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l@ <br />I EAGUE"MINN <br />CITI <br />CONNECTING & INNOVATING <br />. SINCE t9r3ESOTA <br />ES <br />LIABILITY COVERAGE _ WAIVER FORM <br />This decision must be made by the member's governing body every year. You may also wish to discuss these issues withyour attorney. <br />League of Minnesota Cities Insurance Trust (LMCIT) members that obtain liability coverage from LMCIT must decidewhether to waive the statutory tort liability limits to the extent of the coverage purchaseO. ine decision has the folowingenecls: <br />' lf the member does not waive the statutory tort timits, an individual claimant would be able to recover no more than$500'000 on any claim to which the statutory tort limits apply. The total all claimants woutd be able to recover for asingle occurrence to which the statutory tort limits appty wouto be limited to $1,500,000. These statutory tort limitsapply regardless of whether the city purchases the optional excess liability coverage. <br />' lf the member waives the statutory toft limits and does not purchase excess liabitity coverage, a single claimant couldpotentially recover up to $2,000,000 for a single occurrence. (under this option, tne tort caf tiaoitity ]-imits are waived tothe extent of the member's liability coverage limits, and the Lli4ClT per occurrence limit is $z mittion.) fnlioiararrclaimants would be able to recover for a single occurrence to which the statutory tort lim1s appty woltO also be limitedto $2,000,000, regardless of the number of claimants. <br />' lf the member waives the statutory toft limits and purchases excess liabitity coverage, a single claimant couldpotentially recover an amount up to the limit of the coverage purchased. ine totat iil ctaimints would be able torecover for a single occurrence to which the statutory tort limits apply would also be limited to the amount of coveragepurchased, 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 />Jv in+ (bt4>ent,1*l4ov i <br />LMCIT Member Name <br />Check one: <br />) - tck*p fuaqoupv+h <br />E The member DOES NOT WAIVE the monetary limits on municipaltort liability estabtished by Minnesota Statutes,Section 466.04. <br />The member wAlVEs the monetary limits on municipal tort liability estabtished by Minnesota Statutes, Section466.04 to the extent of the timits of the tiability coverage obtained irom LMClr. <br />Date of city counqil/governing bodygreetin g 6 -. - ,t $-- <br />sisn t r. N\-*A 9,,4"J position cg4tn rDA <br />145 UNIVERSITY AVE. WEST <br />ST. PAUL, MN 55103-2044 <br />LMc|Tmemberspurchasingcoveragemustcomp|eteandreturntnisro <br />the coverage. Please return the completed form to your undenrriter or email to ostechrolmc.oro <br />T <br />pHoNE, (651) 287-1200 F^x (651) Z8l-7299 <br />roLL FRxE: (800) 925-1,122 wEB, wwwlMc.oRc