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GUE qF TNNESOTA CITIES CONNECTING 6i INNOVATING :SINGE 19fS LIABILITY COVERAGE — WAIVER FORM Members who obtain liability coverage through the League of Minnesota. Citles-ll isurance Trust (LMCIT) must complete and return this form to LMCIT before the member's effective date of coverage. Return completed form to your underwriter or email tonstech@lmmm. The decision.to waive or not waive the statutory tort limits must he made annually by the member's governing bads, in consultgtton with its dhorney.ifnecessary. Members who obtain liability Coverage from LMC1T.m0st-ddcide-whether to waive the statutory tort liability limits to the extent of the coverage purchased. The decision. has the following et%cts; • If the member does not waive the statutory tort limits, an individual. claimant could over no. more than $500,000 on any claim to which the-statntory tort limits apply. The total all claimants. could recover for a. single occurrence to which the statutory tort limits apply would.be ihnited to $1,500,000. These statutory tort limits would apply regardless of whether the member:purchases the.bpdonal LMCIT excess liability coverage. • If the membo waives the statutory tort limits and does not purchase excess liability coverage, a single claimant could refoo'ver up to $2,000,000 for a single occurrence (under the waive option, the tort cap liability limits are' only waived to the extent of the member's liability.coverage lirr}lts, and the LMCIT per occurrence limit is $ ,000,.000). The total all claimants -could recover for a single occurrence to which the statutory tort limits apply woW4.also be limited to $2,000,000,:regardless of the number of claimants. If tha-member waives the statutory tort limits andpurchases excess liaN itycoverage,:a single claimanYcould poteafially recover an amount up to the limit of the coverage purchased. The total all claimants could 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.. LMCIT Member Name: Check one: M The member DOES NOT WAIVE the monetaiylftifs on municipal tort Iiability-establishedby Minn. Stat. 466.04. The member WAIVES the monetary limits on municipal tort liability established by Minn. Stat. § 466 k.to. the extent: of the .limits .of the liability coverago obtained fi'om.LMCIT. Date of member's governing body.ni0ed.4g: Signature: Position: 145 UNIVE'RSITYAVB. WEST PHONE:. (651.) 281-1200 FAY: (651) 281-I299 ST. PAU L. MN 9SI03=20" ' OLL FREE: (800) 925-1122 WEB; www tMCORG