NOTICE OF CLAIM

1). CLAIMANT:

Name: O.G. by and through his G.A.L. Rev. Darryl George and Brenda Barnes-
George

Address: [edited] City: SHORT HILLS

State: NEW JERSEY Zip Code: 07078

Telephone: [edited] Date of Birth: [edited]

Social Security No.:

Number of Dependant(s): 0

2). NAME OF REPRESENTATIVE:

IF NOTICE AND CORRESPONDENCE IN CONNECTION WITH THIS CLAIM ARE

TO BE SENT TO A PERSON OTHER THAN CLAIMANT, PLEASE COMPLETE
ITEM # 2.

Name: DAMICO, DELSARDO & MONTANARI, LLC

Address: 300 LACKAWANNA AVENUE City: WEST PATERSON

State: NEW JERSEY Zip Code: 07424

Telephone: (973) 785-8181

Relationship, if any: ATTORNEY

3). A) DATE OF ACCIDENT OR OCCURRENCE WHICH GAVE RISE

TO THIS CLAIM:

Date: March 4, 2009 Time:

B) DESCRIBE THE LOCATION OR PLACE OF THE ACCIDENT OR

OCCURRENCE.

Municipality: MILLBURN, NEW JERSEY

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 Exact Location: MILLBURN HIGH SCHOOL, MILLBURN, NEW
JERSEY

C) DESCRIBE HOW THE ACCIDENT OR OCCURRENCE HAPPENED. IF A

DIAGRAM WILL ASSIST YOUR EXPLANATION, PLEASE USE THE
REVERSE SIDE OF THIS FORM.

O.G was a student enrolled at Millburn High School. From the onset of his
enrollment at Millburn High School, O.G. was subject to racial slurs,
terroristic threats and physical brutality by other students at Millburn High
School.

On more than one occasion, O.G. suffered physical injuries as a result of an

assault by other students. O.G. suffered a fracture to his nose as a result of a
racially motivated attack by another student under the control and/or
enrolled at Millburn High School.

O.G. and his family continuously reported the aforementioned incidents to

school administration. The District failed to remediate the hostile
environment and/or take any corrective action.

On or about January 8, 2009, O.G. was physically threatened and was

subjected to additional racial slurs by students enrolled at Millburn High
School while on school premises. The aforementioned was reported to
Millburn High School Administration. No remedial action was taken and/or
counseling offered to any of the parties involved.

On or about January 9, 2009, a hostile incident occurred where O.G. was

further threatened and assaulted.

On or about January 9, 2009, O.G. was the only student to receive a

suspension as a result of the incident. O.G. was treated differently than
others similarly situated due to his race.

On or about February 16, 2009, the Millburn Board of Education conducted

an expulsion hearing wherein all the testimony offered was that O.G. was
engaged in a scuffle with another student, but at no time possessed a bat
and/or caused any physical injuries to any party.

In addition, testimony was offered by O.G. demonstrating that he and his

friends were subjected to racial slurs by the individuals engaged in the
aforementioned assault upon O.G. and that same was reported to the school
administration.

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 Further testimony was offered wherein other white students engaged in
similarly charged conduct as O.G. were at no time expelled nor was an
expulsion sought.

While the Board of Education was in the process of rendering a decision,

they openly heard facts and opinions from the public in O.G.’s absence.

On March 4, 2009, the Board of Education expelled O.G. from Millburn

High School.

D) STATE THE NAME AND ADDRESS OF THE MUNICIPALITY OR AGENCY

THAT YOU CLAIM CAUSED YOUR DAMAGE.

MILLBURN BOARD OF EDUCATION, MILLBURN HIGH SCHOOL

E) STATE THE NAMES OF MUNICIPALITY'S EMPLOYEES WHOM YOU

CLAIM WERE AT FAULT, INCLUDING ANY INFORMATION THAT WILL
ASSIST IN IDENTIFYING THEM.

MILLBURN BOARD OF EDUCATION, , Samuel D. Levy, Noreen Brunini,

Michael Birnberg, Lise P. Chapman, Debra Fox, Scott A. Kamber, Janet
Landau, Jeffrey Waters, Mark Jay Zucker, Richard l. Brodow, Ed. D., Dr.
Michelle Pitts, Dr. William Miron.

F) STATE IN DETAIL EACH AND EVERY NEGLIGENT OR WRONGFUL ACT

OF THE MUNICIPALITY AND MUNICIPAL EMPLOYEES, WHICH
CAUSED YOUR DAMAGE.

All employees mentioned in (E) above are responsible for the following:

Careless, Negligent, and or Reckless by expelling O.G. without sufficient cause.

Careless, reckless, and negligent by failing to discipline students for racial remarks
and/or attacks.

Careless, Negligent, and Reckless by failing to properly investigate claims of racial

hostility and/or hostile environment throughout the District.

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 Careless, reckless and/or negligent by receiving information outside of O.G.’s
presence and considering same when rendering a decision to expel O.G. in violation
of his due process rights.

Creating, causing, and/or failing to remediate a hostile environment.

Violations under the New Jersey law Against Discrimination.

Failing to maintain a policy and/or enforce same against Race Discrimination.

Violation of Civil Rights.

Intentional and Negligent Infliction of Emotional Distress.

G) STATE THE NAME AND ADDRESS OF ALL WITNESSES TO THE

ACCIDENT OCCURRENCE.

