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Sry LEAGUyr CONNECTING & INNOVATING j 1NUNE ES0TA slty� tas3 CITIES LIABILITY COVERAGE — WAIVER FORM LMCIT members purchasing coverage must complete. and return this form to LMOIT before the effective date of the coverage. Please return the completed form to your underwriter or email to pstechalmc:org This decision: must be made by the member's governing body every year. You may also wish to discuss these.issues with your attorney, League of Minnesota Cities Insurance Trust. (LK4CIT) members that obtain liability coverage from 1MC1T must decide whether to waive the statutory roil liability l#mils to the extent of the coverage purchased. The decision has the -following effects: If the meMbOrdoes not waive (he statutory tort Jimits, an individual claimant would be able to recover no more than $500,000 ore any claim to which the statutory tort limits apply. The total all claimants would be able to recover for a single occurrence to which the statutory tort limits apply would be limited to $1,500j()60, These statutorytort limits .apply regardless of whether the city.pwchases. the optional excess Ilability coverage. If the member waives the statutory tort limits and does not.purchese excess liability ❑overags,..a single claimant could potentially recover up to $2,000,000 for a single occurrence. (Under this option, the tort cap liability limits are waived to the extent of the rhembsr's liability coverage limits, and the•LMC1T per Occurrence limit is $2 million.) The total all. claimants would be able to recover for a single occurrence to which the statutory. tort limits apply would. also be limited to $4.000,000, regardless of the number of claimants, it the member waives the statutory tort fimits and purchases excess liabilitycoveraga; a single claimant could potentially recover an amount up to the limit of'the coverage purchased. The total all claimants would he able .to recover fora single occurrence to which the. statutory to.rt.linnits .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, LMCIT Member Name CJ7e vne; The member DOES NOT WAIVE the monetary limitson munlcipaltort liability established by Minnesota Statutes, section 455.04. ❑. The member WAIVES the monetary limits on municipal tort liability established by Minnesota Statutes, Section 465,04. to the extent. of the limits. of the liability coverage obtained from LMCIT, Date of city council/governing body meeting Signature Position 145 UN#VERSITYAVE. WEST F'HDN1Er(OM 281-120a FAR; f6S1).281.1299 5T. 1'Ai]t, MN 55103-2044 Tou:TML (800) 925-1122 weu:unvWi,&jC.URG