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• <br />LEAGUE OF MINNESOTA CITIES INSURANCE TRUST <br />ACCIDENT PLAN FOR CITY VOLUNTEERS <br />Application for Coverage <br />The City of hereby requests coverage under the League of Minnesota Cities <br />Insurance Trust's Accident Plan for City Volunteers effective and agrees to pay the <br />premium established by LMCIT for that coverage. <br />Optional coverages to be included: <br />$1000 medical coverage Yes No <br />Construction or demolition project Yes No <br />• <br />Please describe each construction or demolition project to be covered, including the nature and <br />scope of the project, the dates, and the approximate number of volunteers who will be involved. <br />Signature <br />Date <br />Position <br />Return this form to LMCIT, 145 University Ave W, St. Paul, MN 55103-2044, Attention: Barb <br />Meyer <br />C] <br />