HomeMy WebLinkAboutMiscellaneous - 230 CHICKERING ROAD 4/30/2018 (3) / 230 CHICKERING ROAD U-2
210/467.1-0230-0002.0
41wWoMp Safety Insurance
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: BRIAN DUSSAULT and JENNIFER DUSSAULT
Property Address: 230 CHICKERING RD#2,NORTH ANDOVER, MA
Policy Number: HMA 0328460
Claim Number: BOS00044909
Date of Loss: 8/7/2014
Company: Safety 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.
Allan Leavitt Claim Examiner 8/22/2014
Safety Insurance Company
Homeowners Claims Unit
P. O. Box 55098
Boston, MA 02205-5098
Phone: (617) 951-0600 EXT 3213
Fax: (617) 531-8891
Email: AllanLeavitt@Safetylnsurance.com