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0 0 <br />LEAGUE OF <br />MINNESOTA <br />CITIES <br />CONNECTING & INNOVATING <br />SINCE 1913 <br />LIABILITY COVERAGE — WAIVER FORM <br />Members who obtain liability coverage through the League of Minnesota Cities Insurance Trust (LMCIT) <br />must complete and return this form to LMCIT before the member's effective date of coverage. Return <br />completed form to your underwriter or email to pstechc 1mc.org. <br />The decision to waive or not waive the statutory tort limits must be made annually by the <br />member's governing body, in consultation with its attorney if necessary. <br />Members who obtain liability coverage from LMCIT must decide whether to waive the statutory tort liability limits <br />to the extent of the coverage purchased. The decision has the following effects: <br />• If the member does not waive the statutory tort limits, an individual claimant could recover no more than <br />$500,000 on any claim to which the statutory tort limits apply. The total all claimants could recover for a single <br />occurrence to which the statutory tort limits apply would be limited to $1,500,000. These statutory tort limits <br />would apply regardless of whether the member purchases the optional LMCIT excess liability coverage. <br />• If the member waives the statutory tort limits and does not purchase excess liability coverage, a single claimant <br />could recover up to $2,000,000 for a single occurrence (under the waive option, the tort cap liability limits are <br />only waived to the extent of the member's liability coverage limits, and the LMCIT per occurrence limit is <br />$2,000,000). The total all claimants could recover for a single occurrence to which the statutory tort limits apply <br />would also be limited to $2,000,000, regardless of the number of claimants. <br />• If the member waives the statutory tort limits and purchases excess liability coverage, a single claimant could <br />potentially recover an amount up to the limit of the coverage purchased. The total all claimants could recover for <br />a single occurrence to which the statutory tort limits apply would also be limited to the amount of coverage <br />purchased, regardless of the number of claimants. <br />Claims to which the statutory municipal tort limits do not apply are not affected by this decision. <br />LMCIT Member Name: <br />vt /7 07" j/ a/l <br />Check one: <br />The member DOES NOT WAIVE the monetary limits on municipal tort liability established by Minn. Stat. <br />466.04. <br />The member WAIVES the monetary limits on municipal tort liability established by Minn. Stat. & 466.04, to <br />the extent of the limits of the liability coverage obtained from LMCIT. <br />Date of member's governing body meeting: <br />Signature: <br />145 UNIVERSITY AVE WEST <br />ST. PAUL, MN 55103 -2044 <br />�yld,aff <br />Position: CLAY /1/104 5-e./— <br />PHONE: (651) 281 -1200 FAX: (651) 281 -1299 <br />TOLL FREE: (800) 925 -1122 WEB: WWW.LMC.oRG <br />