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RACES&WALKSaotary 5k for 2022-1-24-2022
RESOLUTION AUTHORIZING ROTARY 5K ROAD RACE/WALK
RESOLUTION NO. 2022
INTRODUCED BY:
WHO MOVED ITS ADOPTION
SECONDED BY:
WHEREAS, the Rotary Club of Glens Falls has requested authorization from the
Queensbury Town Board to conduct its annual 5k road race/walk to benefit the Ben Osborn
Memorial Fund and Southern Adirondack Independent Living(SAIL) as follows:
SPONSOR The Rotary Club of Glens Falls
EVENT 5k Road Race/Walk
DATE Saturday, April 23`d, 2022
TIME Approximately 9:30 a.m.
PLACE Beginning and ending at SUNY Adirondack
NOW, THEREFORE,BE IT
RESOLVED, that the Queensbury Town Board hereby acknowledges receipt of proper
proof of insurance and authorizes the Rotary Club of Glens Falls to conduct a 5k Road Race/Walk
within the Town of Queensbury on Saturday, April 23`d, 2022,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 24Ih day of January, 2022, by the following vote:
AYES
NOES
ABSENT:
+s
TO: TOWN BOARD
FROM: DAVID DUELL
DATE: January 6, 2022
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 23, 2022 at SUNY Adirondack Student Center to benefit Ben Osborn
Memorial Fund and Southern Adirondack Independent Living (SAIL).
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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Sdaturbq, April 23' , - 022
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START TIME. 9.30AM
101 SUNY Adirondack Student enter
Preregistration:On or before April 14,2022-mail to Glens Falls Rotary,PO Box 2702,Glens Falls,NY 12801 or register
online at wwwitsyourracg.com Entry Fee*:ADULT S26,AGE 12 E UNDER S17 Race Packet Pickup:8AM to 9:10AM
One small hill start,then flat and fast! T-shirts.Available for the first 240 entrants[sizes not guaranteed)Awards:
Male and Female overall,age groups 1st,2nd,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:Glens Falls Rotary Foundation,Inc.
Have you been fully vaccinated for COVI➢49? Yes_ No-
1 know that running/walking a road race is a potentially hazardous activity.I hereby attest I am medically able and properly trained to runlivalk.I agree to abide
by any decision of a race official relative to my ability to complete the runlwalk.I assume all risks associated with running/walking in the event including.but not
limited to fall.contact with other participants,the effect of weather including high and low temperatures.wind.communicable disease including CUVIU-ig.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 the waiver and knowing these facts and in consideration of accepting my entry.I for myself and anyone entitled to act
on my behalf,waive and release the Glens Falls Rotary Club,SUNY Adirondack.Town of Uueensbury.warren County.washinton County,USATF,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 t
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9 P Y photographs. P Rotary Y 9 purpose.m permission to use m likeness and/or voice in hota hs.motion pictures.records and/or other record of the Rote 5K for an legitimate ur ose.The Glens
Falls Rotary Club reserves the right fo cancel this event without return of funds due to unforeseen circumstances,such as dangerous weather. �� '�E�
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SIGNATURE DATE
USA
SIGNATURE OF PARENT OR GUARDIAN IF RUNNER IS UNDER 19 YEARS OLD
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RACE ROUTE
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SUNYA®9R®NDACK a D
' PRINT DATE:'12/14/2021
CERWICATE OF INSURANCE
CERTIFICATE NUMBER: 2021 1 21 0874984
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:Accredited Surety and Casualty Company,Inc.NAIC#26379
130 East Washington Street,Suite 800
Indianapolis IN 46204 INSURER B:Allied World National Assurance Company NAIC#19489
EVENT INFORMATION:
Rotary 5K&Corporate Challenge(4123/2022-412412022)
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 fNSURANCE: : POLICY NUMBER(S): EFFECTIVE: EXPIRES: LIMITS:
A ;GENERAL LIABILITY
X Occurrence 1-TPM-IN-17-01268997 11/1/2021 11/1/2022 GENERAL AGGREGATE(Applies Per Event) $4,000,000
12:01 AM 12:01 AM
X Participant Legal Liability EACH OCCURRENCE $2,000,000
DAMAGE TO RENTED PREMISES(Each Occ.) $2,000,000
MEDICAL EXPENSE(Any one person) EXCLUDED
PERSONAL&ADV INJURY S2,000,000
PRODUCTS-COMPIOP AGG S2,000,000
A UMBRELLA/EXCESS LIABILITY
X Occurrence 1-TPM-IN-17-01268998 1111/2021 11/1/2022 EACH OCCURRENCE $3,000,000
12:01 AM 12:01 AM
AGGREGATE $3,000.000
8 10THER
0313-1301 11/1/2021 11/1/2022
X EXCESS LIABILITY EACH OCCURRENCE $7,000,000
-- - 12:01 AM 12:01 AM -
AGGREGATE $7,000,000
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/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:Blanket Additional Insured(RSCG 03 03)
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
2404).
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: