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Policy Number(s): 11 R741681 11 R74224, 15M01763, 281-11940 TR'AVELLER'S J~ <br /> Loss Report Losses From: 08/29/2006 To 08/2912011 <br /> Claimant Adj Off FP Claim Number Accident Date Notice Date Close Date O/C Total Claim Medical Expense <br /> Policy Number:11R74168 <br /> PHILLIPS MARY 028 LR ENJ2781 11123/2010 12/0112010 12101/2010 C <br /> MARY PHILLIPS CLAIMS THAT WHEN OUR OUTBOUND WATER BUS WAS LEAVING NORTHGATE THE BUS HIT HER. Inc: $0.00 $0.00 $0.00 $0.00 <br /> Pd: $0.00 $0.00 $0.00 $0.00 <br /> O/S: $0.00 $0.00 $0.00 $0.00 <br /> TINER TERRIA 028 LR ENJ5150 12/14/2010 12/15/2010 0110312011 C <br /> MS.TINIER STATES THAT WHEN SHE EXITED THE BUS(21 MONROE)SHE SLIPPED ON ICE AND ALMOST FELL AT Inc: $0.00 $0.00 $0.00 $0.00 <br /> THE TRANSIT CENTER.SHE CALLED TODAY STATING SHE WAS VERY SORE. Pd: $0.00 $0.00 $0.00 $0.00 <br /> O/S: $0.00 $0.00 $0.00 $0.00 <br /> Subtotals for Policy Number:11 R74168 <br /> Total Claim Count:2 Inc: $0.00 $0.00 $0.00 $0.00 <br /> Pd: $0.00 $0.00 $0.00 $0.00 <br /> O/S: $0.00 $0.00 $0.00 $0.00 <br /> Policy Number: 11R74224 <br /> KNUCKLES JIM 028 LR ENJ9109 01/11/2011 0111112011 01/13/2011 C <br /> MR.KNUCKLES CALLED ME THIS AFTERNOON STATING HE FELL WHILE BOARDING THE BUS AT FAIRVIEW PLAZA Inc: $0.00 $0.00 $0.00 $0.00 <br /> SHOPPING CENTER. HE THOUGHT THAT HE WAS OK BUT WHEN HE GOT HOME AND TOOK OFF HIS COAT HE Pd: $0.00 $0.00 $0.00 $0.00 <br /> REALIZED THAT HE PROBABLY BROKE HIS WRIST. O/S: $0.00 $0.00 $0.00 $0.00 <br /> Subtotals for Policy Number:11R74224 <br /> Total Claim Count:1 Inc: $0.00 $0.00 $0.00 $0.00 <br /> Pd: $0.00 $0.00 $0.00 $0.00 <br /> O/S: $0.00 $0.00 $0.00 $0.00 <br /> Policy Number:15MO1763 <br /> 028 AB CBE5156 01113/2009 01€14/2009 C <br /> Inc: $0.00 $0.00 $0.00 $0.00 <br /> Pd: $0.00 $0.00 $0.00 $0.00 <br /> O/S: $0.00 $0.00 $0.00 $0.00 <br /> 028 AB CBF-8106 08/07/2009 08117/2009 C <br /> Inc: $0.00 $0.00 $0.00 $0.00 <br /> Pd: $0.00 $0.00 $0.00 $0.00 <br /> O/S: $0.00 $0.00 $0.00 $0.00 <br /> ABDULLAH ALICIA 028 AB CBE4627 11120/2008 11/20/2008 12/18/2008 C <br /> MS.ABDULLAH CAME INTO DISPATCH STATING SHE HAD FALLEN ON OUR BUS AND Inc: $0.00 $0.00 $0.00 $0.00 <br /> Pd: $0.00 $0.00 $0.00 $0.00 <br /> 0/S: $0.00 $0.00 $0.00 $0.00 <br /> Losses as of:08/27/2011 Run Date:08/29/2011 Page 1 <br />