2.5 2.5
RACES&WALKS\Tackett Chiropractic Run for the Ages-6-3-19
RESOLUTION AUTHORIZING TACKETT CHIROPRACTIC'S
"RUN FOR THE AGES" 5K RUN/WALK
RESOLUTION NO. ,2019
INTRODUCED BY:
WHO MOVED ITS ADOPTION
SECONDED BY:
WHEREAS, Tackett Chiropractic has requested permission to conduct its "Run for the
Ages" 5k Run/Walk to benefit Big Brothers Big Sisters of the Southern Adirondacks and the Glens
Falls Senior Center as follows:
SPONSOR: Tackett Chiropractic
EVENT: 5k Run/Walk
DATE: Saturday,June 15th, 2019
TIME: Approximately 9:00 a.m.
PLACE: Beginning and ending at 19 Homer Avenue, Queensbury
NOW,THEREFORE, BE IT
RESOLVED, that the Queensbury Town Board hereby acknowledges receipt of proper
proof of insurance from Tackett Chiropractic to conduct its "Run for the Ages" 5k Run/Walk
within the Town of Queensbury as set forth in the preambles of this Resolution, and
BE IT FURTHER,
RESOLVED, that the Town Board approves this event subject to approval by the Town
Highway Superintendent which approval may be revoked due to concern for road conditions at any
time up to the date and time of the event, and
BE IT FURTHER,
RESOLVED, that this event shall also be subject to the approval of the Warren County
Superintendent of Public Works.
Duly adopted this 3rd day of June, 2019, by the following vote:
AYES :
NOES :
ABSENT:
Of c'l{c'ensbu v
David Duell
pg-�g * ' �(� I l i�>li��at• Superintendent
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I.! Bay Road Oii ensl�ury, NY1�?s{)1• + ' ' I)ei utv 1liglmay Superintendcnl
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Phone (.'i1 ,i ;tit- `lt !
Fax: (5 I S) 7 h:5--1•-Idifi
TO: TOWN BOARD
FROM: David Duell
DATE: MAY 29, 2019
RE: TACKS I I CHIROPRAC I IC RUN FOR THE AGES
I have reviewed the request for the Run for the Ages 5K race to be held June 15th, 2019,
beginning at 9:30 AM. I hereby grant my approval for the event to be held on the following
roadways: Homer Avenue and Everts Avenue.
David Duell
Highway Superintendent
Town of Queensbury
Chirop ae
6_,
�'#, -. _ ___ - , :f'01 tit
Bri( Bing G('ilerations �*� w t i
Saturday,June 15, 2019
Proceeds benefit Big Brothers Big Sisters
and Glens Falls Senior Center
Registration: 8 to 9 a.m. Race Day at Tackett Chiropractic, 19 Homer Ave. Queensbury,NY
Entrance Fee: $20 Pre-Registration Online (Active.com till 6/13) or Mail-In 98
$25 Race Day Registration RUNNERS/WALKERS WELCOME f$ hi 0,74C 111�1
T-Shirts: Available to the first 150 entrants ®It, •
the „1 lj.�C
Information: Dr. Tackett (518) 798-4322 or go to Run4ages.com
Awards: Top 3 Overall Males/Females and Top 3 Males/Females in 10-year age groups
2 mile fun walk
TI1ank you to our corporate sponsors:
Queensbury NY
! ondacegoaallli
JEFFREY.:D HOWARD.a>
625 BAY BOAC The Mohican Motel
Lake George, NY
CottrellD '
THOROUGHBRED
�`t's uii —ADVISORS—
Detach Here
Name M F
Street Address
City State Zip
Age on Race Day Email
Shirt size (Please circle) S M L XL XXL
Checks can be made payable to: Big Brothers Big Sisters `SEE BACK FOR PRIZEStt►tt
Mail entry slip to: Tackett Chiropractic, 19 Homer Ave. Queensbury,NY 12804 or sign up on ACTIVE.COM
Waiver:In consideration of the acceptance of this entry,I waive all claims for myself and my heirs against the sponsors and cooperating and coordinating groups and
any individuals associated with this event and will hold them harmless for any and all injuries which may result from my participation.I hereby give my permission to
the media to use my name and photograph in the newspaper,broadcast and telecast of this event without limitation or obligation.I certify that I am physically fit for this
event and understand the risks involved by participating in this event.
Signature: Date:
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• PRINT DATE: 5/29/2019
CERTIFICATE OF INSURANCE
CERTIFICATE NUMBER: 20190501697184
AGENCY:
Integro USA Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
d/b/a Integro Insurance Brokers CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES
2727 Paces Ferry Road,Building Two,Suite 1500 NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
Atlanta,GA 30339 BELOW.
678-324-3300(Phone),678-324-3303(Fax)
NAMED INSURED: INSURERS AFFORDING COVERAGE:
USA Track&Field,Inc. Tackett chiropractic 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:
Run For The Ages(6/15/2019-6/16/2019)
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.
INS TYPE OF INSURANCE: POLICY NUMBER(S): EFFECTIVE: I EXPIRES: I 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 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 PHUB652176 11/1/2018 11/1/2019 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 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:
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.
queensbury NY 12804 AUTHORIZED REPRESENTATIVE: