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Mid-Hudson Road Runners2010-01-19 JCM FOR INTERNAL USE ONLY Received by: Christine Fulton '~( Sue Rose ^ Date Received: ~ l /~V / l ~ Serial #: Application ^ $100.00 ^ Cert. of LI ,~ Notified Recreation (date: 1 a• Town of Wappinger Agreement for the Use of the Town Hall Facilities €e~-~ee~t~ JAIL 2 4 20i2 N OF WAPPINGER TOWN CLERK Agreement for the Use of the Town Hall Facilities for Meetings ~1171~5 Vi7S~N Zo,4~ zt?i•~IJCcRS Name of Organization or Group Pests- .S~-~r=1L~PP~ Name of person representing the Organization or Group Address Phone No. This will confirm the arrangements being requested for your groups' use of the Wappinger Town Hall Facilities, as noted below: Senior Citizens Room Large Meeting Room O Other: Specify: The group is not expected to exceed ~ J~ persons Date(s): ~J Cl~'T~M~~Q.- ~ ~Lti Time: ~. O~r1?'~1 ~"' ~ •(~r~ti1 It should be understood that groups using the Buildings' Facilities for evening meetings must select dates when Town Meetings are normally scheduled (i.e., Justice Court, Planning Board, etc.) Special requests will be considered upon their own merit, and arrangements can be made for access to, and closing, the building at the close of your meeting. You and your Organization hereby agree to adhere to the rules set forth on the attached page by signature of an authorized member of your Organization or group. The Town of Wappinger reserves the right to suspend temporarily this agreement should the Town have need of the facility for its own purposes. Advance notice will be given as soon as possible on such occasions. The Town Clerk should be informed promptly of any schedule change or cancellation of your group activities. Arrangements for access to specific area to be used should be made with the Town Clerk at the time this form is submitted. No application shall be considered approved until it has been submitted to the Town Clerk for review and Clearance. 2010-0 l -19 JCM Terms of the agreement must be strictly adhered to by the contracting group as any disregard or abuse of the rules for use of the facilities will result in termination of use by the offending group, and they will not be granted reinstatement. I have read and understand the rules and regulations for the use of the Facilities in the Town of Wappinger Town Hall, and will comply with these requirements. Signed: For: M 1,~i-~vi~5d+~ '-Zd~.~ 2v N N ~~S (Name of Group or Organization) Date: c~ r /~I)/ Z~ t~ -T Approved: Town Clerk Date: . • On behalf of The Mid Hudson Road Runners I am also requesting all fees associated with the use of Town of Wappinger parks and buildings be waived by the Town of Wappinger for the dates requested. l OJAN2012 8 CARMINE Dl WAPPINGERS 1 ALLU NY 12590 TOWN SUPERVISOR BARBARA GUTZLER TOWN COUNCIL TOWN OF WAPPINGER,NY 12590 MS.GUTZLER I WOULD LIKE PERMISSION FROM THE TOWN OF WAPPINGER TO RUN FOUR RACES THIS YEAR. JUNE 2ND IS THE JOSEPH MCDONALD/BILL CRUSIE MEMORIAL RUN.THIS WILL BE THE 35TH YEAR FOR THE RACE. START/FINISH IS AT MESIER PARK,VILLAGE OF WAPPINGERS.THE RACE RUNS ON CREEK ROAD IN THE TOWN. THE 21''D RACE IS THE MAMAS & PAPAS SENIOR CITIZEN RUN/WALK ON SEPTEMBER 1ST .THE START & FINISH IS AT THE TOWN HALL. IT RUNS THROUGH THE VILLAGE & TOWN. THE 3~ RACE IS THE DUTCHESS COUNTY CLASSIC ON SEPTEMBER 16TH AT ROBINSON LANE RECREATION FACILITY. .THE 4TH RACE IS THE SPORTS MUSUEM HALL OF FAME OF DUTCHESS COUNTY CROSS COUNTRY RUN WHICH WILL BE HELD AT THE CARNWARTH FARMS LOCATION. CjC T.. ~? - N LIABILITY INSURANCE WILL BE PROVIDED THROUGH THE MIDHUDSON ROAD RUNNERS CLUB. I WOULD NEED FOR THE MAMAS & PAPAS RUN/WALK,THE BATHROOM FACILITIES AND A FEW TABLES & CHAIRS.. FOR FURTHER INFORMATION PLEASE CALL PETE SANFILIPPO. PH NO 297 - 7950 THANKK YOU PET S FILIPPO DIRECTOR MHRRC G3C~C~~M[~D FEB 0 71012 _ _ _ __-- _ _ _ i TflWN dF VVARPINGER ~_ TOWN CLERK 0 G J ~ <<, ~ ~Z Q..