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LIABILITY COVERAGE Î WAIVER FORM <br />Memberswho obtainliability coverage through the League of Minnesota Cities Insurance Trust (LMCIT) <br />must complete and return this form to LMCIT before themember Ós effective date of coverage.Return <br />completed form to your underwriter or email to pstech@lmc.org. <br />The decision to waive or not waive the statutory tort limits must be made annually by the <br />memberÓs governing body, in consultation with its attorney if necessary. <br />Members who obtain liability coverage from LMCIT must decide whether to waive the statutory tort liability limits <br />to the extent of the coverage purchased. The decision has the following effects: <br />If the member does not waive the statutory tort limits, an individual claimant couldrecover no more than <br />$500,000 on any claim to which the statutory tort limits apply. The total all claimants could recover for a single <br />occurrence to which the statutory tort limitsapply would be limited to $1,500,000. These statutory tort limits <br />would apply regardless of whetherthe member purchases the optionalLMCITexcess liability coverage. <br />If the member waives the statutory tort limits and does not purchase excess liability coverage, a single claimant <br />could recover up to $2,000,000for a single occurrence(under the waive option, the tort cap liability limits are <br />only waived to the extent of the memberÓs liability coverage limits, and the LMCIT per occurrence limit i s <br />$2,000,000).The total all claimants could recover for a single occurrence to which the statutory tort limits apply <br />would also be limited to $2,000,000, regardless of the number of claimants. <br />If the member waives the statutory tort limitsand purchases excess liability coverage, a single claimant could <br />potentially recover an amount up to the limit of the coverage purchased. The total all claimants couldrecover for <br />a single occurrence to which the statutory tort limits 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 />ElkRiverMunicipalUtilities <br />LMCIT Member Name: __________________________________________________________________________ <br />Check one: <br />o The member DOES NOT WAIVE the monetary limits on municipal tort liability established by Minn.Stat.£ <br />466.04. <br />o The member WAIVES the monetary limits onmunicipaltort liability established by Minn.Stat.£466.04, to <br />the extent of the limits of the liability coverage obtained from LMCIT. <br />Date of member Ós governing body meeting:__________________________________________________________ <br />Signature:_______Position:_______________ <br />47 <br />