HomeMy WebLinkAboutInsurance Notice of Claim - Correspondence - 40 FERNVIEW AVENUE 11 2/18/2019 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: Lisa Massone
Property Address: 40 Fernview Avenue, Unit 11
Company: Providence Mutual Fire Insurance Company
Policy/Claim Number: HP0079722, 19-1013KV
Date/Cause of Loss: 2/1812019, Water/Pipe Burst
Our File Number: 36818-D
Claire 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.
Daniel Paul, Ext. 117
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.
(2
Sigk4iure 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 g
North Andover, MA 01845 North Andover, MA 01845