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LEAGUE OF MINNESOTA CITIES INSURANCE TRUST <br /> LIABILITY COVERAGE—WAIVER FORM <br /> Cities obtaining liability coverage from the League of Minnesota Cities Insurance Trust must decide <br /> whether or not to waive the statutory tort liability limits to the extent of the coverage purchased. The <br /> decision to waive or not to waive the statutory limits has the following effects: <br /> If the city does not waive the statutory tort limits,an individual claimant would be able to recover no <br /> more than $300,000.on any claim to which the statutory tort limits apply. The total which all claimants <br /> would be able to recover for a single occurrence to which the statutory tort limits apply would be <br /> limited to$1,000,000. These statutory tort limits would apply regardless of whether or not the city <br /> purchases the optional excess liability coverage. <br /> if the city waives the statutory tort limits and does not purchase excess liability coverage, a single <br /> claimant could potentially recover up to$1,000,000. on a single occurrence. The total which all <br /> claimants would be able to recover for a single occurrence to which the statutory tort limits apply would <br /> also be limited to$1,000,000.,regardless of the number of claimants. <br /> if the city waives the statutory tort limits and purchases excess liability coverage, a single claimant <br /> could potentially recover an amount up to the limit of the coverage purchased. The total which all <br /> claimants would be able to recover for a single occurrence to which the statutory tort limits apply would <br /> also be limited to the amount of coverage purchased,regardless of the number of claimants. <br /> Claims to which the statutory municipal tort limits do not apply are not affected by this decision. <br /> This decision.must be made by the city council. Cities purchasing coverage must complete and <br /> return this form to LMCIT before the effective date of the coverage. For further information, contact <br /> LMCIT. You may also wish to discuss these issues with your city attorney. <br /> accepts liability coverage limits of$ from the League of <br /> Minnesota Cities Insurance Trust(LMCIT). . <br /> Check one: <br /> F] The city DOES NOT WAIVE the monetary limits on municipal tort liability established.by <br /> i <br /> Minnesota Statutes 466.04. <br /> ❑ The city WAIVES the monetary limits on tort liability established by Minnesota Statutes 466.04, <br /> to the extent of the limits of the liability coverage obtained from LMCIT. <br /> I <br /> Date of city council meeting <br /> Signature/Date Position <br /> Return this completed form to LMCIT, 145 UnlversityAve. W.,St. Paul, MN. 55103-2044 <br /> s <br /> LMCIT(11/00)(Rev.11/03) Page i of 1 <br /> ;i+ <br />