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SECTION I: LIABILITY COVERAGE WAIVER FORM <br />Cities obtaining liability coverage from the League of Minnesota Cities Insurance Trust must decide whether or not to <br />waive the statutory tort liability limits to the extent of the coverage purchased The decision to waive or not to waive <br />the statutory limits has the following effects: <br />if the city does not waive the statutory tort limits, an individual claimant would be able to recover no more than <br />S00,0o0. on any claim to which the statutory tort limits apply The total which all claimants gould be able to <br />recover for a single occurrence to which the statutory tort limits apply would be limited to $1,1 00,000 These <br />statutory tort limits would apply regardless of whether or not the city purchases the optional excess liability <br />coverage <br />If the city waives the statuto tort limits and does not purchase excess liability coverage, a single claimant could <br />potentially recover up to $lio,000 on a single occurrence The total which all claimants would be able to <br />recover for a single occurrence to which the statutory tort limits apply would also be limited to $1*o,000 , <br />regardless of the number of claimants <br />If the city waives the statutory tort limits and purchases excess liability coverage, a single claimant could <br />potentially recover an amount up to the limit of the coverage purchased The total which all claimants would be <br />able to recover for a single occurrence to which the statutory tort limits apply would also be limited to the amount <br />of coverage 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 />This decision must be made by the city council Cities purchasing coverage must complete and return this form <br />to LMCIT before the effective date of the coverage. For further information, contact LMCIT You may also wish <br />to discuss these issues with your city attorney <br />Citv of Gem Lake accepts liability coverage limits of $1.500.000 from the League <br />of Minnesota Cities Insurance Trust (LMCIT) <br />Check one <br />® The city DOES NOT WAIVE the monetary limits on municipal tort liability established by Minnesota Statutes <br />46604 <br />❑ The city WAIVES the monetary limits on tort liability established by Minnesota Statutes 465 04, to the <br />extent of the limits of the liability coverage obtained from LMCIT <br />Date of city council meeting March 16, 2010 <br />Signature <br />Position <br />Return this completed form to LMCIT, 145 University A ve. W., 5t. Paul, MN. 55103-2044 <br />P:iLL� 16 <br />