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Phone: 978-632-2660 Fax. 978-632-2662
JAMES A. TRUDEAU
Adjustment Service Inc.
P. O.Box 7
Gardner,MA 01440
claimsAtrudeauadj.com
Notice of Casualty Loss of Building
Under Massachusetts General Laws, Chapter 139, Section 3B
July 28, 2016
/Building Inspector
120 Main Street
North Andover,MA 01845
Board of Health
120 Main Street
North Andover,MA 01845
Fire Department
Dept. of Records
124 Main Street
North Andover,MA 01845
Insured: Melbro Park&Wash
Loss Location: 62 Main Street,North Andover,MA 01845
Insurance Company: Preferred Mutual Insurance Co.
Policy No.: BOP 0100702909
Date of Loss: July 27,2016
File Number: 16-14687
Claim Number: 16113215
Type of Loss: Fire
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 313" is appropriate, please direct it to the writer and include a reference to the
captioned insured, location,policy number, date of loss, and file or claim number.
Claim has been made involving loss, damage or destruction of the above-captioned property, which may
exceed $5000. If any notice under Massachusetts General Laws, Chapter 175, Section 97A is appropriate,
please direct it to the attention of this writer and include a reference to the above-captioned insured,
location,policy number,date of loss and claim number.
On this date, I cause copies of this notice to be sent to the person(s) named above at the address indicated by first
class mail.
Sincerely,
Joshua M. Trudeau
Claims Adjuster
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a We and Water Damage Ken Barry
o Carpet and Upholstery Cleaning
o Insurance Repair Contractor
o Llc#077579 f,, 46 ,t 1PO Box 5026
�F! Andover,MA 01810
Office: 1-978-975-5555 Fax: 1-978-683-5262
Toll free: 1-800-253-2650 E-mail: kenbarry0mediaone.net
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WILLIAM J. SCOTT
Director
(978)688-9531 Fax (978)688-9542
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COMPLAINT FORM
DATE:
COMPLAINTANT:
ADDRESS: li2d 1`c>z�
PHONE: 6 f-Za —
COMPLAINT AGAINST:
ADDRESS:
PHONE: q7 _ 7S
COMPLAINT:
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BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535