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Policy Number(s): 11 R74168, 11 R74224, 15M01763, 28L11940 TRAVELERSAJ <br /> Policy Number:15MO1763 <br /> YOUNG TOBIAS 028 AS A5C1246 10/21/2008 11110/2008 10/19/2009 C <br /> MR.YOUNG STATED THAT OUR BUS OPERATOR BRAKED VERY HARD AND THE BUS JE Inc: $28.00 $0.00 $0.00 $28.00 <br /> Pd: $27.60 $0.00 $0.00 $27.60 <br /> O/S: $0.00 $0.00 $0.00 $0.00 <br /> YOUNG TOBIAS 028 LR CBE4299 10/22/2008 10/22/2008 11/14/2008 C <br /> MR.YOUNG STATED THAT OUR BUS OPERATOR BRAKED VERY HARD AND THE BUS JE 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 /> Subtotals for Policy Number:15M01763 <br /> Total Claim Count:32 Inc: $40,271.00 $37,703.00 $0.00 $2,568.00 <br /> Pd: $34,899.84 $32,332.18 $0.00 $2,567.66 <br /> O/S: $5,371.16 $5,370.82 $0.00 $0.00 <br /> Policy Number:28L11940 <br /> BURROWS HAROLD 155 AB CFQ0151 09[0212006 09/27/2006 01121/2007 C <br /> LEG GAVE OUT WHEN WHEN PICKING UP DROPPED CANE,WHICH CAUSED CLAIMANT 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 /> EICHORN NATHAN A 220 AD CDS5585 09/22/2006 09/22/2006 11113/2006 C <br /> TURNING FROM BUENA VISTA ONTO 17TH ST OUR DRIVER WAS TURNING FROM BUEN Inc: $3,677.00 $3,677.00 $0.00 $0.00 <br /> Pd: $3,677.07 $3,677.07 $0.00 $0.00 <br /> 0/S: $0.00 $0.00 $0.00 $0.00 <br /> Subtotals for Policy Number:281-11940 <br /> Total Claim Count:2 Inc: $3,677.00 $3,677.00 $0.00 $0.00 <br /> Pd: $3,677.07 $3,677.07 $0.00 $0.00 <br /> O/S: $0.00 $0.00 $0.00 $0.00 <br /> Report Grand Totals <br /> Total Claim Count:37 Inc: $43,948.00 $41,380.00 $0.00 $2,568.00 <br /> Pd: $38,576.91 $36,009.25 $0.00 $2,567.66 <br /> O/S: $5,371.09 $5,370.75 $0.00 $0.00 <br /> Losses as of:08/27/2011 Run Date:08/29/2011 Page 5 <br />