HomeMy WebLinkAboutInsurance Notice of Claim - Correspondence - 209 GREENE STREET 2/2/2019 Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or
Inspector of Buildings
120 Main Street
North Andover, MA 01845
RE: Insured: Judith Pulzetti
Property Address: 209 Greene Street
Company: Commerce Insurance Company
Policy/Claim Number: BCKLQR, RHWT05
Date/Cause of Loss: 2/2/2019, Pipe(s) Froze & Burst
Our File Number: 36775-M
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER
143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL 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 or
file number.
Mike Peterson, Ext. 115
On this date, I caused copies of this Notice to be sent to the persons named above at the
addresses indicated above by First Class Mail.
Signature and Date
ANDERSON ADJUSTMENT CO., INC.
50 Nashua Road, Suite 303
PO Box 1098
Londonderry, NH 03053
Cc: Health Department North Andover Fire Department
120 Main Street 795 Chickering Road
North Andover, MA 01845 North Andover, MA 01845
® The Commerce Insurance Company'""
MAPFRE Citation Insurance Company'"
11 Gore Road,Webster,Massachusetts 01570
INSURANCE® 508.949,1500 www.mapfreinsurance.com
February 04, 2019
BUILDING COMMISSIONER or Board of Health or
INSPECTOR OF BUILDINGS Board of Selectmen
TOWN/CITY HALL Town/City Hall
NORTH ANDOVER MA 01845
RE: Our Insured: JUDITH PULZETTI
Property Address: 209 GREENS STREET
Policy#: BCKLQR
Date of Loss: 02/02/2019
File#: RH VT05-PCCCTO
Claim has been made involving loss, damage, or destruction of the above captioned
property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143,
Section 6 to be applicable.
If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate,
please direct it to my attention. Please reference the above captioned insured, location,
policy number, date of loss, and file number on any correspondence.
SHERYL PARKER Telephone: (508)949-1500 Ext: 15901
CLAIM REP, CAT RESPONSE Toll Free: 1-800-221-1605,Ext.15901
On.this date, I cause copies of this notice to be.sent to the persons indicated above, at the
address above,by first class mail.
February 04, 2019
CIC 254 (Rev.4/95) NIAII- Y60