HomeMy WebLinkAboutInsurance Corespondence - Correspondence - 32 OLYMPIC LANE 5/14/2021 t
WAIIState.P.O. BOX 666 '
WALLAS TX 7.5266
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I I 1111 11111 11111 111 d 11111111111 1111 1111
TOWN OF NORTH ANDOVER
1.20 STAIN ST
NORTH AN D OTE R MA 018452420
May 19,2021
INSURED: MARK DO EGAN PRONENUMBER: 800�726-2235
DATE OF LOSS: May 14,2021 FAX NUMBER: 66-447429
CLAIM NUMBER: 0626682173 RRR OFFICE HOURS: Mon i-Fri 8:00 am- : 0 pm,
PROPERTY ADDRESS: 32 OLYMPIC LN,NORTH Sat :00 am-2:00 pm
—ADER,MA
POLICY NO.: 000925824934
i
Form ofNotice of Casualty Loss to Building
Under as . en.Las. h, 139.See.3
TO:
Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
CITY/TOWN HALL: North Andover,MA
ADDRESS: 32 Olympic Lane
CITY/TOWN/ZIP CODE: North Andover,MA 01 45
Claim has been made involvingw less,da ] ge or destruction of the above-captioned property which may either exceed
1,000. 0 or cause,lass.Gen. Laws,Chapter 143 Section 6 to be applicable. if any notice under Mass. Geri.
Laws Chapter 139 Section 3B is appropriate,please direct it to the attention of the undersigned and include a
reference to the captioned insured, location,policy number,date ofless and clam number.
-- this date,I us Ed iopies o f this ri ti -to be s r-t to the persons ren ed ab o ve at the addresses'in i t d-ab o ve ley
first class mail.
SIGNATURE AND DATE
ROBBRT R M NIK
May .i ,2021
PR P054
000 1051 STSW90DO84600100100 137