NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Member: ALLOWAY TOWNSHIP BOARD OF EDUCATION Location: ALLOWAY BOARD OF EDUCATION Coverage: ERRORS AND OMISSIONS QN-3736 ALLOWAY BOARD OF ERRORS AND OMISSIONS 7/10/2020 Open Creating/Perpet Hostile 0.00 EDUCATION Envir Totals for ERRORS AND OMISSIONS - 1 Claim Totals for ALLOWAY BOARD OF EDUCATION - 1 Claim Totals for ALLOWAY TOWNSHIP BOARD OF EDUCATION - 1 Claim Member: ANDOVER REGIONAL BOARD OF EDUCATION Location: LONG POND SCHOOL Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01237Y LONG POND SCHOOL (11) WORKERS' COMP 7/16/2020 Open STRUCK BY 250.00 MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for LONG POND SCHOOL - 1 Claim Totals for ANDOVER REGIONAL BOARD OF EDUCATION - 1 Claim Member: BASS RIVER TOWNSHIP BOARD OF EDUCATION Location: BASS RIVER TWP E.S. Coverage: PROPERTY 20PR00112Q BASS RIVER TWP E.S. PROPERTY 7/23/2020 Open WATER DAMAGE - 0.00 PIP/EQUIP LEAK Totals for PROPERTY - 1 Claim Totals for BASS RIVER TWP E.S. - 1 Claim Totals for BASS RIVER TOWNSHIP BOARD OF EDUCATION - 1 Claim Member: BAYONNE BOARD OF EDUCATION Location: BAYONNE H.S. AND ADMIN. OFFICES Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01188B BAYONNE H.S. AND (11) WORKERS' COMP 7/8/2020 Open FALL SAME LEVEL - 575.65 ADMIN. OFFICES MEDICAL ONLY DISREPAIR SURF Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Coverage: (18) NO LOST TIME MC FEE 20WC01180C BAYONNE H.S. AND (18) NO LOST TIME MC 7/1/2020 Open FALL DIFFERENT LEVEL - 419.46 ADMIN. OFFICES FEE STAIRS/STEPS Totals for (18) NO LOST TIME MC FEE - 1 Claim Totals for BAYONNE H.S. AND ADMIN. OFFICES - 2 Claims Totals for BAYONNE BOARD OF EDUCATION - 2 Claims Member: BELLEVILLE BOARD OF EDUCATION

9/10/2020 8:07:41 AM Page 1 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Location: BELLEVILLE SENIOR HS Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01197B BELLEVILLE SENIOR HS (11) WORKERS' COMP 7/14/2020 Closed STRUCK AGAINST 517.29 MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for BELLEVILLE SENIOR HS - 1 Claim Totals for BELLEVILLE BOARD OF EDUCATION - 1 Claim Member: BERNARDS TOWNSHIP BOARD OF EDUCATION Location: BERNARDS TWP BOE Coverage: ERRORS AND OMISSIONS QN-3725 BERNARDS TWP BOE ERRORS AND OMISSIONS 7/7/2020 Closed DUE PROCESS 0.00 QN-3741 BERNARDS TWP BOE ERRORS AND OMISSIONS 7/24/2020 Open DUE PROCESS 0.00 Totals for ERRORS AND OMISSIONS - 2 Claims Totals for BERNARDS TWP BOE - 2 Claims Totals for BERNARDS TOWNSHIP BOARD OF EDUCATION - 2 Claims Member: BLOOMFIELD TOWNSHIP BOARD OF EDUCATION Location: BLOOMFIELD H.S. Coverage: GENERAL LIABILITY PREMISES MED PAYMENTS 19GL00763D BLOOMFIELD H.S. GENERAL LIABILITY 10/29/2019 Open ATHLETICS 5,000.00 PREMISES MED PAYMENTS Totals for GENERAL LIABILITY PREMISES MED PAYMENTS - 1 Claim Totals for BLOOMFIELD H.S. - 1 Claim Totals for BLOOMFIELD TOWNSHIP BOARD OF EDUCATION - 1 Claim Member: BLOOMSBURY BOARD OF EDUCATION Location: BLOOMSBURY ES Coverage: PROPERTY 20PR00113Q BLOOMSBURY ES PROPERTY 7/23/2020 Open COLLAPSE 0.00 Totals for PROPERTY - 1 Claim Totals for BLOOMSBURY ES - 1 Claim Totals for BLOOMSBURY BOARD OF EDUCATION - 1 Claim Member: BOE OF SPECIAL SERVICES SCHOOL DISTRICT & VO TECH SCHOOL DISTRICT COA Location: ATLANTIC CO VOTECH (VOC)

9/10/2020 8:07:41 AM Page 2 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Coverage: GENERAL LIABILITY BODILY INJURY 20GL00179S ATLANTIC CO VOTECH GENERAL LIABILITY 4/27/2020 Closed DEFAMATION OF 0.00 (VOC) BODILY INJURY CHARACTER Totals for GENERAL LIABILITY BODILY INJURY - 1 Claim Totals for ATLANTIC CO VOTECH (VOC) - 1 Claim Location: ATLANTIC COUNTY SPECIAL SERVICES Coverage: ERRORS AND OMISSIONS QN-3735 ATLANTIC COUNTY ERRORS AND OMISSIONS 7/15/2020 Open Employ Related 0.00 SPECIAL SERVICES Totals for ERRORS AND OMISSIONS - 1 Claim Totals for ATLANTIC COUNTY SPECIAL SERVICES - 1 Claim Totals for BOE OF SPECIAL SERVICES SCHOOL DISTRICT & VO TECH SCHOOL DISTRICT COA - 2 Claims Member: BOGOTA BOARD OF EDUCATION Location: E. ROY BIXBY ES Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01248K E. ROY BIXBY ES (11) WORKERS' COMP 7/27/2020 Open FALL SAME LEVEL - 292.69 MEDICAL ONLY WET/SLIP SURF Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for E. ROY BIXBY ES - 1 Claim Totals for BOGOTA BOARD OF EDUCATION - 1 Claim Member: BOONTON TOWN BOARD OF EDUCATION Location: JOHN HILL ES Coverage: (10) WORKERS' COMP LOST TIME- IND 20WC01226T JOHN HILL ES (10) WORKERS' COMP 7/21/2020 Closed OVEREXERTION - 5,016.93 LOST TIME- IND LIFT/LOWER Totals for (10) WORKERS' COMP LOST TIME- IND - 1 Claim Totals for JOHN HILL ES - 1 Claim Totals for BOONTON TOWN BOARD OF EDUCATION - 1 Claim Member: BOONTON TOWNSHIP BOARD OF EDUCATION Location: ROCKAWAY VALLEY ES Coverage: (14) WORKERS' COMP NO MANAGED CARE - MO 19WC04645F ROCKAWAY VALLEY ES (14) WORKERS' COMP NO 7/25/2019 Open FALL SAME LEVEL - 0.00 MANAGED CARE - MO OTHER Totals for (14) WORKERS' COMP NO MANAGED CARE - MO - 1 Claim Totals for ROCKAWAY VALLEY ES - 1 Claim Totals for BOONTON TOWNSHIP BOARD OF EDUCATION - 1 Claim

9/10/2020 8:07:41 AM Page 3 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Member: BRIDGETON BOARD OF EDUCATION Location: ADMINISTRATION BUILDING Coverage: PROPERTY 20PR00105H ADMINISTRATION PROPERTY 7/13/2020 Closed ALL OTHER PERILS 33,421.17 BUILDING Totals for PROPERTY - 1 Claim Totals for ADMINISTRATION BUILDING - 1 Claim Location: BRIDGETON SENIOR H.S. Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01194W BRIDGETON SENIOR H.S. (11) WORKERS' COMP 7/13/2020 Open STRUCK AGAINST 250.00 MEDICAL ONLY 20WC01200K BRIDGETON SENIOR H.S. (11) WORKERS' COMP 7/14/2020 Open FALL DIFFERENT LEVEL - 1,483.24 MEDICAL ONLY LADDER/SCAFFOLD Totals for (11) WORKERS' COMP MEDICAL ONLY - 2 Claims Coverage: PROPERTY 20PR00102E BRIDGETON SENIOR H.S. PROPERTY 7/7/2020 Closed ALL OTHER PERILS 1,921.40 Totals for PROPERTY - 1 Claim Totals for BRIDGETON SENIOR H.S. - 3 Claims Location: QUARTER MILE LANE E.S. Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01245K QUARTER MILE LANE E.S. (11) WORKERS' COMP 7/28/2020 Open STRUCK BY 250.00 MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for QUARTER MILE LANE E.S. - 1 Claim Totals for BRIDGETON BOARD OF EDUCATION - 5 Claims Member: BRIDGEWATER-RARITAN REGIONAL BOARD OF EDUCATION Location: BRIDGEWATER-RARITAN HS Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01182W BRIDGEWATER-RARITAN (11) WORKERS' COMP 3/16/2020 Closed INTERNAL/SUDDEN - 250.00 HS MEDICAL ONLY RESIPIRATOR/INHAL Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for BRIDGEWATER-RARITAN HS - 1 Claim Location: CRIM PRIMARY Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01254B CRIM PRIMARY (11) WORKERS' COMP 2/26/2020 Closed SPECIAL ED ACTING OUT 250.00 MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim

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Claim Number Location Coverage Loss Date Status Cause Total Paid Totals for CRIM PRIMARY - 1 Claim Location: TRANSPORTATION DEPT Coverage: GENERAL LIABILITY PREMISES MED PAYMENTS 19GL00765Q TRANSPORTATION DEPT GENERAL LIABILITY 10/4/2019 Open HORSEPLAY 0.00 PREMISES MED PAYMENTS Totals for GENERAL LIABILITY PREMISES MED PAYMENTS - 1 Claim Totals for TRANSPORTATION DEPT - 1 Claim Totals for BRIDGEWATER-RARITAN REGIONAL BOARD OF EDUCATION - 3 Claims Member: BURLINGTON COUNTY INSTITUTE OF TECHNOLOGY Location: INST.OF TECH - WESTAMPTON Coverage: (10) WORKERS' COMP LOST TIME- IND 20WC01203V INST.OF TECH - (10) WORKERS' COMP 7/14/2020 Open ELECTRICAL SHOCK 3,772.69 WESTAMPTON LOST TIME- IND Totals for (10) WORKERS' COMP LOST TIME- IND - 1 Claim Totals for INST.OF TECH - WESTAMPTON - 1 Claim Totals for BURLINGTON COUNTY INSTITUTE OF TECHNOLOGY - 1 Claim Member: BURLINGTON COUNTY SPECIAL SERVICES Location: LUMBERTON CAMPUS Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01260U LUMBERTON CAMPUS (11) WORKERS' COMP 7/31/2020 Open FALL DIFFERENT LEVEL - 255.00 MEDICAL ONLY CHAIR/TABLE Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for LUMBERTON CAMPUS - 1 Claim Totals for BURLINGTON COUNTY SPECIAL SERVICES - 1 Claim Member: CAMDEN CITY SCHOOL DISTRICT Location: OCTAVIUS V. CATTO SCHOOL Coverage: GENERAL LIABILITY BODILY INJURY 20GL00173S OCTAVIUS V. CATTO GENERAL LIABILITY 2/3/2020 Open FALL SAME LEVEL - 0.00 SCHOOL BODILY INJURY WET/SLIP SURF Totals for GENERAL LIABILITY BODILY INJURY - 1 Claim Totals for OCTAVIUS V. CATTO SCHOOL - 1 Claim Totals for CAMDEN CITY SCHOOL DISTRICT - 1 Claim Member: CAMDEN COUNTY TECHNICAL SCHOOLS Location: CAMDEN CO. VOC-TECH V.S. (GLO.)

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Claim Number Location Coverage Loss Date Status Cause Total Paid Coverage: AUTO PHYSICAL DAMAGE 20AL00095H CAMDEN CO. VOC-TECH AUTO PHYSICAL DAMAGE 7/6/2020 Closed NON COLLISION - OTHER 0.00 V.S. (GLO.) Totals for AUTO PHYSICAL DAMAGE - 1 Claim Totals for CAMDEN CO. VOC-TECH V.S. (GLO.) - 1 Claim Totals for CAMDEN COUNTY TECHNICAL SCHOOLS - 1 Claim Member: CAPE MAY COUNTY SPECIAL SERVICES Location: CAPE MAY COUNTY SPECIAL SERVICES Coverage: PROPERTY 20PR00100Q CAPE MAY COUNTY PROPERTY 3/16/2020 Closed ALL OTHER PERILS 0.00 SPECIAL SERVICES Totals for PROPERTY - 1 Claim Totals for CAPE MAY COUNTY SPECIAL SERVICES - 1 Claim Totals for CAPE MAY COUNTY SPECIAL SERVICES - 1 Claim Member: CARTERET BOROUGH BOARD OF EDUCATION Location: CARTERET MS Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01178U CARTERET MS (11) WORKERS' COMP 7/2/2020 Open STRUCK AGAINST 634.83 MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for CARTERET MS - 1 Claim Location: PVT. NICHOLAS MINUE SCHOOL Coverage: (18) NO LOST TIME MC FEE 20WC01205W PVT. NICHOLAS MINUE (18) NO LOST TIME MC 7/14/2020 Open OVEREXERTION - OTHER 2,115.73 SCHOOL FEE Totals for (18) NO LOST TIME MC FEE - 1 Claim Totals for PVT. NICHOLAS MINUE SCHOOL - 1 Claim Totals for CARTERET BOROUGH BOARD OF EDUCATION - 2 Claims Member: CLIFFSIDE PARK BOARD OF EDUCATION Location: CLIFFSIDE PARK BOARD OF EDUCATION Coverage: GENERAL LIABILITY BODILY INJURY 16GL02041E CLIFFSIDE PARK BOARD GENERAL LIABILITY 9/1/2016 Closed WRONGFUL DISCHARGE/ 0.00 OF EDUCATION BODILY INJURY EMPLOYMENT PRACTICE Totals for GENERAL LIABILITY BODILY INJURY - 1 Claim Totals for CLIFFSIDE PARK BOARD OF EDUCATION - 1 Claim Location: MIDDLE SCHOOL

9/10/2020 8:07:41 AM Page 6 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Coverage: ERRORS AND OMISSIONS QN-3724 MIDDLE SCHOOL ERRORS AND OMISSIONS 6/9/2020 Open Employ Related 0.00 Totals for ERRORS AND OMISSIONS - 1 Claim Totals for MIDDLE SCHOOL - 1 Claim Location: SCHOOL #4 ES Coverage: (10) WORKERS' COMP LOST TIME- IND 20WC01259V SCHOOL #4 ES (10) WORKERS' COMP 7/29/2020 Open FALL DIFFERENT LEVEL - 3,337.94 LOST TIME- IND STAIRS/STEPS Totals for (10) WORKERS' COMP LOST TIME- IND - 1 Claim Totals for SCHOOL #4 ES - 1 Claim Totals for CLIFFSIDE PARK BOARD OF EDUCATION - 3 Claims Member: CLINTON TOWNSHIP BOARD OF EDUCATION Location: PATRICK MCGAHERAN SCHOOL Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01235U PATRICK MCGAHERAN (11) WORKERS' COMP 7/20/2020 Open TEMPERATURE 368.06 SCHOOL MEDICAL ONLY EXTREME - HOT Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for PATRICK MCGAHERAN SCHOOL - 1 Claim Totals for CLINTON TOWNSHIP BOARD OF EDUCATION - 1 Claim Member: CUMBERLAND REGIONAL BOARD OF EDUCATION Location: CUMBERLAND REG HS Coverage: (10) WORKERS' COMP LOST TIME- IND 20WC01230G CUMBERLAND REG HS (10) WORKERS' COMP 7/22/2020 Open FALL SAME LEVEL - 6,746.43 LOST TIME- IND WET/SLIP SURF 20WC01191V CUMBERLAND REG HS (10) WORKERS' COMP 7/9/2020 Open FALL DIFFERENT LEVEL - 6,396.85 LOST TIME- IND OTHER Totals for (10) WORKERS' COMP LOST TIME- IND - 2 Claims Totals for CUMBERLAND REG HS - 2 Claims Totals for CUMBERLAND REGIONAL BOARD OF EDUCATION - 2 Claims Member: DENVILLE TOWNSHIP BOARD OF EDUCATION Location: DENVILLE TWP BOE Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01220W DENVILLE TWP BOE (11) WORKERS' COMP 7/13/2020 Open STRUCK AGAINST 250.00 MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for DENVILLE TWP BOE - 1 Claim

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Claim Number Location Coverage Loss Date Status Cause Total Paid Totals for DENVILLE TOWNSHIP BOARD OF EDUCATION - 1 Claim Member: EAST BRUNSWICK TOWNSHIP BOARD OF EDUCATION Location: EAST BRUNSWICK H.S. Coverage: (10) WORKERS' COMP LOST TIME- IND 20WC01223V EAST BRUNSWICK H.S. (10) WORKERS' COMP 7/21/2020 Open FALL SAME LEVEL - 650.00 LOST TIME- IND WET/SLIP SURF Totals for (10) WORKERS' COMP LOST TIME- IND - 1 Claim Totals for EAST BRUNSWICK H.S. - 1 Claim Location: EAST BRUNSWICK TWP. BOARD OF ED. Coverage: ERRORS AND OMISSIONS QN-3746 EAST BRUNSWICK TWP. ERRORS AND OMISSIONS 6/1/2020 Open Employ Related 0.00 BOARD OF ED. Totals for ERRORS AND OMISSIONS - 1 Claim Coverage: GENERAL LIABILITY BODILY INJURY 20GL00184S EAST BRUNSWICK TWP. GENERAL LIABILITY 6/1/2020 Closed DISCRIMINATION 0.00 BOARD OF ED. BODILY INJURY Totals for GENERAL LIABILITY BODILY INJURY - 1 Claim Totals for EAST BRUNSWICK TWP. BOARD OF ED. - 2 Claims Totals for EAST BRUNSWICK TOWNSHIP BOARD OF EDUCATION - 3 Claims Member: EAST WINDSOR REGIONAL BOARD OF EDUCATION Location: BLDG & GRDS Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01255B BLDG & GRDS (11) WORKERS' COMP 7/21/2020 Open OVEREXERTION - 250.00 MEDICAL ONLY HOLD/CARRY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for BLDG & GRDS - 1 Claim Location: ETHEL MCKNIGHT E.S. Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01177Y ETHEL MCKNIGHT E.S. (11) WORKERS' COMP 7/2/2020 Open STRUCK BY 250.00 MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for ETHEL MCKNIGHT E.S. - 1 Claim Totals for EAST WINDSOR REGIONAL BOARD OF EDUCATION - 2 Claims Member: EDGEWATER BOARD OF EDUCATION Location: EDGEWATER BOARD OF EDUCATION

9/10/2020 8:07:41 AM Page 8 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Coverage: ERRORS AND OMISSIONS QN-3740 EDGEWATER BOARD OF ERRORS AND OMISSIONS 6/30/2020 Open Employ Related 0.00 EDUCATION Totals for ERRORS AND OMISSIONS - 1 Claim Totals for EDGEWATER BOARD OF EDUCATION - 1 Claim Totals for EDGEWATER BOARD OF EDUCATION - 1 Claim Member: EDISON TOWNSHIP PUBLIC SCHOOLS Location: EDISON HS Coverage: (15) WORKERS' COMP NO MANAGED CARE- IND 20WC01240A EDISON HS (15) WORKERS' COMP NO 7/15/2020 Open OVEREXERTION - 654.27 MANAGED CARE- IND HOLD/CARRY Totals for (15) WORKERS' COMP NO MANAGED CARE- IND - 1 Claim Totals for EDISON HS - 1 Claim Location: EDISON TWP BOE Coverage: ERRORS AND OMISSIONS QN-3734 EDISON TWP BOE ERRORS AND OMISSIONS 5/23/2020 Open DUE PROCESS 0.00 QN-3743 EDISON TWP BOE ERRORS AND OMISSIONS 3/16/2020 Open DENIAL 0.00 Totals for ERRORS AND OMISSIONS - 2 Claims Coverage: GENERAL LIABILITY PROPERTY DAMAGE 20GL00183Q EDISON TWP BOE GENERAL LIABILITY 3/16/2020 Closed BREACH OF CONTRACT 0.00 PROPERTY DAMAGE Totals for GENERAL LIABILITY PROPERTY DAMAGE - 1 Claim Totals for EDISON TWP BOE - 3 Claims Totals for EDISON TOWNSHIP PUBLIC SCHOOLS - 4 Claims Member: ENGLEWOOD CITY BOARD OF EDUCATION Location: ENGLEWOOD BOARD OF EDUCATION Coverage: GENERAL LIABILITY - RECORD ONLY 20GL00175X ENGLEWOOD BOARD OF GENERAL LIABILITY - 6/23/2020 Closed NO OTHER CLASS - MISC 0.00 EDUCATION RECORD ONLY 20GL00185X ENGLEWOOD BOARD OF GENERAL LIABILITY - 7/29/2020 Closed NO OTHER CLASS - MISC 0.00 EDUCATION RECORD ONLY Totals for GENERAL LIABILITY - RECORD ONLY - 2 Claims Totals for ENGLEWOOD BOARD OF EDUCATION - 2 Claims Location: ENGLEWOOD CITY BOARD OF EDUCATION

9/10/2020 8:07:41 AM Page 9 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Coverage: ERRORS AND OMISSIONS QN-3748 ENGLEWOOD CITY ERRORS AND OMISSIONS 7/20/2020 Open IEP 0.00 BOARD OF EDUCATION QN-3747 ENGLEWOOD CITY ERRORS AND OMISSIONS 6/24/2020 Open DUE PROCESS 0.00 BOARD OF EDUCATION Totals for ERRORS AND OMISSIONS - 2 Claims Totals for ENGLEWOOD CITY BOARD OF EDUCATION - 2 Claims Totals for ENGLEWOOD CITY BOARD OF EDUCATION - 4 Claims Member: FLORHAM PARK BOARD OF EDUCATION Location: FLORHAM PARK BOE Coverage: ERRORS AND OMISSIONS QN-3721 FLORHAM PARK BOE ERRORS AND OMISSIONS 7/1/2020 Closed DUE PROCESS 0.00 Totals for ERRORS AND OMISSIONS - 1 Claim Totals for FLORHAM PARK BOE - 1 Claim Totals for FLORHAM PARK BOARD OF EDUCATION - 1 Claim Member: FOUNDATION ACADEMY CHARTER SCHOOL Location: Middle and Intermediate Schools Coverage: PROPERTY 20PR00107E Middle and Intermediate PROPERTY 7/15/2020 Closed VANDALISM 3,200.00 Schools Totals for PROPERTY - 1 Claim Totals for Middle and Intermediate Schools - 1 Claim Totals for FOUNDATION ACADEMY CHARTER SCHOOL - 1 Claim Member: FREEHOLD TOWNSHIP BOARD OF EDUCATION Location: CLIFTON T BARKALOW MS Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01190B CLIFTON T BARKALOW (11) WORKERS' COMP 7/10/2020 Closed INTERNAL/SUDDEN - 617.50 MS MEDICAL ONLY EYES Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for CLIFTON T BARKALOW MS - 1 Claim Totals for FREEHOLD TOWNSHIP BOARD OF EDUCATION - 1 Claim Member: GARFIELD BOARD OF EDUCATION Location: GARFIELD HS Coverage: PROPERTY 20PR00114Q GARFIELD HS PROPERTY 7/6/2020 Open WEATHER - WIND 0.00 Totals for PROPERTY - 1 Claim

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Claim Number Location Coverage Loss Date Status Cause Total Paid Totals for GARFIELD HS - 1 Claim Location: GARFIELD MS Coverage: GENERAL LIABILITY PROPERTY DAMAGE 20GL00177S GARFIELD MS GENERAL LIABILITY 5/5/2020 Open TITLE 18A 0.00 PROPERTY DAMAGE Totals for GENERAL LIABILITY PROPERTY DAMAGE - 1 Claim Totals for GARFIELD MS - 1 Claim Location: WASHINGTON IRVINGTON SCHOOL #4 Coverage: (10) WORKERS' COMP LOST TIME- IND 20WC01262T WASHINGTON (10) WORKERS' COMP 7/29/2020 Open STRUCK BY 5,375.21 IRVINGTON SCHOOL #4 LOST TIME- IND Totals for (10) WORKERS' COMP LOST TIME- IND - 1 Claim Totals for WASHINGTON IRVINGTON SCHOOL #4 - 1 Claim Totals for GARFIELD BOARD OF EDUCATION - 3 Claims Member: GCSSSD & BOE OF SSSD & VSDCG Location: BANKRIDGE REGIONAL SCHOOL Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01211U BANKRIDGE REGIONAL (11) WORKERS' COMP 7/16/2020 Open STRUCK AGAINST 800.81 SCHOOL MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for BANKRIDGE REGIONAL SCHOOL - 1 Claim Totals for GCSSSD & BOE OF SSSD & VSDCG - 1 Claim Member: GLASSBORO BOARD OF EDUCATION Location: GLASSBORO INTERMEDIATE SCHOOL Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01247Y GLASSBORO (11) WORKERS' COMP 7/28/2020 Open FALL SAME LEVEL - 711.89 INTERMEDIATE SCHOOL MEDICAL ONLY OTHER Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for GLASSBORO INTERMEDIATE SCHOOL - 1 Claim Totals for GLASSBORO BOARD OF EDUCATION - 1 Claim Member: HACKENSACK BOARD OF EDUCATION Location: FAIRMOUNT ES Coverage: (10) WORKERS' COMP LOST TIME- IND 20WC01218T FAIRMOUNT ES (10) WORKERS' COMP 7/20/2020 Open OVEREXERTION - OTHER 6,584.50 LOST TIME- IND Totals for (10) WORKERS' COMP LOST TIME- IND - 1 Claim Totals for FAIRMOUNT ES - 1 Claim

9/10/2020 8:07:41 AM Page 11 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Location: HACKENSACK HS Coverage: (10) WORKERS' COMP LOST TIME- IND 20WC01183T HACKENSACK HS (10) WORKERS' COMP 7/2/2020 Open FALL SAME LEVEL - 7,426.59 LOST TIME- IND WET/SLIP SURF Totals for (10) WORKERS' COMP LOST TIME- IND - 1 Claim Totals for HACKENSACK HS - 1 Claim Totals for HACKENSACK BOARD OF EDUCATION - 2 Claims Member: HALEDON BOARD OF EDUCATION Location: HALEDON ES Coverage: ERRORS AND OMISSIONS QN-3742 HALEDON ES ERRORS AND OMISSIONS 7/20/2020 Open Employ Related 0.00 Totals for ERRORS AND OMISSIONS - 1 Claim Totals for HALEDON ES - 1 Claim Totals for HALEDON BOARD OF EDUCATION - 1 Claim Member: HAMBURG BOROUGH BOARD OF EDUCATION Location: HAMBURG ES Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01221K HAMBURG ES (11) WORKERS' COMP 7/14/2020 Closed ANIMAL/INSECT/PLANT 1,010.00 MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for HAMBURG ES - 1 Claim Totals for HAMBURG BOROUGH BOARD OF EDUCATION - 1 Claim Member: HAMILTON TOWNSHIP BOARD OF EDUCATION Location: CROCKETT M.S. Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01251B CROCKETT M.S. (11) WORKERS' COMP 7/29/2020 Closed FALL SAME LEVEL - 250.00 MEDICAL ONLY OTHER Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for CROCKETT M.S. - 1 Claim Location: GRICE M.S. Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01258Y GRICE M.S. (11) WORKERS' COMP 7/23/2020 Open FALL SAME LEVEL - 250.00 MEDICAL ONLY WET/SLIP SURF Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for GRICE M.S. - 1 Claim Location: HAMILTON H.S. EAST - STEINERT

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Claim Number Location Coverage Loss Date Status Cause Total Paid Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01208B HAMILTON H.S. EAST - (11) WORKERS' COMP 7/16/2020 Closed ANIMAL/INSECT/PLANT 250.00 STEINERT MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for HAMILTON H.S. EAST - STEINERT - 1 Claim Location: HAMILTON H.S. NORTH - NOTTHINGHAM Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01184Y HAMILTON H.S. NORTH - (11) WORKERS' COMP 6/30/2020 Open OVEREXERTION - OTHER 250.00 NOTTHINGHAM MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for HAMILTON H.S. NORTH - NOTTHINGHAM - 1 Claim Location: HAMILTON H.S. WEST Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01195B HAMILTON H.S. WEST (11) WORKERS' COMP 7/14/2020 Open INTERNAL/SUDDEN - 352.03 MEDICAL ONLY EYES Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for HAMILTON H.S. WEST - 1 Claim Location: YARDVILLE E.S. Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01204U YARDVILLE E.S. (11) WORKERS' COMP 7/15/2020 Open STRUCK BY 400.07 MEDICAL ONLY 20WC01227W YARDVILLE E.S. (11) WORKERS' COMP 7/22/2020 Open STRUCK BY 250.00 MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 2 Claims Totals for YARDVILLE E.S. - 2 Claims Totals for HAMILTON TOWNSHIP BOARD OF EDUCATION - 7 Claims Member: HANOVER PARK REGIONAL HIGH SCHOOL DISTRICT Location: HANOVER PARK HS Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01215U HANOVER PARK HS (11) WORKERS' COMP 7/10/2020 Open OVEREXERTION - 313.22 MEDICAL ONLY LIFT/LOWER Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for HANOVER PARK HS - 1 Claim Totals for HANOVER PARK REGIONAL HIGH SCHOOL DISTRICT - 1 Claim Member: HARMONY TOWNSHIP BOARD OF EDUCATION Location: HARMONY TWP ES

9/10/2020 8:07:41 AM Page 13 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01243Y HARMONY TWP ES (11) WORKERS' COMP 7/14/2020 Open FALL DIFFERENT LEVEL - 250.00 MEDICAL ONLY OTHER Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for HARMONY TWP ES - 1 Claim Totals for HARMONY TOWNSHIP BOARD OF EDUCATION - 1 Claim Member: HARRISON BOARD OF EDUCATION Location: HARRISON BOE Coverage: PROPERTY 20PR00099H HARRISON BOE PROPERTY 7/1/2020 Open WATER DAMAGE - BUILD 64,332.07 LEAK Totals for PROPERTY - 1 Claim Totals for HARRISON BOE - 1 Claim Totals for HARRISON BOARD OF EDUCATION - 1 Claim Member: HAZLET TOWNSHIP BOARD OF EDUCATION Location: BLDG & GRDS Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01253W BLDG & GRDS (11) WORKERS' COMP 7/29/2020 Open STRUCK BY 380.30 MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for BLDG & GRDS - 1 Claim Totals for HAZLET TOWNSHIP BOARD OF EDUCATION - 1 Claim Member: HILLSBOROUGH TOWNSHIP BOARD OF EDUCATION Location: HILLSBORO TWP. BOARD OF EDUCATION Coverage: (15) WORKERS' COMP NO MANAGED CARE- IND 20WC01187Z HILLSBORO TWP. BOARD (15) WORKERS' COMP NO 2/3/2020 Open OVEREXERTION - OTHER 0.00 OF EDUCATION MANAGED CARE- IND Totals for (15) WORKERS' COMP NO MANAGED CARE- IND - 1 Claim Totals for HILLSBORO TWP. BOARD OF EDUCATION - 1 Claim Location: HILLSBOROUGH ES Coverage: (10) WORKERS' COMP LOST TIME- IND 20WC01241Z HILLSBOROUGH ES (10) WORKERS' COMP 7/27/2020 Open OVEREXERTION - 2,845.20 LOST TIME- IND PUSH/PULL Totals for (10) WORKERS' COMP LOST TIME- IND - 1 Claim Totals for HILLSBOROUGH ES - 1 Claim Totals for HILLSBOROUGH TOWNSHIP BOARD OF EDUCATION - 2 Claims

9/10/2020 8:07:41 AM Page 14 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Member: HILLSIDE TOWNSHIP BOARD OF EDUCATION Location: HILLSIDE HS Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01186U HILLSIDE HS (11) WORKERS' COMP 7/8/2020 Open FALL SAME LEVEL - 1,772.48 MEDICAL ONLY OTHER Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for HILLSIDE HS - 1 Claim Totals for HILLSIDE TOWNSHIP BOARD OF EDUCATION - 1 Claim Member: HOPEWELL VALLEY REGIONAL SCHOOL DISTRICT Location: ADMIN BLDG Coverage: RECORD-ONLY CYBER LIABILITY 20CL00005X ADMIN BLDG RECORD-ONLY CYBER 6/24/2020 Closed NETWORK COMPROMISE 0.00 LIABILITY Totals for RECORD-ONLY CYBER LIABILITY - 1 Claim Totals for ADMIN BLDG - 1 Claim Totals for HOPEWELL VALLEY REGIONAL SCHOOL DISTRICT - 1 Claim Member: HOWELL TOWNSHIP BOARD OF EDUCATION Location: ADMINISTRATION OFFICE Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01225U ADMINISTRATION OFFICE (11) WORKERS' COMP 7/21/2020 Open OVEREXERTION - 679.50 MEDICAL ONLY LIFT/LOWER Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for ADMINISTRATION OFFICE - 1 Claim Location: LAND O PINES SCHOOL Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01214A LAND O PINES SCHOOL (11) WORKERS' COMP 7/9/2020 Open FALL SAME LEVEL - 911.59 MEDICAL ONLY OTHER Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for LAND O PINES SCHOOL - 1 Claim Location: TRANSPORTATION BLDG Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01210U TRANSPORTATION BLDG (11) WORKERS' COMP 5/4/2020 Closed STRUCK BY 721.66 MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for TRANSPORTATION BLDG - 1 Claim Totals for HOWELL TOWNSHIP BOARD OF EDUCATION - 3 Claims Member: JERSEY CITY BOARD OF EDUCATION

9/10/2020 8:07:41 AM Page 15 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Location: Coverage: GENERAL LIABILITY BODILY INJURY 19GL00764S INFINITY INSTITUTE GENERAL LIABILITY 9/20/2019 Open SEXUAL ASSAULT 0.00 BODILY INJURY Totals for GENERAL LIABILITY BODILY INJURY - 1 Claim Totals for INFINITY INSTITUTE - 1 Claim Location: JERSEY CITY PUBLIC SCHOOLS Coverage: ERRORS AND OMISSIONS QN-3755 JERSEY CITY PUBLIC ERRORS AND OMISSIONS 7/22/2020 Closed DENIAL 0.00 SCHOOLS QN-3777 JERSEY CITY PUBLIC ERRORS AND OMISSIONS 6/2/2020 Open 0.00 SCHOOLS Totals for ERRORS AND OMISSIONS - 2 Claims Totals for JERSEY CITY PUBLIC SCHOOLS - 2 Claims Location: MCNAIR ACADEMIC HS Coverage: PROPERTY 20PR00117Q MCNAIR ACADEMIC HS PROPERTY 6/22/2020 Closed MOLD REMEDIATION 0.00 ONLY Totals for PROPERTY - 1 Claim Totals for MCNAIR ACADEMIC HS - 1 Claim Totals for JERSEY CITY BOARD OF EDUCATION - 4 Claims Member: KEYPORT BOARD OF EDUCATION Location: CENTRAL ES Coverage: (10) WORKERS' COMP LOST TIME- IND 20WC01212M CENTRAL ES (10) WORKERS' COMP 7/15/2020 Open OVEREXERTION - 1,103.64 LOST TIME- IND LIFT/LOWER Totals for (10) WORKERS' COMP LOST TIME- IND - 1 Claim Totals for CENTRAL ES - 1 Claim Totals for KEYPORT BOARD OF EDUCATION - 1 Claim Member: KINGWOOD TOWNSHIP BOARD OF EDUCATION Location: KINGWOOD TWP BOE Coverage: PROPERTY 20PR00101Q KINGWOOD TWP BOE PROPERTY 6/1/2020 Closed ALL OTHER PERILS 0.00 Totals for PROPERTY - 1 Claim Totals for KINGWOOD TWP BOE - 1 Claim Totals for KINGWOOD TOWNSHIP BOARD OF EDUCATION - 1 Claim Member: LACEY TOWNSHIP BOARD OF EDUCATION

9/10/2020 8:07:41 AM Page 16 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Location: LACEY TWP BOE Coverage: ERRORS AND OMISSIONS QN-3732 LACEY TWP BOE ERRORS AND OMISSIONS 5/27/2020 Open DUE PROCESS 0.00 Totals for ERRORS AND OMISSIONS - 1 Claim Totals for LACEY TWP BOE - 1 Claim Totals for LACEY TOWNSHIP BOARD OF EDUCATION - 1 Claim Member: LINDEN BOARD OF EDUCATION Location: MCMANUS MIDDLE SCHOOL Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01201Y MCMANUS MIDDLE (11) WORKERS' COMP 7/14/2020 Closed ANIMAL/INSECT/PLANT 313.22 SCHOOL MEDICAL ONLY 20WC01202Y MCMANUS MIDDLE (11) WORKERS' COMP 7/14/2020 Closed ANIMAL/INSECT/PLANT 585.08 SCHOOL MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 2 Claims Totals for MCMANUS MIDDLE SCHOOL - 2 Claims Totals for LINDEN BOARD OF EDUCATION - 2 Claims Member: LITTLE FALLS TOWNSHIP BOARD OF EDUCATION Location: SCHOOL #3 Coverage: PROPERTY 20PR00106L SCHOOL #3 PROPERTY 7/8/2020 Open FIRE - ELECTRICAL 0.00 Totals for PROPERTY - 1 Claim Totals for SCHOOL #3 - 1 Claim Totals for LITTLE FALLS TOWNSHIP BOARD OF EDUCATION - 1 Claim Member: LITTLE SILVER BOROUGH BOARD OF EDUCATION Location: LITTLE SILVER BOROUGH BOE Coverage: ERRORS AND OMISSIONS QN-3733 LITTLE SILVER BOROUGH ERRORS AND OMISSIONS 6/24/2020 Open DUE PROCESS 0.00 BOE Totals for ERRORS AND OMISSIONS - 1 Claim Totals for LITTLE SILVER BOROUGH BOE - 1 Claim Totals for LITTLE SILVER BOROUGH BOARD OF EDUCATION - 1 Claim Member: LODI BOARD OF EDUCATION Location: LODI BOE Coverage: ERRORS AND OMISSIONS QN-3749 LODI BOE ERRORS AND OMISSIONS 12/1/2019 Open DENIAL 0.00 Totals for ERRORS AND OMISSIONS - 1 Claim

9/10/2020 8:07:41 AM Page 17 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Coverage: GENERAL LIABILITY BODILY INJURY 19GL00762D LODI BOE GENERAL LIABILITY 12/1/2019 Open ASSAULT 0.00 BODILY INJURY Totals for GENERAL LIABILITY BODILY INJURY - 1 Claim Totals for LODI BOE - 2 Claims Totals for LODI BOARD OF EDUCATION - 2 Claims Member: LONG BRANCH BOARD OF EDUCATION Location: MIDDLE SCHOOL Coverage: (18) NO LOST TIME MC FEE 20WC01231W MIDDLE SCHOOL (18) NO LOST TIME MC 7/15/2020 Open STRUCK BY 3,057.83 FEE Totals for (18) NO LOST TIME MC FEE - 1 Claim Totals for MIDDLE SCHOOL - 1 Claim Totals for LONG BRANCH BOARD OF EDUCATION - 1 Claim Member: MANCHESTER TOWNSHIP BOARD OF EDUCATION Location: ADMIN BLDG Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01181U ADMIN BLDG (11) WORKERS' COMP 6/7/2020 Closed FALL SAME LEVEL - ??? 250.00 MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for ADMIN BLDG - 1 Claim Totals for MANCHESTER TOWNSHIP BOARD OF EDUCATION - 1 Claim Member: MATAWAN-ABERDEEN REGIONAL BOARD OF EDUCATION Location: CAMBRIDGE PARK ES Coverage: (18) NO LOST TIME MC FEE 20WC01175J CAMBRIDGE PARK ES (18) NO LOST TIME MC 6/30/2020 Closed ANIMAL/INSECT/PLANT 436.75 FEE Totals for (18) NO LOST TIME MC FEE - 1 Claim Totals for CAMBRIDGE PARK ES - 1 Claim Location: MATAWAN REGIONAL HS Coverage: BOILER AND MACHINERY 20PR00119E MATAWAN REGIONAL HS BOILER AND MACHINERY 7/28/2020 Open BOILER AND MACHINERY 0.00 Totals for BOILER AND MACHINERY - 1 Claim

9/10/2020 8:07:41 AM Page 18 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Coverage: GENERAL LIABILITY - RECORD ONLY 20GL00180X MATAWAN REGIONAL HS GENERAL LIABILITY - 7/17/2020 Closed NO OTHER CLASS - MISC 0.00 RECORD ONLY Totals for GENERAL LIABILITY - RECORD ONLY - 1 Claim Totals for MATAWAN REGIONAL HS - 2 Claims Totals for MATAWAN-ABERDEEN REGIONAL BOARD OF EDUCATION - 3 Claims Member: MENDHAM BOROUGH BOARD OF EDUCATION Location: MOUNTAIN VIEW MS Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01219Y MOUNTAIN VIEW MS (11) WORKERS' COMP 7/17/2020 Open OVEREXERTION - 425.00 MEDICAL ONLY LIFT/LOWER 20WC01261K MOUNTAIN VIEW MS (11) WORKERS' COMP 7/29/2020 Open OVEREXERTION - 501.12 MEDICAL ONLY LIFT/LOWER Totals for (11) WORKERS' COMP MEDICAL ONLY - 2 Claims Totals for MOUNTAIN VIEW MS - 2 Claims Totals for MENDHAM BOROUGH BOARD OF EDUCATION - 2 Claims Member: MIDDLESEX BOROUGH BOARD OF EDUCATION Location: MIDDLESEX BORO BOE Coverage: ERRORS AND OMISSIONS QN-3750 MIDDLESEX BORO BOE ERRORS AND OMISSIONS 7/31/2020 Open Employ Related 0.00 Totals for ERRORS AND OMISSIONS - 1 Claim Totals for MIDDLESEX BORO BOE - 1 Claim Totals for MIDDLESEX BOROUGH BOARD OF EDUCATION - 1 Claim Member: MIDDLESEX COUNTY VOCATIONAL & TECHNICAL HIGH SCHOOLS Location: EAST BRUNSWICK CAMPUS Coverage: (18) NO LOST TIME MC FEE 20WC01242R EAST BRUNSWICK (18) NO LOST TIME MC 7/24/2020 Open OVEREXERTION - 3,677.36 CAMPUS FEE LIFT/LOWER Totals for (18) NO LOST TIME MC FEE - 1 Claim Totals for EAST BRUNSWICK CAMPUS - 1 Claim Totals for MIDDLESEX COUNTY VOCATIONAL & TECHNICAL HIGH SCHOOLS - 1 Claim Member: MIDDLETOWN TOWNSHIP BOARD OF EDUCATION Location: BAYSHORE MS

9/10/2020 8:07:41 AM Page 19 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01176U BAYSHORE MS (11) WORKERS' COMP 6/30/2020 Closed OVEREXERTION - 462.06 MEDICAL ONLY LIFT/LOWER Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for BAYSHORE MS - 1 Claim Location: THOMPSON MS Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01185W THOMPSON MS (11) WORKERS' COMP 6/15/2020 Closed OVEREXERTION - 380.30 MEDICAL ONLY PUSH/PULL Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for THOMPSON MS - 1 Claim Totals for MIDDLETOWN TOWNSHIP BOARD OF EDUCATION - 2 Claims Member: MILLVILLE BOARD OF EDUCATION Location: MILLVILLE SR HS Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01228Y MILLVILLE SR HS (11) WORKERS' COMP 7/21/2020 Open STRUCK AGAINST 250.00 MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for MILLVILLE SR HS - 1 Claim Totals for MILLVILLE BOARD OF EDUCATION - 1 Claim Member: MONROE TOWNSHIP BOARD OF EDUCATION (MIDDLESEX) Location: MONROE TWP. BOARD OF EDUCATION Coverage: ERRORS AND OMISSIONS QN-3729 MONROE TWP. BOARD ERRORS AND OMISSIONS 7/7/2020 Open DUE PROCESS 0.00 OF EDUCATION Totals for ERRORS AND OMISSIONS - 1 Claim Coverage: PROPERTY 19PR00220E MONROE TWP. BOARD PROPERTY 7/16/2019 Open ALL OTHER PERILS 22,448.00 OF EDUCATION Totals for PROPERTY - 1 Claim Totals for MONROE TWP. BOARD OF EDUCATION - 2 Claims Totals for MONROE TOWNSHIP BOARD OF EDUCATION (MIDDLESEX) - 2 Claims Member: MONTGOMERY TOWNSHIP BOARD OF EDUCATION Location: MONTGOMERY TWP. BOARD OF EDUCATION

9/10/2020 8:07:41 AM Page 20 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Coverage: ERRORS AND OMISSIONS QN-3738 MONTGOMERY TWP. ERRORS AND OMISSIONS 7/21/2020 Closed STUDENT ACT 0.00 BOARD OF EDUCATION Totals for ERRORS AND OMISSIONS - 1 Claim Totals for MONTGOMERY TWP. BOARD OF EDUCATION - 1 Claim Totals for MONTGOMERY TOWNSHIP BOARD OF EDUCATION - 1 Claim Member: MORRIS SCHOOL DISTRICT BOARD OF EDUCATION Location: MORRISTOWN H.S. Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01252Y MORRISTOWN H.S. (11) WORKERS' COMP 7/28/2020 Open FALL SAME LEVEL - 425.00 MEDICAL ONLY OTHER Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for MORRISTOWN H.S. - 1 Claim Location: NORMANDY PARK SCHOOL Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01250K NORMANDY PARK (11) WORKERS' COMP 7/29/2020 Open STRUCK BY 250.00 SCHOOL MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for NORMANDY PARK SCHOOL - 1 Claim Totals for MORRIS SCHOOL DISTRICT BOARD OF EDUCATION - 2 Claims Member: Mount Olive Township Board of Education Location: Mount Olive MS Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01193Y Mount Olive MS (11) WORKERS' COMP 7/10/2020 Open FALL DIFFERENT LEVEL - 872.44 MEDICAL ONLY LADDER/SCAFFOLD Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for Mount Olive MS - 1 Claim Totals for Mount Olive Township Board of Education - 1 Claim Member: NEPTUNE TOWNSHIP BOARD OF EDUCATION Location: Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01238U NEPTUNE HIGH SCHOOL (11) WORKERS' COMP 7/23/2020 Open INTERNAL/SUDDEN - 259.84 MEDICAL ONLY EYES Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for NEPTUNE HIGH SCHOOL - 1 Claim Totals for NEPTUNE TOWNSHIP BOARD OF EDUCATION - 1 Claim

9/10/2020 8:07:41 AM Page 21 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Member: NORTH BERGEN BOARD OF EDUCATION Location: LINCOLN SCHOOL Coverage: (18) NO LOST TIME MC FEE 20WC01174M LINCOLN SCHOOL (18) NO LOST TIME MC 6/29/2020 Open OVEREXERTION - OTHER 8,225.95 FEE Totals for (18) NO LOST TIME MC FEE - 1 Claim Totals for LINCOLN SCHOOL - 1 Claim Totals for NORTH BERGEN BOARD OF EDUCATION - 1 Claim Member: NORTH HALEDON BOARD OF EDUCATION Location: MEMORIAL ES Coverage: GENERAL LIABILITY - RECORD ONLY 20GL00176X MEMORIAL ES GENERAL LIABILITY - 6/30/2020 Closed NO OTHER CLASS - MISC 0.00 RECORD ONLY Totals for GENERAL LIABILITY - RECORD ONLY - 1 Claim Totals for MEMORIAL ES - 1 Claim Location: NORTH HALEDON BOE Coverage: ERRORS AND OMISSIONS QN-3722 NORTH HALEDON BOE ERRORS AND OMISSIONS 7/7/2020 Open DUE PROCESS 0.00 QN-3745 NORTH HALEDON BOE ERRORS AND OMISSIONS 7/7/2020 Open DUE PROCESS 0.00 Totals for ERRORS AND OMISSIONS - 2 Claims Totals for NORTH HALEDON BOE - 2 Claims Totals for NORTH HALEDON BOARD OF EDUCATION - 3 Claims Member: NORTHERN VALLEY REGIONAL BOARD OF EDUCATION Location: NORTHERN VALLEY DEMAREST HS Coverage: GENERAL LIABILITY BODILY INJURY 19GL00766E NORTHERN VALLEY GENERAL LIABILITY 2/13/2019 Open HIB OTHER 0.00 DEMAREST HS BODILY INJURY Totals for GENERAL LIABILITY BODILY INJURY - 1 Claim Totals for NORTHERN VALLEY DEMAREST HS - 1 Claim Totals for NORTHERN VALLEY REGIONAL BOARD OF EDUCATION - 1 Claim Member: OCEAN CITY BOARD OF EDUCATION Location: INTERMEDIATE SCHOOL Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01249B INTERMEDIATE SCHOOL (11) WORKERS' COMP 7/28/2020 Closed OVEREXERTION - 250.00 MEDICAL ONLY LIFT/LOWER Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim

9/10/2020 8:07:41 AM Page 22 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Totals for INTERMEDIATE SCHOOL - 1 Claim Totals for OCEAN CITY BOARD OF EDUCATION - 1 Claim Member: OCEAN TOWNSHIP BOARD OF EDUCATION (MONMOUTH) Location: ADMIN BLDG Coverage: (18) NO LOST TIME MC FEE 20WC01209K ADMIN BLDG (18) NO LOST TIME MC 7/16/2020 Open STRUCK BY 380.30 FEE Totals for (18) NO LOST TIME MC FEE - 1 Claim Totals for ADMIN BLDG - 1 Claim Totals for OCEAN TOWNSHIP BOARD OF EDUCATION (MONMOUTH) - 1 Claim Member: OCEAN TOWNSHIP BOARD OF EDUCATION (OCEAN) Location: OCEAN TWP. BOARD OF EDUCATION Coverage: PROPERTY 20PR00115Q OCEAN TWP. BOARD OF PROPERTY 7/23/2020 Open WEATHER - WIND 0.00 EDUCATION Totals for PROPERTY - 1 Claim Totals for OCEAN TWP. BOARD OF EDUCATION - 1 Claim Totals for OCEAN TOWNSHIP BOARD OF EDUCATION (OCEAN) - 1 Claim Member: PASSAIC CITY BOARD OF EDUCATION Location: DANIEL F. RYAN SCHOOL No. 19 Coverage: GENERAL LIABILITY BODILY INJURY 18GL00826L/01 DANIEL F. RYAN SCHOOL GENERAL LIABILITY 6/30/2018 Open HIB RACE 0.00 No. 19 BODILY INJURY Totals for GENERAL LIABILITY BODILY INJURY - 1 Claim Totals for DANIEL F. RYAN SCHOOL No. 19 - 1 Claim Totals for PASSAIC CITY BOARD OF EDUCATION - 1 Claim Member: PASSAIC COUNTY TECHNICAL INSTITUTE Location: PASSAIC COUNTY TECH. INSTITUTE Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01246U PASSAIC COUNTY TECH. (11) WORKERS' COMP 7/28/2020 Open FALL DIFFERENT LEVEL - 437.36 INSTITUTE MEDICAL ONLY STAIRS/STEPS Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for PASSAIC COUNTY TECH. INSTITUTE - 1 Claim Totals for PASSAIC COUNTY TECHNICAL INSTITUTE - 1 Claim Member: PATERSON PUBLIC SCHOOL DISTRICT Location: MLK School

9/10/2020 8:07:41 AM Page 23 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Coverage: PROPERTY 20PR00109H MLK School PROPERTY 7/15/2020 Open ALL OTHER PERILS 0.00 Totals for PROPERTY - 1 Claim Totals for MLK School - 1 Claim Location: School No. 14 Coverage: PROPERTY 20PR00103Q School No. 14 PROPERTY 6/30/2020 Open VANDALISM 0.00 Totals for PROPERTY - 1 Claim Totals for School No. 14 - 1 Claim Totals for PATERSON PUBLIC SCHOOL DISTRICT - 2 Claims Member: PEOPLE'S PREPARATORY CHARTER SCHOOL Location: PEOPLE'S PREP CHARTER Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01224Z PEOPLE'S PREP (11) WORKERS' COMP 7/21/2020 Open MOTOR VEHICLE 250.00 CHARTER MEDICAL ONLY ACCIDENT - OTHER Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for PEOPLE'S PREP CHARTER - 1 Claim Totals for PEOPLE'S PREPARATORY CHARTER SCHOOL - 1 Claim Member: PERTH AMBOY BOARD OF EDUCATION Location: PERTH AMBOY Coverage: ERRORS AND OMISSIONS QN-3726 PERTH AMBOY ERRORS AND OMISSIONS 3/30/2020 Closed DENIAL 0.00 Totals for ERRORS AND OMISSIONS - 1 Claim Totals for PERTH AMBOY - 1 Claim Location: PERTH AMBOY ADMIN BLDG Coverage: GENERAL LIABILITY PROPERTY DAMAGE 20GL00178E PERTH AMBOY ADMIN GENERAL LIABILITY 7/1/2020 Closed BREACH OF CONTRACT 0.00 BLDG PROPERTY DAMAGE Totals for GENERAL LIABILITY PROPERTY DAMAGE - 1 Claim Totals for PERTH AMBOY ADMIN BLDG - 1 Claim Totals for PERTH AMBOY BOARD OF EDUCATION - 2 Claims Member: PHILIP'S ACADEMY CHARTER SCHOOL Location: PHILIPS ACADEMY CHARTER BOE

9/10/2020 8:07:41 AM Page 24 of 34 NJSIG July 2020 New Claims Reported (New) Valued as of 09/10/2020

Claim Number Location Coverage Loss Date Status Cause Total Paid Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01206B PHILIPS ACADEMY (11) WORKERS' COMP 7/15/2020 Closed TEMPERATURE 397.90 CHARTER BOE MEDICAL ONLY EXTREME - HOT Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for PHILIPS ACADEMY CHARTER BOE - 1 Claim Totals for PHILIP'S ACADEMY CHARTER SCHOOL - 1 Claim Member: PINELANDS REGIONAL SCHOOL DISTRICT Location: PINELANDS HIGH SCHOOL Coverage: PROPERTY 20PR00104Q PINELANDS HIGH PROPERTY 7/1/2020 Open WEATHER - WIND 13,450.00 SCHOOL Totals for PROPERTY - 1 Claim Totals for PINELANDS HIGH SCHOOL - 1 Claim Totals for PINELANDS REGIONAL SCHOOL DISTRICT - 1 Claim Member: PISCATAWAY TOWNSHIP BOARD OF EDUCATION Location: ADMIN BLDG Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01189K ADMIN BLDG (11) WORKERS' COMP 7/9/2020 Closed FALL SAME LEVEL - 900.85 MEDICAL ONLY WET/SLIP SURF Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for ADMIN BLDG - 1 Claim Location: BLDG & GRDS Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01192U BLDG & GRDS (11) WORKERS' COMP 7/13/2020 Open OVEREXERTION - 875.83 MEDICAL ONLY PUSH/PULL Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for BLDG & GRDS - 1 Claim Location: PISCATAWAY TWP BOE Coverage: ERRORS AND OMISSIONS QN-3723 PISCATAWAY TWP BOE ERRORS AND OMISSIONS 7/7/2020 Open DUE PROCESS 0.00 Totals for ERRORS AND OMISSIONS - 1 Claim Totals for PISCATAWAY TWP BOE - 1 Claim Location: THEODORE SCHOR M.S.

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Claim Number Location Coverage Loss Date Status Cause Total Paid Coverage: PROPERTY 20PR00116D THEODORE SCHOR M.S. PROPERTY 7/23/2020 Open WEATHER - WIND 0.00 Totals for PROPERTY - 1 Claim Totals for THEODORE SCHOR M.S. - 1 Claim Totals for PISCATAWAY TOWNSHIP BOARD OF EDUCATION - 4 Claims Member: PLAINFIELD BOARD OF EDUCATION Location: PLAINFIELD BOARD OF EDUCATION Coverage: ERRORS AND OMISSIONS QN-3719 PLAINFIELD BOARD OF ERRORS AND OMISSIONS 6/25/2020 Closed DENIAL 0.00 EDUCATION QN-3739 PLAINFIELD BOARD OF ERRORS AND OMISSIONS 7/1/2020 Open Employ Related 0.00 EDUCATION QN-3727 PLAINFIELD BOARD OF ERRORS AND OMISSIONS 7/8/2020 Closed DENIAL 0.00 EDUCATION Totals for ERRORS AND OMISSIONS - 3 Claims Coverage: GENERAL LIABILITY PROPERTY DAMAGE 18GL00853Q PLAINFIELD BOARD OF GENERAL LIABILITY 9/1/2018 Closed BREACH OF CONTRACT 0.00 EDUCATION PROPERTY DAMAGE Totals for GENERAL LIABILITY PROPERTY DAMAGE - 1 Claim Totals for PLAINFIELD BOARD OF EDUCATION - 4 Claims Totals for PLAINFIELD BOARD OF EDUCATION - 4 Claims Member: PRINCETON PUBLIC SCHOOLS Location: PRINCETON BOE Coverage: GENERAL LIABILITY - RECORD ONLY 20GL00181X PRINCETON BOE GENERAL LIABILITY - 3/12/2020 Closed NO OTHER CLASS - MISC 0.00 RECORD ONLY Totals for GENERAL LIABILITY - RECORD ONLY - 1 Claim Totals for PRINCETON BOE - 1 Claim Totals for PRINCETON PUBLIC SCHOOLS - 1 Claim Member: RAHWAY BOARD OF EDUCATION Location: RAHWAY BOARD OF EDUCATION Coverage: AUTO LIABILITY PROPERTY DAMAGE 20AL00096H RAHWAY BOARD OF AUTO LIABILITY 6/9/2020 Closed NON INTERSECTION - HIT 0.00 EDUCATION PROPERTY DAMAGE BY Totals for AUTO LIABILITY PROPERTY DAMAGE - 1 Claim Totals for RAHWAY BOARD OF EDUCATION - 1 Claim

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Claim Number Location Coverage Loss Date Status Cause Total Paid Totals for RAHWAY BOARD OF EDUCATION - 1 Claim Member: ROSELLE BOROUGH BOARD OF EDUCATION Location: ABRAHAM CLARK HIGH SCHOOL Coverage: PROPERTY 20PR00110S ABRAHAM CLARK HIGH PROPERTY 7/15/2020 Open ALL OTHER PERILS 0.00 SCHOOL Totals for PROPERTY - 1 Claim Totals for ABRAHAM CLARK HIGH SCHOOL - 1 Claim Totals for ROSELLE BOROUGH BOARD OF EDUCATION - 1 Claim Member: ROSELLE PARK BOARD OF EDUCATION Location: ROSELLE PARK BOARD OF EDUCATION Coverage: ERRORS AND OMISSIONS QN-3730 ROSELLE PARK BOARD ERRORS AND OMISSIONS 7/1/2020 Open Employ Related 0.00 OF EDUCATION Totals for ERRORS AND OMISSIONS - 1 Claim Totals for ROSELLE PARK BOARD OF EDUCATION - 1 Claim Totals for ROSELLE PARK BOARD OF EDUCATION - 1 Claim Member: ROXBURY TOWNSHIP BOARD OF EDUCATION Location: TRANSPORTATION Coverage: (14) WORKERS' COMP NO MANAGED CARE - MO 20WC01179Z TRANSPORTATION (14) WORKERS' COMP NO 4/27/2020 Open OVEREXERTION - 0.00 MANAGED CARE - MO LIFT/LOWER Totals for (14) WORKERS' COMP NO MANAGED CARE - MO - 1 Claim Totals for TRANSPORTATION - 1 Claim Totals for ROXBURY TOWNSHIP BOARD OF EDUCATION - 1 Claim Member: SALEM CITY BOARD OF EDUCATION Location: JOHN FENWICK ACADEMY Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01217K JOHN FENWICK (11) WORKERS' COMP 7/16/2020 Open OVEREXERTION - 512.73 ACADEMY MEDICAL ONLY PUSH/PULL Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for JOHN FENWICK ACADEMY - 1 Claim Totals for SALEM CITY BOARD OF EDUCATION - 1 Claim Member: SCOTCH PLAINS FANWOOD BOARD OF EDUCATION Location: TERRILL MS

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Claim Number Location Coverage Loss Date Status Cause Total Paid Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01232B TERRILL MS (11) WORKERS' COMP 7/23/2020 Open FALL SAME LEVEL - 250.00 MEDICAL ONLY HOUSEKEEPING Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for TERRILL MS - 1 Claim Totals for SCOTCH PLAINS FANWOOD BOARD OF EDUCATION - 1 Claim Member: SHREWSBURY BOROUGH BOARD OF EDUCATION Location: SHREWBURY E.S. Coverage: GENERAL LIABILITY BODILY INJURY 20GL00182Q SHREWBURY E.S. GENERAL LIABILITY 6/29/2020 Closed STRUCK AGAINST 0.00 BODILY INJURY Totals for GENERAL LIABILITY BODILY INJURY - 1 Claim Totals for SHREWBURY E.S. - 1 Claim Totals for SHREWSBURY BOROUGH BOARD OF EDUCATION - 1 Claim Member: SOMERVILLE BOARD OF EDUCATION Location: SOMERVILLE BOE Coverage: GENERAL LIABILITY PROPERTY DAMAGE 17GL04456L SOMERVILLE BOE GENERAL LIABILITY 5/3/2017 Closed BREACH OF CONTRACT 0.00 PROPERTY DAMAGE Totals for GENERAL LIABILITY PROPERTY DAMAGE - 1 Claim Totals for SOMERVILLE BOE - 1 Claim Location: SOMERVILLE HS Coverage: PROPERTY 20PR00118L SOMERVILLE HS PROPERTY 7/30/2020 Open ALL OTHER PERILS 0.00 Totals for PROPERTY - 1 Claim Totals for SOMERVILLE HS - 1 Claim Location: VAN DERVEER ES Coverage: (11) WORKERS' COMP MEDICAL ONLY 19WC04647Y VAN DERVEER ES (11) WORKERS' COMP 3/21/2019 Closed SPECIAL ED ACTING OUT 706.00 MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for VAN DERVEER ES - 1 Claim Totals for SOMERVILLE BOARD OF EDUCATION - 3 Claims Member: SOUTH ORANGE-MAPLEWOOD BOARD OF EDUCATION Location: MAPLEWOOD MS

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Claim Number Location Coverage Loss Date Status Cause Total Paid Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01233U MAPLEWOOD MS (11) WORKERS' COMP 7/22/2020 Open OVEREXERTION - 346.96 MEDICAL ONLY PUSH/PULL Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for MAPLEWOOD MS - 1 Claim Location: TRANSPORTATION DEPT Coverage: AUTO PHYSICAL DAMAGE 20AL00097H TRANSPORTATION DEPT AUTO PHYSICAL DAMAGE 7/5/2020 Open STOLEN/VANDALISM 0.00 VEHICLE Totals for AUTO PHYSICAL DAMAGE - 1 Claim Totals for TRANSPORTATION DEPT - 1 Claim Totals for SOUTH ORANGE-MAPLEWOOD BOARD OF EDUCATION - 2 Claims Member: TEAM ACADEMY CHARTER SCHOOL Location: BOLD ACADEMY Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01222K BOLD ACADEMY (11) WORKERS' COMP 7/21/2020 Open OVEREXERTION - 1,102.73 MEDICAL ONLY PUSH/PULL Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for BOLD ACADEMY - 1 Claim Totals for TEAM ACADEMY CHARTER SCHOOL - 1 Claim Member: TOWNSHIP OF UNION BOARD OF EDUCATION Location: BURNET MS Coverage: (10) WORKERS' COMP LOST TIME- IND 20WC01196P BURNET MS (10) WORKERS' COMP 7/14/2020 Open OVEREXERTION - OTHER 9,903.24 LOST TIME- IND Totals for (10) WORKERS' COMP LOST TIME- IND - 1 Claim Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01239K BURNET MS (11) WORKERS' COMP 7/26/2020 Closed INTERNAL/SUDDEN - 966.96 MEDICAL ONLY EYES Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for BURNET MS - 2 Claims Location: UNION HIGH SCHOOL (UNION) Coverage: (18) NO LOST TIME MC FEE 20WC01256A UNION HIGH SCHOOL (18) NO LOST TIME MC 7/29/2020 Open OVEREXERTION - 3,818.98 (UNION) FEE HOLD/CARRY Totals for (18) NO LOST TIME MC FEE - 1 Claim

