HomeMy WebLinkAboutInsurance Corespondence - Correspondence - 220 BOXFORD STREET 12/2/2019 IBC T Northbrook
PO BOX 672041
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MDALLAS TX 75267
YoLfre In good hands,
CITY OF NORTH ANDOVER
120 MAIN Six
NORTH ANDOVER MA 018452420
December 02,2019
INSURED. PETER KEIVER PHONE NUMBER: 800-806-55
DATE� FLOSS: December 02,2019 FAX NUMBER: 877-292-9527
CLAIM 1UMBEi,R: 05701562816MFI OFFICE HOURS: Mon- Fri 7: am-7:00 pm,
PROPERTY ADDRESS-SS- 2 BOXF RD ST,NORTH Sat : o am -- : o pm
A D elER, 4A
POLICY O.: 000925886219
Form of Notice ofCasualty Loss to Building
rider IM ass.G en.Lawskh, 139.S ee.3 D
TO:
uiIding Conimissi one r or hoard of Health or
Inspector of Buildings Board of Selectmen
1r1� �I' WN I ": �I,von of i-th Andover
ADDRESS: 120 main strett
CITY/TOWN/ZIP CODE- North Andover, M A 01 5
Claim has been made involving loss, damage or de tftl tiorl of the above-captioned property which may either exceed
150 .00 or cause Mass. Gen. LaNys Chapter 143 Section 6 to be applicable. If any notice under Mass.Gen.
Laws,Chapter 139,Section 3D is appropriate, please direct it to tine attention of the undersigned and include a
reference to the captioned insured, location, policy number,date of loss and claim number.
n this date, 1 caused copies of this notice to be seat to the persons named above at the addresses indicated above by
first class mail.
SIGNATURE AND DATE
MIKE HENS HEL
December 02,2019
PROP054 0570156281 6MH t
40 00201 1202TR008000404001001000550