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4.11 V 4.11 RACES&WALKS\Cerebral Palsy 5K—Glens Falls Elks—BPOE#81 -9-23-19 RESOLUTION AUTHORIZING GLENS FALLS ELKS LODGE (BPOE #81) TO CONDUCT RACE FOR CEREBRAL PALSY 5K RESOLUTION NO.: ,2019 INTRODUCED BY: WHO MOVED ITS ADOPTION SECONDED BY: WHEREAS, the Glens Falls Elks Lodge (BPOE #81) has requested permission to conduct its Race for Cerebral Palsy 5k within the Town of Queensbury as follows: SPONSOR: Glens Falls Elks Lodge(BPOE#81) EVENT: Cerebral Palsy 5k Race (Information describing the event presented at this meeting) DATE/TIME: Saturday, October 19th, 2019 - Approximately 9:00 a.m. PLACE: Glens Falls Elks Lodge(BPOE#81), 32 Cronin Road, Queensbury and WHEREAS, the applicant shall be responsible to obtain any other municipal agency's approval(s) as may be necessary for their event, NOW, THEREFORE, BE IT RESOLVED, that the Queensbury Town Board hereby acknowledges receipt of proof of proper insurance from the Glens Falls Elks Lodge (BPOE #81) to conduct its Race for Cerebral Palsy 5k to be held on Saturday, October 19`h, 2019 within the Town of Queensbury, 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 as well as other municipal agency's approval(s) as may be required. Duly adopted this 23`d day of September, 2019, by the following vote: AYES : NOES : ABSENT: Town of Queensbuiy Highway David Duell Department Highway Superintendent 742 Bay Road—Queensbury, NY 12804 _ lbas Mark Benware Phone: (518) 761-8211 Deputy Highway Superintendent Fax: (518) 745-4466 / TO: QUEENSBURY TOWN BOARD FROM: David Duell DATE: September 17, 2019 RE: October 19, 2019"Race for Cerebral Palsy"5K I have reviewed the request of The Race for cerebral Palsy 5K being held by Glens Falls Elks Lodge #81 on Saturday October 19, 2018 at 9am. I hereby grant my approval for the race to be held on the following roadway that is under my jurisdiction: Cronin Road, Meadowbrook Road and Everts Ave.. All other roads that are not under my jurisdiction my need further approval from the County. Sincerely, ba•teb4; David Duell Highway Superintendent Y ,,a,�'�� fir• �`s�`rv#� �p�'z _ -. x .F ;3-rh' - �" r ice' '1► tiO u. �t s r N * - , &5 1� -, rw x4„ii k i 3 -a, ,-r7: Yx z.., ,: ».. _ .0-e 2 e -- .s: ,c.. k"• . i x. d. t`&' ,,, ^'t ; iv�� 1. ' fir wens Falls •-� 19, � r. ,.n.r s �$. x-ii ram`" _ v, ! - � � Elks Lode � - <o ^a x ',..,-.4-2": #81 per i. _. ,-_ '- ...s....,. y` A4 Elks have been providing financial assistance to Cerebral Palsy since 1964 through our Major Project efforts specifically funding Cerebral Palsy's "Home Services Program ". This program provides salaries for the Home Services Program Directors and a van to provide transportation to appointments and provide in home services for adults and children with Cerebral Palsy and their families, including evaluation, advocacy, counseling, program services and program development. JOIN US SAT , OCT. 19 Registration 8am Race begins 9am Register and view map at Activecom OR Pick up registration or sponsorship forms at Elks Lodge 32 Cronin Rd Qby For info: in .a ars yah*•omco . . . V,: . . F . . ,k4tv. . -:)(.1-V.:41a- ; ''''l z. ' •:;—.‹.-.4-t e: s'-'" :-.• ' - -'- --. - i 44,,-,.z. --1 ,--i-,---,:i 1 ift, , ' _ r s o ?' 4 't t'«� \. .. • r .... -,... ..,...-- ti IF. / ,- - '`-..-. I 1 1 , f /,,, 11// I I 1 ...,_... - --- e,,,,t, •-•.6,....-....,.*/ i !r 1 ,, N.,...<:.\ .,....\...\\ -: ,,... I I i '. •-.. • I .•; l 1 ,. •-.,,\-s;'-.-----.4.F-:.:t-:.-.-03-,-•---. . 1 I i I I . V•";',.::-•!f;'...;'.':6"-z--.,.,•-:',•--;.-7--- -T.:;'1:--.-., .''. li •-,-\-i.',:•,..r.,:c;'2_•.".i.-,:,::-.7::_t.,I., r ..'''' i I/1 I •, .: ,1 - I ) ,,,---,n I ,I --.-- - --::----- ' \ I I i I 1 ' - i ill I . . . . . ,a -- . 1;‘I-61 . , . . -.. ,.. ,•-.. .,..•.'r.. .' :::... .S.'::'Z''...-.... : :_..,,-;-:..;-1 'I .-- -, -.'''...'-it'g ,. • „ _-, .'e.:, , 1 4 -...-..-:--.„'-.,_:.:..,:,:!.?:.„,,,..:.,1.....'..•,.,.-.,.,..'.:,_._:_;.. '..„..,.. ,,,-.---.........- ---.-.-'•,1 (1 I-i, ..'L,1' 1 10 i1% ...,..,..._ __ ... RECEIVED • Town of Queensbury JUL 1 5 2019 Highway Department ACOA�?L7® CERTIFICATE OF LIABILITY INSURANCE °05iii/20 sue' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: HCC Specialty PHONE FAX (A A/MAIio.Extl: (A/C,No): 401 Edgewater Place,Suite 400 • ADDRESS: PRODUCER Wakefield,MA 01880 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: U.S.Specialty Insurance Company 29599 BPOE#81 5K Run INSURERS: United States Fire Insurance Company 21113 32 Cronin Rd. INSURER C: Queensbury, NY 12804 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT,•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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL UABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X SEL333132540 05/22/2019 10/22/2019 DAMAGE TO RENTED 300,000 PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 X Host Liquor PERSONAL&ADV INJURY $ 1,000,000 B x Medical Expense US1107641 05/22/2019 10/22/2019 GENERAL AGGREGATE $ 2,000,000 GEM%AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY n JE r- fl LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ �1 tt r�.,,� $ NON-OWNED AUTOS RECEIVED ( _EI��E GTOM..4Fd $ • UMBRELLA UAB — OCCUR �F L+L�{,J4.U!}/ EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE JUL 2�yJ» ' AGGREGATE $ _ DEDUCTIBLE I ( $ RETENTION $ $ WORKERS ION COMPENSAT wabIAlU ohH AND EMPLOYERS'LIABILITYION TORY LIMITS -ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y`" Highway Department E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ II yes,descn'be under DESCRIPTION OF OPERATIONS below El.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) The Certificate Holder is added as Additional Insured with respects to our Insureds operations only. This insurance is primary and non-contributory as required by written contract. This coverage is with respect to BPOE#81 5K Run event to be held 10/20/2019-10/21/2019 at Elks Club Queensbury NY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Town of Queensbury BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEUVERED 842 Bay Rd. IN ACCORDANCE WITH THE POLICY PROVISIONS. Queensbury, NY 12804 AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved.