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 9/10/2020 8:07:41 AM Page 4 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 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.) 9/10/2020 8:07:41 AM Page 5 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: 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.