~.( Town of Wappingers Department of Recreation 20 Middlebush Rd. Wappingers Fails, NY 12590 This letter is to request use of Schlathaus Park, Wappingers Falls on Saturday, October 6, 2012, for the Mid Hudson Road Runners Club annual Schlathaus Park Memorial 5K Race and kids' 1 mile run. Registration for these events begins at 9AM, with the 5K race starting at 10AM and the kids' run beginning at 10:45AM (after the 5K finishes). Awards are presented after the kids' run from the bandstand. My crew and I clean up the park afterwards, picking up trash, etc. and returning tables and chairs to the garage. We are gone from the park by 11:30AM. This race has been held at Schlathaus Park since 1980, with the cooperation of the Wappingers Rec Department, and has been a favorite on the MHRRC schedule ever since. Thank you for your continued cooperation, Linda Stow Race Director G°~CC~C~OMC~D ___ -_ -- - FEB 7 2~ t2 TOWN C'I FRK '`'~ °® CERTIFICATE OF LIABILITY INSURANCE 4ii,i2o1~' 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 NAONMEACT Judy Weaver STAR Insurance - Fort Wayne Office PNONE (260) 467-5697 FAX . (260) 467-5651 2130 East DuPont Road -MaL .judy.weaver@starfinancial.com INSURERS AFFORDING COVERAGE NAIC # Fort Wayne IN 46825 INSURERANational Casualt Com an 11991 INSURED INSURERBNat10nW1de Life Insurance Co. 66869 Road Runners Club of America/2012 6 INSURERC: I t3 Member Clubs INSURER D 1501 Lee Highway Suite 140 INSURERE: Arlln ton VA 22209 INSURERE: COVERAGES CERTIFICATE NUMBER:2012 - $2M A. I . 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 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER MM DD EFF MMIDD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2 , 000.000 X COMMERCIAL GENERAL LIABILITY PREMIS Ea occunence $ 500 , 000 A CLAIMS-MADE a OCCUR X 0000002210900 2/31/2011 2/31/2012 MED EXP (Any one person) $ 5 , 000 X Legal Liab. to Partic. 2:01 A.M. 2:01 A.M. PERSONAL&ADVINJURY $ 2,000,000 $2,000,000 GENERAL AGGREGATE $ NONE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 , 000 , 000 X POLICY PRO LOC iM Aggregate $5,000,000 ABUSE&MOLESTATION $ 500,000 AUTOMOBILE LIABILITY E MBINdED IN LE LIMIT 2 000 000 A ANY AUTO 0000002210900 2/31/2011 2/31/2012 gODILYINJURY(Perperson) $ ALL OWNED SCHEDULED X 2:01 A.M. 2:01 A.M. BODILY INJURY (Per accident) $ S X X AUT SWNED PROPERTY DAMAGE $ AUTOS HIR D UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION ' WC STATU- OTH- AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE ~ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ B E7{CESS MEDICAL & ACCIDENT X PR 0000025293800 2/31/2011 2/31/2012 EXCESS MEDICAL $10,000 ($250 DEDUCTIBLE/CLAIM) 2:01 A.M. 2:01 A.M. ADBSPECIFICLOSS $2,500 DESCRIPTION OF OPERATIONS (LOCATIONS /VEHICLES (Attach ACORD 101, Addll3onal Remarks Schedule, If more space Is required) CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED. DATE OF EVENT: 06/02/12 Joseph McDonald/Bill Crusie Memorial Run-1 Mile, 5R and 1010 INSURED CLUB: Mid-Hudson roa runners Club, attn: Pete San i ippo; 8 Carmine Drive, Wappingers Falls, NY 12590 ~~~~~ l:/ ~D TD W N C) E= VVA P i HO LD ANY F THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ION DATE THEREOF, NOTICE WILL BE DELIVERED IN C ANC WITH THE POLICY PROVISIONS. 06/02/12 Town of Wappin er, ~'t~~NN CL_ 20 Middlebush Road --.~.._.... _~_.__._~ Wappinger, NY 12590 ~ ESENTATIVE John Lefever/JOPE RD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. Sl9mnn51 M Thn ~PtlRll n~mu ~nrl Innn ern renie4erorl msrlrc of eR(1Rr1