4.22 4.22
RACES&WALKS\.TeffAurelia 5k—12-17-18
RESOLUTION AUTHORIZING JEFF AURELIA
SCHOLARSHIP FUND 5K ROAD RACE
RESOLUTION NO. ,2018
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 Monday, January 1st, 2019
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 approves the Jeff Aurelia Scholarship
Fund's 5k Road Race partially within the Town of Queensbury to benefit the Jeff Aurelia Scholarship
Fund on Monday, January 1', 2019 subject to the Town's receipt of proper proof of insurance
acceptable to the Town, 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 17ffi day of December, 2018,by the following vote:
AYES
NOES
ABSENT:
' David I�llell
Town n q f 0I�GL'C'l1Sl)'l(.1-Y�1 ar Supt`riiell lent
Highway
Department
i\larl; Ben-ware
71.2 Bay Road —Queensbury, NY 12801' D puti Iliyhwa%• Suh('rintcn(lc•nt
fholic•: (51 N) ;GI-62 1 1 '� e► 1 1.)1 5s 76 1-ti2 10
TO: TOWN BOARD
FROM: DAVID DUELL
DATE: DECEMBER 4, 2018
RE: Jeff Aurelia Scholarship Fund Big A's 5K Race
I have reviewed the request by the Peter D. Casertino, which will hold their Jeff Aurelia
Scholarship Fund Big A'; 5K Race event on Tuesday January 1, 2019 to benefit College
scholarships for Queensbury and Glens Falls High School Graduates.
Weather permitting, I hereby grant my approval for this event to be held on the following roadway
that is under my jurisdiction: Upper Sherman Ave from Western Ave to Hidden Hill Dr to Oak
Tree Cir, Maple Dr back to Hidden Hill Dr., Dixon Rd to Jerome Ave. The remaining roadways are
not in my jurisdiction and may require additional authorization.
David Duell
Highway Superintendent
Town of Queensbury
r
The Jeff Aurelia Scholarship Fund ®� 1
10 Northup Ln . `
Queensbury, NY 12804
Town of Queensbury Clerk,
The Jeff Aurelia Scholarship Fund is requesting to run the Big A's 5K race
in the Town of Queensbury and the City of Glens Falls on January 1, 2019 at
10:00am and end around 11:30am. The race was established several years ago
when Jeff Aurelia, a Queensbury High School teacher suddenly passed away on
New Years Eve. The proceeds from the race and other donations go to college
scholarships for Queensbury and Glens Falls High School Graduates.
The race begins and ends at the Glens Falls High School. Again this year we
have all the traffic intersections manned by race volunteers. I have been in contact
with Lt. Peter Defiori or the Warren County Sheriff's Department and he has no
concerns. A copy of the race map is included with this written request. A copy of
the insurance certificate is included also.
If there are any questions please do not hesitate to call.
Respectfull submitted
1 y
Peter D. Casertino
518-361-7689
rIr
CAIaM
Stevens
06,
n pays CD
v.�
CJD
Ashley P! 16 /�A�
Rim Pj
spruce Cs
u
AVM '�et�rana
"up aT a
CB
Dixon C
A.
r
A
4
�� tk 0&Tree Cir
I AT
F CERTIFICATE OF INSURANCE PRINT D E: 12/312018 I ----
CERTIFICATE NUMBER: 20181203670419
AGENCY:
Integro USA Inc THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND l
d/b/a Integro Insurance Brokers CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES
2727 Paces Ferry Road,Building Two,Suite 1500 1 NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
Atlanta,GA 30339 BELOW.
678-324-3300(Phone),678-324-3303(Fax) ;
I �
NAMED INSURED: }INSURERS AFFORDING COVERAGE: !