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Claim Number Location Coverage Loss Date Status Cause Total Paid Totals for UNION HIGH SCHOOL (UNION) - 1 Claim Totals for TOWNSHIP OF UNION BOARD OF EDUCATION - 3 Claims Member: TRENTON BOARD OF EDUCATION Location: ADMINISTRATION BUILDING Coverage: ERRORS AND OMISSIONS QN-3758 ADMINISTRATION ERRORS AND OMISSIONS 8/15/2019 Open DENIAL 0.00 BUILDING Totals for ERRORS AND OMISSIONS - 1 Claim Totals for ADMINISTRATION BUILDING - 1 Claim Location: DUNN MIDDLE SCHOOL Coverage: (10) WORKERS' COMP LOST TIME- IND 20WC01234R DUNN MIDDLE SCHOOL (10) WORKERS' COMP 7/23/2020 Open FALL SAME LEVEL - 6,895.00 LOST TIME- IND WET/SLIP SURF Totals for (10) WORKERS' COMP LOST TIME- IND - 1 Claim Totals for DUNN MIDDLE SCHOOL - 1 Claim Location: MARTIN LUTHER KING E.S. Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01213B MARTIN LUTHER KING (11) WORKERS' COMP 7/16/2020 Open FALL SAME LEVEL - 250.00 E.S. MEDICAL ONLY WET/SLIP SURF Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for MARTIN LUTHER KING E.S. - 1 Claim Totals for TRENTON BOARD OF EDUCATION - 3 Claims Member: UNION CITY BOARD OF EDUCATION Location: EUGENIA DE HOSTOS EARLY CHILDHOOD CENTER Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01229W EUGENIA DE HOSTOS (11) WORKERS' COMP 7/21/2020 Open OVEREXERTION - OTHER 461.29 EARLY CHILDHOOD MEDICAL ONLY CENTER Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for EUGENIA DE HOSTOS EARLY CHILDHOOD CENTER - 1 Claim Location: THEODORE ROOSEVELT ES Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01207W THEODORE ROOSEVELT (11) WORKERS' COMP 7/15/2020 Open STRUCK BY 753.80 ES MEDICAL ONLY 20WC01257W THEODORE ROOSEVELT (11) WORKERS' COMP 7/27/2020 Open OVEREXERTION - 903.57 ES MEDICAL ONLY LIFT/LOWER Totals for (11) WORKERS' COMP MEDICAL ONLY - 2 Claims

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Claim Number Location Coverage Loss Date Status Cause Total Paid Totals for THEODORE ROOSEVELT ES - 2 Claims Location: VETERANS MEMORIAL ES Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01198W VETERANS MEMORIAL (11) WORKERS' COMP 7/9/2020 Open STRUCK BY 856.56 ES MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for VETERANS MEMORIAL ES - 1 Claim Totals for UNION CITY BOARD OF EDUCATION - 4 Claims Member: VINELAND CITY BOARD OF EDUCATION Location: VINELAND TRANSPORTATION Coverage: AUTO LIABILITY PIP 19AL00017L/01 VINELAND AUTO LIABILITY PIP 1/15/2019 Open INTERSECTION - HIT BY 0.00 TRANSPORTATION Totals for AUTO LIABILITY PIP - 1 Claim Totals for VINELAND TRANSPORTATION - 1 Claim Totals for VINELAND CITY BOARD OF EDUCATION - 1 Claim Member: WAYNE TOWNSHIP BOARD OF EDUCATION Location: WAYNE VALLEY H.S. Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01236W WAYNE VALLEY H.S. (11) WORKERS' COMP 7/24/2020 Open INTERNAL/SUDDEN - 250.00 MEDICAL ONLY EYES Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for WAYNE VALLEY H.S. - 1 Claim Totals for WAYNE TOWNSHIP BOARD OF EDUCATION - 1 Claim Member: WEEHAWKEN TOWNSHIP BOARD OF EDUCATION Location: DANIEL WEBSTER SCHOOL Coverage: PROPERTY 20PR00086H/02 DANIEL WEBSTER PROPERTY 6/20/2020 Open ASBESTOS REMEDIATION 8,065.20 SCHOOL ONLY Totals for PROPERTY - 1 Claim Totals for DANIEL WEBSTER SCHOOL - 1 Claim Location: WEEHAWKEN HIGH SCHOOL Coverage: PROPERTY 20PR00108D WEEHAWKEN HIGH PROPERTY 7/15/2020 Open WATER DAMAGE - 0.00 SCHOOL PIP/EQUIP LEAK Totals for PROPERTY - 1 Claim Totals for WEEHAWKEN HIGH SCHOOL - 1 Claim

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Claim Number Location Coverage Loss Date Status Cause Total Paid Totals for WEEHAWKEN TOWNSHIP BOARD OF EDUCATION - 2 Claims Member: WEST DEPTFORD BOARD OF EDUCATION Location: WEST DEPTFORD HS Coverage: (10) WORKERS' COMP LOST TIME- IND 20WC01216V WEST DEPTFORD HS (10) WORKERS' COMP 7/16/2020 Open OVEREXERTION - OTHER 4,517.70 LOST TIME- IND Totals for (10) WORKERS' COMP LOST TIME- IND - 1 Claim Totals for WEST DEPTFORD HS - 1 Claim Totals for WEST DEPTFORD BOARD OF EDUCATION - 1 Claim Member: WEST WINDSOR-PLAINSBORO BOARD OF EDUCATION Location: WEST WINDSOR-PLAINSBORO Coverage: (11) WORKERS' COMP MEDICAL ONLY 20WC01244K WEST WINDSOR- (11) WORKERS' COMP 7/20/2020 Open STRUCK AGAINST 889.37 PLAINSBORO MEDICAL ONLY Totals for (11) WORKERS' COMP MEDICAL ONLY - 1 Claim Totals for WEST WINDSOR-PLAINSBORO - 1 Claim Totals for WEST WINDSOR-PLAINSBORO BOARD OF EDUCATION - 1 Claim Member: WESTFIELD BOARD OF EDUCATION Location: WESTFIELD BOE Coverage: AUTO PHYSICAL DAMAGE 20AL00098L WESTFIELD BOE AUTO PHYSICAL DAMAGE 7/24/2020 Open COLLISION - MOVING 0.00 Totals for AUTO PHYSICAL DAMAGE - 1 Claim Totals for WESTFIELD BOE - 1 Claim Totals for WESTFIELD BOARD OF EDUCATION - 1 Claim Member: WILDWOOD CITY BOARD OF EDUCATION Location: WILDWOOD CITY BOE Coverage: (15) WORKERS' COMP NO MANAGED CARE- IND 19WC04646I WILDWOOD CITY BOE (15) WORKERS' COMP NO 3/11/2019 Open OVEREXERTION - 0.00 MANAGED CARE- IND LIFT/LOWER Totals for (15) WORKERS' COMP NO MANAGED CARE- IND - 1 Claim Totals for WILDWOOD CITY BOE - 1 Claim Totals for WILDWOOD CITY BOARD OF EDUCATION - 1 Claim Member: WOODBRIDGE TOWNSHIP BOARD OF EDUCATION Location: AVENEL M.S.

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Claim Number Location Coverage Loss Date Status Cause Total Paid Coverage: AUTO PHYSICAL DAMAGE 20AL00099H AVENEL M.S. AUTO PHYSICAL DAMAGE 7/13/2020 Open NON COLLISION - THEFT 5,977.12 Totals for AUTO PHYSICAL DAMAGE - 1 Claim Totals for AVENEL M.S. - 1 Claim Totals for WOODBRIDGE TOWNSHIP BOARD OF EDUCATION - 1 Claim Member: WOODLAND PARK BOARD OF EDUCATION Location: Memorial Middle School Coverage: PROPERTY 20PR00111E Memorial Middle School PROPERTY 6/29/2020 Open WATER DAMAGE - 0.00 PIP/EQUIP LEAK Totals for PROPERTY - 1 Claim Totals for Memorial Middle School - 1 Claim Totals for WOODLAND PARK BOARD OF EDUCATION - 1 Claim Grand Totals - 172 Claims

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Report Definition

Description: New Claims Reported by Location and Coverage

Filters: Report Date is between 07/01/2020 and 07/31/2020

Groups: Member then Location then Coverage

Sorts: No Sorts

Options Incurred Formula is Default Formula

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