of the weather including high or low temperatures,wind,traffic and the conditions of the road all such
risks are being known and appreciated by me.For safety reasons,dogs are not allowed and headphones,roller skates and similar devices are prohibited Having
read this waiver and knowing these facts and in consideration of your accepting my entry,I,for myself and anyone entitled to act on my behati,waive and release
the Glens Falls Rotary Club,SUHY Adirondack,Town of 4ueensbury,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 and/or
voice in photographs,motion pictures,records and/or other record of the Rotary 5K for any legitimate purpose.The Glens Falls Rotary Club reserves the right to
cancel this event without the return of fees due to unforeseen circumstances.such as dangerous weather.
SIGNATURE DATE
SIGNATURE OF PARENT OR GUARDIAN IF RUNNER IS UNDER 18 YEARS OLD USA
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j PRINT DATE: 11/26/2018
i CERTIFICATE OF INSURANCE ,
{ ? CERTIFICATE NUMBER:i20181126669433
�AGEN'C`Y:
f Imegro USA Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
j d/b/a Integro Insurance Brokers i CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES
4 2727 Paces Ferry Road,Building Two,Suite 1500 i NOT AMEND,EXTEND OR ALTER_ THE COVERAGE AFFORDED BY THE POLICIES
I Atlanta,GA 30339 BELOW.
678-324-3300(Phone),678-324-3303(Fax)
NAMED INSURED: 'INSURERS AFFORDING COVERAGE:
USA Track&Feld,Inc. Glens Falls Rotary Club 130 East Washington Street,Suite 800 INSURER A Philadelphia Indemnity Ins.Co.NAIC#.18058
Indianapolis IN 46204 {INSURER B:Philadelphia Indemnity Ins.Co.NAIC M 18058
F
EVENT INFORMATION:
Rotary SK&Corporate Challenge(4/13/2019-4/14/2019)
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
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_
{INSI TYPE OF INSURANCE: POLICY NUMBER(S):{ EFFECTIVE: I EXPIRES: i LIMITS:
A I GENERAL LIABILITY
X Occurrence PH j 11/1i2018 11/1/2019 GENERAL AGGREGATE(Applies Per Event) $3,000,000
112:01 AM 12:01 AM
X Participant Legal Liability { EACH OCCURRENCE $1,000,000
III { DAMAGE TO RENTED PREMISES(Each Occ.) $1,000.000
{ ( MEDICAL EXPENSE(Any one person) EXCLUDED
I PERSONAL&ADV INJURY $1,000,000
j { PRODUCTS-COMP/OP AGG $3,000,000
B UMBRELLA/EXCESS LIABILITY I
X Occurrence PHUB652176 (11/1/2018 I l l/1/2019 EACH OCCURRENCE $10,000,000
l 1201 AM 12:01 AM
# AGGREGATE(Applies Per Event) $10,000,000
I
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 per the following endorsement Additional Insured-Certificate Holders(Form PI-AM-002)
f
The General Liability policy is primary and non-contributory with respect to the negligence of the Named Insureds(Form CG 00 01)
I
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
2404).
j Excess policy follows form of underlying General Liability.
CERTIFICATE HOLDER: !NOTICE OF CANCELLATION-
Town of Queensbury l Should any of the above described policies be cancelled before the expiration date thereof,
1 742 Bay Rd E notice will be delivered in accordance with the policy provisions. 1
Queensbury NY 12804 AUTHORIZED REPRESENTATIVE:
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