O.G., Rev. Darryl George, Brenda Barnes-George, Lamar Amir George, all
employees and students of Millburn School District, Minnotti.

H) IF VEHICLE ACCIDENT, STATE THE NAMES, ADDRESSES, AGE AND

RELATIONSHIP TO THE INSURED OF ALL PASSENGERS IN YOUR
VEHICLE.

N/A

I) STATE THE NAMES OF ALL POLICE OFFICERS AND POLICE

DEPARTMENTS WHO INVESTIGATED THE ACCIDENT.

N/A

4). A) CLAIM FOR DAMAGES (check appropriate one)

____X__ Bodily Injury _______ Property Damage

___X__ Other- Explain: Psychological, Lost Earnings, Compensatory.

B) IF YOU CLAIM BODILY INJURY, DESCRIBE YOUR INJURIES RESULTING

FROM THIS ACCIDENT OR OCCURRENCE.

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 C) DO YOU CLAIM PERMANENT DISABILITY RESULTING FROM THIS
INJURY?

___X__ YES ______ NO

D) IF YES, DESCRIBE THE INJURIES BELIEVED TO BE PERMANENT.

Psychological and a diminished capacity to earn wages.

E) FOR EACH HOSPITAL, DOCTOR, OR OTHER PRACTITIONER

RENDERING TREATMENT, EXAMINATION OR DIAGNOSTIC SERVICE,
STATE: N/A.

NAME OF HOSPITAL DATES OF AMOUNT OF AMOUNT PAID OR

OR DOCTOR TREATMENT CHARGE TO PAYABLE BY OTHER
DATE INSURANCE

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 IF YOU CLAIM LOSS OF WAGES OR INCOME AS A RESULT OF THE INJURY,
STATE:

Future income to be calculated by expert.

F) DID THIS ACCIDENT OCCUR IN THE COURSE OF EMPLOYMENT?

______ YES ___X__ NO

G) NAME OF EMPLOYER: CLAIMANT WAS A STUDENT ATTENDING

MILLBURN, HIGH SCHOOL
ADDRESS:
YOUR OCCUPATION:
DATE EMPLOYED AT THIS JOB: BROOKLYN, NEW YORK 11236
DATES OF ABSENCES FROM WORK:
DATES OF LOST TIME:
RATE OF PAY:
TOTAL LOST WAGES TO DATE:

NOTE: IF YOU CLAIMED LOSS OF INCOME ARISES FROM SELF-

EMPLOYMENT OR OTHER THAN WAGE, ATTACH A
CALCULATION SHOWING THE BASIS OF YOUR CALCULATION
OF LOSS INCOME.

H) SET FORTH ANY AND ALL OTHER LOSSES OR DAMAGES CLAIMED BY

YOU.

NONE OTHER THAN ABOVE.

I) IF YOU CLAIM PROPERTY DAMAGE: N/A

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1). DESCRIBE THE PROPERTY DAMAGED IF VEHICLE, INCLUDE MAKE,
MODELYEAR, COLOR, VEHICLE IDENTIFICATION NUMBER, LICENSE PLATE
NUMBER, STATE, AND PARTS OF VEHICLE DAMAGED.

2). THE PRESENT LOCATION AND TIME WHEN THE PROPERTY CAN BE
INSPECTED.

3). DATE PROPERTY WAS ACQUIRED.

4). COST OF PROPERTY.

5). VALUE OF PROPERTY AT TIME OF ACCIDENT.

APPROXIMATELY

6). DESCRIPTION OF DAMAGE.

7). HAS THE DAMAGE BEEN REPAIRED?

______ YES __X___ NO

IF YES, BY WHOM AND COST OF REPAIRS.

(ATTACH EACH ESTIMATE OF REPAIR COST TO THIS FORM.)

8). THE AMOUNT OF CLAIM: 10,000,000.00

9). HAVE YOU RECEIVED OR AGREED TO RECEIVE ANY MONEY FROM ANYONE
FOR DAMAGES CLAIMED HEREIN?

______ YES ___X___ NO

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 IF SO, SET FORTH THE NAMES AND ADDRESSES OF ALL PERSONS AND
INSURANCE COMPANIES AGAINST WHOM YOU HAVE MADE SUCH CLAIM.

10). OTHER PARTIES INVOLVED.

NAME:
ADDRESS:
TELEPHONE NO.:
HOW INVOLVED:

11). IF THIS CLAIM INVOLVES AN AUTOMOBILE, PLEASE STATE:

N/A

A) THE NAME OF THE INSURANCE CARRIER COVERING THIS

AUTO:

B) THE NAME AND ADDRESS OF YOUR LOCAL INSURANCE

AGENT.

C) YOUR POLICY NUMBER AND DATES OF COVERAGE.

12). THE NAME OF YOUR HOMEOWNERS INSURANCE COMPANY.

N/A
A) THE NAME OR NAMES OF YOUR LOCAL INSURANCE AGENT.
B) YOUR POLICY NUMBER AND DATES OF COVERAGE.

13). IF YOU HAVE ANY OTHER FORM OR KIND OF LIABILITY INSURACE, PLEASE
STATE:

a) THE NAME OR NAMES OF THE INSURANCE COMPANY.

b) TYPE OF COVERAGE.

c) THE NAME AND ADDRESS OF YOUR LOCAL INSURANCE AGENT.

d) THE POLICY NUMBER OR NUMBERS.

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