USA Track&Feld,Inc The Jeff Aurelia Scholarship Fund }INSURER A:Philadelphia Indemnity Ins.Co.NAIC#.18058
130 East Washington Street,Suite 800
Indianapolis IN 46204 INSURER B:Philadelphia Indemnity Ins.Co.NAIC#:18058 }
EVENT INFORMATION:
Big As 5K(111/2019-1/212019) '
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 RESPECTTO 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. I
INS ITYPE OF INSURANCE: I POLICY NUMBER(S):} EFFECTIVE: I EXPIRES: }LIMITS: 1
A GENERAL LIABILITY
PHPK1899025 i11/1/2018 11/1/2019 t
X Occurrence ; GENERAL AGGREGATE(Applies Per Event) $3,00
12:01 AM 12:01 AM 0,000
X Participant Legal Liability EACH OCCURRENCE $1,000.000 1
— I i
DAMAGE TO RENTED PREMISES(Each Occ.) $1,000,0oo
MEDICAL EXPENSE(Any one person) EXCLUDED
PERSONAL&ADV INJURY $1,000,000 t
1 } PRODUCTS-COMP/OP AGG S3,000,000
B U�MBRE SS LIABILITY IPHUB652176 !t 11/112018 11/1/2019
I
EACH OCCURRENCE $10.000,000
12:01 AM 12:01 AM
} AGGREGATE(Applies Per Event) $10.0oo,00o j
t
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL 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. j
I
Excess policy follows form of underlying General Liability. f
Evidence of coverage only
i
} I
E
}CERTIFICATE HOLDER: }NOTICE OF CANCELLATION:
The Jeff Aurelia Scholarship Fund }Should any of the above described policies be cancelled before the expiration date thereof,
19 Northup Drive i notice will be delivered in accordance with the policy provisions.
Queensbury NY 12804 ;AUTHORIZED REPRESENTATIVE:
C � t
PRINT DATE:f 12/6/2018
CERTIFICATE OF INSURANCE
CERTIFICATE NUMBER:�20181206670846
I
1 AGENCY:
I Integro USA Inc. — THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
i d/b/a Integro Insurance Brokers i CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES
1 2727 Paces Ferry Road,Building Two,Suite 1500 j NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
Atlanta,GA 30339 j BELOW.
678-324-3300(Phone),678-324-3303(Fax)
i
NAMED INSURED: I INSURERS AFFORDING COVERAGE:
USA Track&Field,Inc. The Jeff Aurelia Scholarship Fund INSURER A:Philadelphia Indemnity Ins.Co.NAIC#:18058
130 East Washington Street,Suite 800
Indianapolis IN 46204 INSURER B:Philadelphia Indemnity Ins.Co.NAIC#:16058
_ I
EVENT INFORMATION:
Big A's 5K(1/1/2019-1/2/2019) i
POLICY/COVERAGE INFORMATION:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY j
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 — j POLICY NUMBERS) EFFECTIVE I EXPIRES LIMITS:
A GENERAL LIABILITY
. •..- _•- --- ____
X Occurrence PHPK1899025 11/1/2018 11/1/2019 GENERAL AGGREGATE(Applies Per Event) $3,000,000
-----__.—___ 12:01 AM 12:01 AM -- — — - _
X Participant Legal Liability I EACH OCCURRENCE $1 000,000
DAMAGE TO RENTED PREMISES(Each Occ.) $1,000,000
MEDICAL EXPENSE(Any one person) EXCLUDED i
1 PERSONAL&ADV INJURY $1,000 000 j
i PRODUCTS-COMP/OP AGG $3,000 000
B (UMBRELLA/EXCESS LIABILITY
IPHUB652176 11/1/2018 ill/l/2019
X Occurrence { EACH OCCURRENCE $10,000 000
I( 12:01 AM i 12:01 AM
AGGREGATE(Applies Per Event) $10,000 000
DESCRIPTION OF OPERATIONS/LOCATIONSA/EHICLES/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.
i
The certificate holder is an additional insured per the following endorsement:Additional Insured-Certificate Holders(Form PI-AM-002) I
i
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
2404).
i
Excess policy follows form of underlying General Liability.
t
I
i
CERTIFICATE HOLDER: �— — — NOTICE OF CANCELLATION:—-- --
Town of Queensbury Should any of the above described policies be cancelled before the expiration date thereof, ,
72 Bay Road (notice will be delivered In accordance with the policy provisions
Queensbury NY 12804
AUTHORIZED REPRESENTATIVE:
(