3.01 3.1
RACES&WALKS\Rotary 5k for 2020—1 l-l 8-19
RESOLUTION AUTHORIZING ROTARY 5K ROAD RACE/WALK
RESOLUTION NO. ,2019
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 Big Brothers
Big Sisters and the World Awareness Children's Museum as follows:
SPONSOR : The Rotary Club of Glens Falls Foundation, Inc.
EVENT : 5k Road Race/Walk
DATE : Saturday, April 25th, 2020
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 proper
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 20`", 2020, 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 18th day of November, 2019,by the following vote:
AYES :
NOES :
ABSENT:
Town of QueensbuQueensbury David Dwell
Ifighvv at Supe intcn(.ivnt
Highway 761 S'21_2
Department
Mark Be-war
71•,? Bay Road —Oueensbuty, NY 1,25()t• f Deputy Highm upe,intender t
Phone: (5 18) ;b 1-tip'1 1 ( 1 s) 61 se 10
Fax: (518) 7 1,5- 166
TO: TOWN BOARD
FROM: DAVID DUELL
DATE: OCTOBER 29, 2019
RE: GLENS FALLS ROTARY CLUB, 5K RUN
I have reviewed the request by the Glens Falls Rotary Club, which will hold their 5k Run run/walk
event on Saturday, April 25, 2020 at SUNY Adirondack Student Center to benefit Big Brothers
Big Sisters & World Awareness Children's Museum.
Weather permitting, I hereby grant my approval for this event to be held on the following roadway
that is under my jurisdiction: Meadowbrook Road and Cronin Road. The remaining roadways are
not in my jurisdiction and may require additional authorization.
David Duell
Highway Superintendent
Town of Queensbury
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Saturday, April 25, 2020
Proceeds benefit Big Brothers Big Sisters START Tll'4E: 10:00 All
& World Awareness Children's Museum at SUllY Adirondack Student Center
Pre-registration:On or before April 16th.2020-mail to Glens Falls Rotary,PO Box 2702.Glens Falls NY 12801 or register
online at wwwactive.com Entry Fee`:ADULT S26,AGE 12&UNDER S17 Race Day Registration:RAM to 9:15AM ADULT
331,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,and,3rd,Team Awards[see page 21
NAME M 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.I hereby attest I am medically able and properly trained to runlw.alk.I agree to abide by
any decision of a race official relative to my ability to safely complete the run/walk.I assume all risks associated with running/walking in this event including,but
not[muted to.fall contact with other participants.the effect of the weather including high or law temperatures.wind traffic and the conditions of the.road.ar such
risks are being known and appreciated by me.For safety reasons,dogs are not allowed and headphones.roller skates and similar devices are prohibted 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 behalf,waive and release
the Glens Falls Rotary Club,SIINY 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 or
voice in photographs motion pictures.records and/or other record of the Rotary IX far 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 '
LISA
SIGNATURE OF PARENT OR GUARDIAN IF RUNNER IS UNDER 18 YEARS OLD
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PRINT DATE: 10/26/2019
CERTIFICATE OF INSURANCE
CERTIFICATE NUMBER: 20191021748398
AGENCY:
Edgewood Partners Insurance Center THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
2727 Paces Ferry Road,Building Two,Suite 1500 CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES
Atlanta,GA 30339 NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
678-324-3300(Phone),678-324-3303(Fax) BELOW.
NAMED INSURED: INSURERS AFFORDING COVERAGE:
USA Track&Field,Inc. Glens Falls Rotary Club 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:
Rotary 5K&Corporate Challenge(4/25/2020-4/26/2020)
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: EXPIRES: LIMITS:
A GENERAL LIABILITY
X Occurrence PHPK2050515 11/1/2019 11/1/2020 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 PHUB697455 11/1/2019 11/1/2020 EACH OCCURRENCE $10,000,000
12:01 AM 12:01 AM
AGGREGATE $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:
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