GROUP, INC. 442 WATER ST P O BOX 567 WAKEFIELD, MA 01880 Bureau File No. 913768515 Federal ID No. PERIOD- 13633 Agency Code 02/08/22 TO 02/08/23 12:01 AM STANDARD TIME THE ADDRESS OF THE INSURED AS STATED HEREIN.

Butch McKenna wake McDonald Funeral Home 7 i Te j (19 Yale Ave, Wakefield, MA 01880) GaryJ. Christenson 2 3 4 5 6 Gary J.

Falls, MA 01376 Gardner Housing Authority, 116 Church Street, Gardner, MA 01440 Stockbridge Housing Authority, 5 Pine St, Stockbridge, MA 1262 Stoughton Housing Authority, 4 Capen St, Stoughton, MA 2072 Taunton Housing Authority, 30 Olney Street, Taunton, MA 02780 Tewksbury Housing Authority, Saunders Circle, Tewksbury, MA 01876 Gloucester Housing Authority, 259 Washington St, Gloucester, MA 1930 Wakefield Housing Authority, 26 CRESCENT STREET, Wakefield

Westfield MA 6/8/2021 Douglas MA 5/30/2021 Malden MA 5/30/2021 Vernon CT 5/25/2021 Melrose MA 5/23/2021 Oxford MA 5/23/2021 Reading MA 5/11/2021 BURLINGTON MA 5/10/2021 Brockton MA 5/7/2021 Stoughton MA 5/7/2021 Woodstock CT 5/7/2021 Lynn MA 5/5/2021 Millbury MA 5/5/2021 Webster MA 5/2/2021 Mattapoisett MA 4/30/2021 Hadley MA 4/27/2021 Brockton MA 4/1/2021 Randolph MA 3/29/2021 Framingham MA 3/24/2021 Weymouth MA 3/21/2021 Centerville MA 3/18/2021 Wakefield

POLICE, TOWN: IF HOSPITAL, HOSPITAL NAME: Morton Hospital DEPARTMENT: ICU IF NURSING HOME, NURSING HOME NAME: IF ANY OTHER FACILITY, SPECIFY: OFFICER ON SCENE: BIRTH DATE: 05/19/1959 SCENE CONTACT NUMBER(S): Demographic Information AGE: 60 GESTATIONAL WEEKS (BABY): SOCIAL SECURITY NUMBER: 025-52-9576 SEX: Male RACE: White MARITAL STATUS: Single, never married APPROXIMATE WEIGHT (lb): 200 APPROXIMATE WEIGHT(g): DECEDENT ADDRESS: 298 Water Street Wakefield

INJURY: Yes INJURY AT WORK: No DATE OF INJURY: NOVEMBER 2, 2020 TIME OF INJURY: UNKNOWN HOW INJURY OCCURRED: SHOT BY OTHER(S) PLACE OF INJURY (TYPE): INSIDE VEHICLE LOCATION OF INJURY: 39 WITT STREET, LYNN, MA BODY DECOMPOSED: No BONES INVOLVED: No Emergency Contact/ Person at Scene EMERGENCY CONTACT: ADDRESS: CONTACT NUMBER: EMERGENCY CONTACT RELATIONSHIP: OTHER, SPECIFY: Next of Kin NEXT OF KIN: Daniela Fenma ADDRESS: 14 Audubon Road, Apt. 125, Wakefield

Storrs CT Sudbury MA Suffield CT Syracuse NY Syracuse, NY Syracuse, NY Syracuse, NY Tamworth NH Taunton MA Tavares FL Tipton Pennsylvania Tolland CT Topsham ME Topsham ME Topsham ME Topsham ME Troy NH Troy NH Troy NH Trumbull CT Trussville AL Tyngsboro MA Uncasville CT Upton MA Uxbridge MA Uxbridge MA Varennes QC Varennes, QC Varennes, QC Varennes, QC Varennes, QC Vergennes VT Vernon Rockville CT Victor NY victoria island Lagos Waban Massachusetts Wakefield

Storrs CT Sudbury MA Suffield CT Syracuse NY Syracuse, NY Syracuse, NY Syracuse, NY Tamworth NH Taunton MA Tavares FL Tipton Pennsylvania Tolland CT Topsham ME Topsham ME Topsham ME Topsham ME Troy NH Troy NH Troy NH Trumbull CT Trussville AL Tyngsboro MA Uncasville CT Upton MA Uxbridge MA Uxbridge MA Varennes QC Varennes, QC Varennes, QC Varennes, QC Varennes, QC Vergennes VT Vernon Rockville CT Victor NY victoria island Lagos Waban Massachusetts Wakefield

Storrs CT Sudbury MA Suffield CT Syracuse NY Syracuse, NY Syracuse, NY Syracuse, NY Tamworth NH Taunton MA Tavares FL Tipton Pennsylvania Tolland CT Topsham ME Topsham ME Topsham ME Topsham ME Troy NH Troy NH Troy NH Trumbull CT Trussville AL Tyngsboro MA Uncasville CT Upton MA Uxbridge MA Uxbridge MA Varennes QC Varennes, QC Varennes, QC Varennes, QC Varennes, QC Vergennes VT Vernon Rockville CT Victor NY victoria island Lagos Waban Massachusetts Wakefield

Telephone Number Doug Lyons, Superintendent 781-246-6400 Address (street and No., city/town, state, and ZIP code) 60 Farm Street, Wakefield MA 7. 6. Fax Number 01880 Unit involved (attached additional sheets if necessary) 8a. No. of employees in Unit Included See description of bargaining unit in Article I, Recognition 9 of current CBA between Wakefield School Committe and WEA 8b.

Address (street and No., city/town, state, and ZIP code) 13 New Salem St Wakefield Ma 01880 14. FAX Number 15. E-mail address MBaez@nrtbus.com 16. Firm/Organization Name NRT BUS TRANSPORTATION EMPLOYEE ORGANIZATION (if any) 17. Name NRT Bus inc 18. Telephone Number 781-349-5729 1 19,20,21,22. Address (street and No., city/town, state, and ZIP code) 13 New Salem St Wakefield Ma 01880 23.

Vocational 100 Hemlock Road Wakefield, MA (781)246-0810 Jim Picone 19 Daily School Runs Field Trips, Athletics Brookline Public Schools 333 Washington Street Brookline MA 02445 5 Daily School Runs Field Trips, Athletics Mary Murphy (617) 730-2195 Billerica Public Schools 35 River Street Billerica, MA 27 Daily School Routes Bernie Duggan (978) 528-8500 REFERENCES Wellesley Public Schools 40 Kingsbury Street Wellesley Ma 02481 15 Daily School & METCO

Each January first during the life of this Agreement, the Union shall have the right to increase the detail rate up to $2.00 per hour. 17,3 It is understood that all street repairs and construction done by contractors hired by the Town of Wakefield, or done by any utilities company or done by any department of the Town of Wakefield where any hazard to the public exists, as determined by the Chief of Police or his designee, where detouring of traffic