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LE49V{gr <br />CON N ECTING & IN NOVATING <br />sINCE 1913 <br />MTNNESOTA <br />crTrEs <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 with <br />your attorney. <br />League of Minnesota Cities Insurance Trust (LMCIT) members that obtain liability coverage from LMCIT must decide <br />whether to waive the statutory tort liability limits to the extent of the coverage purthased. The decision has the following <br />effecls: <br />^ lf the member does nol waive the statutory torl lirnits, an individual claimant would be able to recover no more than <br />$s00,000 on any ctaim to which the stalutory tort timit. apply. The total all claimants would be able to recover for a <br />single occurrence to which lhe statutory tort limits appry wburc be limited to $'1,500,000, These statulory tort limits <br />app"ty regarOless of whether the city purchases the optional excess liabllity coverage' <br />" lf llte memberwaives the slaluto ry tort limitsand does not purchase ercess liabilily coverage' a single claimant could <br />potentiauy recover up to $2,000,0b0 for a slngG occurr"n"". (Under this option, the tort cap liability limils are waived to <br />the extent or yre membetr= illiriiy.ouerage iimits, and the LMCIr per occurrence limit is $2 million') The total all <br />. <br />claimants would be able to recover for a singre occurrence to which the statutory tort limits apply would also be limited <br />to $2,000,000, regardless of the number of claimants <br />, lf the member waives the slatulory toft timits and purchases excess liabitity coverage, a single claimant could <br />potentially recover an amount up io the limit of the .ou"t"g" purchased. The total all claimants would be able to <br />recover for a single occurrence io which tne staiuioiy tort'iimits 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 />rnsurance TrustllMcn.selects <br />liability coverage limits of $ <br />Check one: <br />tr The member DoES NoT WAIVE the monetary limits on municipal tort liability established by Minnesota slatutes' <br />Section 466.04' <br />;1 rhe member SAIVES the monelary limits on municipal tort liability established by Minnesota statutes' section <br />466.04 to the extent of the limits ot ine tiaoitity coverage obtained from LMCIT' <br />Date of city council/governing body meeting <br />from the League of Minnesota Cities <br />Position <br />rnor.re (651) 281'12A0 r x' (651) 281-1299 <br />roLL FR!E, (800) 925-1122 wE0r wwl{!MC'o&G <br />Signature <br />145 UNIVERSITY AYT. WEST <br />ST. PAUL, MN 55i03-2044 <br />is form to LMCIT before the effectlve date of <br />the coverage. Please return-the coqpleted fornt tb yo