Miscellaneous: Britany Goldberg Individually and On behalf of all others similarly situated vs. John F. Shea Company, Inc. et al

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                                                                                                                                  Trial Court of Massachusetts                                 =
        CIVIL ACTION COVER SHEET
                                                                                      ai             193!                         The Superior Court
 PLAINTIFF(S):         Britany Goldberg, individually & on behalf of all others similarly situated                           COUNTY
                                                                                                                                        Middlesex
 ADDRESS:
                                                                                                     DEFENDANT(S):     John F. Shea Company, Inc., Joshua M. David, and Christopher J. Sears


ATTORNEY:             ‘Adam J. Safran
ADDRESS:              Rudolph Friedmann LLP                                                          ADDRESS:
 92 State Street, Boston, MA 02109


BBO;                  670460
                                                       TYPE OF ACTION AND TRACK DESIGNATION (see reverse side)
             CODE NO.                              TYPE OF ACTION (specify)              TRACK             HAS A JURY CLAIM BEEN MADE?
       AO1                              Services/Labor                                    FE                   YES     0 no
   “If "Other" please describe:

              Is there a claim under G.L. c. 93A?                                                               Js this_a class action under Mass. R. Civ. P. 23?
                   YES           x)                                                                                                          lO
                                                              STATEMENT OF DAMAGES PURSUANT TO GL. c. 212, § 3A

The following is a full, itemized and detailed statement of the facts on which the undersigned plaintiff or plaintiff's counsel relies to determine money damages.
For this form, disregard double or treble damage claims; indicate single damages only.
                                                                                               TORT CLAIMS
                                                                                  (attach additional sheets as necessary)
|A. Documented medical expenses to date:
             1. Total hospital expenses
             2. Tata! doctor expenses .
             3. Tota! chiropractic expenses
             4. Total physical therapy expenses
             5, Total other expenses (describe below) .                                                     THE One or THE
                                                                                                     ‘OR THE COUNTY                                                    ys
                                                                                                                    Of MIDDLESEX
IB. Documented lost wages and compensation te date
Cc. Documented property damages to date ....                                                             SE             02
D. Reasonably anticipated future medi              and hospital expenses
IE. Reasonably anticipated lost wages
F, Other documented items of damages.

                                                                                                              CLERK
|G. Briefly describe plaintiff's injury, including the nature and extent of injury:

                                                                                                                                                          TOTAL (A-F):$




                                                                {attach additional sheets as necessary)
      This action includes a claim involving collection of a debt incurred pursuant to a revolving credit agreement. Mass. R. Civ. P. 8.1(a).
Provide a detailed description of claim(s):
                                                                                                                                                               TOTAL: $ 60,000+
Class action for failure to pay reporting pay to all employees, plus treble damages, attorneys’ fees, costs, & interest
Signature of Attorney/ Unrepresented Plaintiff:
                                                                              ALE —
RELATED ACTIONS: Please provide the case number, case name, and county of any related actions pending in the Superior Court.
                                                                                                                                                            Date:       ahif2y



                                                                CERTIFICATION PURSUANT TO SJC RULE 1:18
| hereby certify that | have complied with requirements of Rule 5 of the Supreme Judicial Court Uniform Rules on Dispute Resolution (SUC
Rule 1:18) requiring that | provide my clients with information about court-connected dispute resolution services and discuss with them the
jadvantages and disadvantages of the various metheds of dispute resolution.

Signature of Attorney of Record:                   X                                                                                                        Date:       qh fey