HomeMy WebLinkAboutMiscellaneous - 12 LITTLE ROAD 4/30/2018 12 LITTLE ROAD
210/016.0-0007-0000.0
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PO Box55098
` — — :Duston,WLA 02205;5098°-
617.-951-0600
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectman
City Hall City Hall
NORTH ANDOVER, MA 01845 NORTH ANDOVER,MA 01845
RE: Insured: HAZEL WITZGALL -
Property Address: 12 LITTLE ROAD,NORTH ANDOVER, MA
Policy Number: HMA 0105648
Claim Number: BOS00047499
Date of Loss: 2/3/2015
Company: Safety Indemnity Insurance Company
Claim has been made involving loss, damage or destruction of the above-captioned property,
which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be
applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate,please
direct it to the attention of the writer and include a reference to the captioned insured, location,
policy number, date of loss and claim number.
Bryan Savosik Claim Examiner 2/4/2015
Safety Insurance Company
Homeowners Claims Unit
P. O. Box 55098
Boston, MA 02205-5098
Phone: (617) 951-0600 EXT 2070
Fax: (617) 535-5841
Email: BryanSavosik@Safetylnsurance.com