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LEAGUE OF MINNESOTA CITIES INSURANCE TRUST LIABILITY COVERAGE - WAIVER FORM Cities obtaining liability coverage from the League of Minnesota Cities Insurance Trust must decide whether or not to waive the statutory tort liability limits to the extent of the coverage purchased. The decision tO~ive or not to waive the statutory limits has the following effects: L-jtXJtMO New ~s fYmfaf-vr.; Urn;-/- c If the cft oes not waive the statutory tort limits, an individual claimant would be able to recover no more tha S'l"(),ggo.,on any claim to which the statutory tort limits apply. The total which all claimants would be able to recover for a single occurrence to which the statutory tort limits apply would be Ii~ $'I,lltlO,uuu. These statutory tort limits would apply regardless of whether or not the city ~ 000 .--------purchafes the optional excess liability coverage. i S+ohYIc (Y\,T. If the city waives the statutory tort limits and does not purchase excess liability coverage, a single claimant could potentially recover up to $1,000,000. on a single occurrence. The total which all claimants would be able to recover for a single occurrence to which the statutory tort limits apply would also be limited to $1,000,000., regardless of the number of claimants. If the city waives the statutory tort limits and purchases excess liability coverage, a single claimant could potentially recover an amount up to the limit of the coverage purchased. The total which all claimants would be able to recover for a single occurrence to which the statutory tort limits apply would also be limited to the amount of coverage purchased, regardless of the number of claimants. Claims to which the statutory municipal tort limits do not apply are not affected by this decision. This decision must be made by the city council. Cities purchasing coverage must complete and return this form to LMCIT before the effective date of the coverage. For further information, contact LMCIT. You may also wish to discuss these issues with your city attorney. City of Arden Hills accepts liability coverage limits of $ d I ;J.{X), (b() from the League of Minnesota Cities Insurance Trust (LMCIT). ' Check one: ~ The city DOES NOT WAIVE the monetary limits on municipal tort liability established by Minnesota Statutes 466.04. o The city WAIVES the monetary limits on tort liability established by Minnesota Statutes 466.04, to the extent of the limits of the liability coverage obtained from LMCIT. Date of city council meeting Signature/Date Position Return this completed form to LMelT, 145 University Ave. w., St Paul, MN. 55103-2044 LMClT (1lI00)(Rev. 11/03) Page I oft