HomeMy WebLinkAboutInsurance Letter - Correspondence - 3 BRIGHTWOOD AVENUE 7/2/2022 hisurance ("xroup(
PO Box 1,5145
Worcester MA 01615-0145
Tel eplhone. 617-320-4257 Ext.-
Fax Number: 5018-926-56160
3uly 05, 2022
TOWN CLERK
1210 MAIN ST
NORTH ANDOVER MA 01845
Re.- Our, Insured-. Jocelyn Mae Fitzgibbons
Policy Number: HPN D7233,16
Claim, Numb,e�r: 85-00176,635 001
Date of Loss: 07/02/2,022
Property Address,: 3 Brightwood; Avenue North Andover MA
T whomi it may concern:
Claim hzis been made Involving loss, damage or clest ruiction of the above captioned pro,perty,
which, may either exceed $1,000.00 or cause Mass. General Laws, Ch. IA3, Sec. 6 to be
applicable. If' ziny notice, under Mass,. General L,a_ws C h. 13 9, c., 3LB is appropriate, please
direct 'it the attelln'tion ofthe undersigned and inclucle a reference! 'to the captionled insurecl,
location, policy, number-,, date, of loss, and, cla,im number.
On this date, I caused copies of this notice to be, sent to the persons named above at the
addresses indicated, above, by first class mail.
S
=11y incere
Christopher Lennon
Outside! Propefty, Splecialist
The Citizens, Insurance Company of America,
617-3,20-4257
Page J., of 1
27 1-ry,6S-1(2/22)
Fraud Warning Statement for all States(except a -individ ally listed below):
Any person who knowingly and with .intent'°to defraud .:any insurance company or other person files an application for insurance
containing. any materially false information or conceals, for the purpose of rnl leading, information Concerning -any fact material
thereto commits a fraudulent in.su-ran'ce act, which is a crime.and subjects that person'to criminal and civil penaltie's (In Oregon, the
aforementioned actions may constitute a fraudulent insurance act which mar be a crime and may and
the person to penalties). I;n
New York,the civil pe'alty i �not.to exc ed fine thou and dollars($ , 00)ar�nd the stated value of the claim for each such v oIation).(Not
applicable in AL,AR,A ,CA, CO, DC, FL, KS, LA, M.E, [ ID, IVINI Ni 1, OIL, PIS, RI,TN,VA,VT,WA and WV).
APPLICABLE IN AL, AFC, DC, LA, MD, NM, l 1, TX (Workers' Coimpensation Only), and WV: Any person
who knowingly wingly r willfully in MD) presents a false or fr uddent claim for payment of a loss or benefit or who
knowingly (or willfully in MD) presents false information in an application for insurance is guilty of a crime and may besub-
ject to fines or confinement in prison.
APPLICABLE IN AI I ONA: For your protection Arizona law requires the following rig statement t
appear on this form. Any person who knowingly presents a false r'fraudulent claim for payment of
Ions is subject to criminal and civil penalties.
APPLICABLE IN CALI FORNW. F6 r your protection California Ia r requires the following to appear on this form.Any person who i nov -
ingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty
of a crime and may be subject to fines.and confinennent in state prison.
APPLICABLE IN COLO ADO: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance
company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, dental of
insurance and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or
mi Iead'ing facts or ihforrnation to a polic holder or cIaimant for the purpose of defrauding car attempting to defraud tine policyholder or
claimant with regard to a settlernent.or award payable frern insurance proceeds shall be reported-to the Colorado Division of Insurance
within the department of regulatory agencies.
APPLICABLE IN DELAWARE, FLOI IDA and OKLAHOMA;Any person who knowingly and with.intent to injure,defraud,or deceive any
insurer files a-state rnent of claim or a n appllcatibn conta.ihing any false,.in ornplete,or-misleading information is guilty of a felony(In FL,
a person is guilty of a felony of the third degree).
APPLICABLE IN I ANSAS: Any person who, knowingly and with intent to defraud, presents, causes to be presented or-prepares with
knowledge or-belief that it will be presented to or by an insurer, purported insurer, broker or-any'agent thereof, ap written statement
as part of, or in support of, an appiication for the issuance-of,' or the rating of-an insurance policy f r personal or commercial insurances
or a claim for payment o r oth e r:ben efit pursuant to a n insurance policy for commerci l r-personal insurance wh1ch-such person knows
to contain materially false information concerning any fact material thereto; or:conceals, for the-purpose of misleading, information
concerning any fact material there 0 commits a fraudulent insurance act.
APPLICABLE IN MA1 N E,TENNE SEE,VI RG I IN IA,WAS HIIN T N..AN D NORTH CAROUNA►: It i.s a crime to kn.o ingly provide falser
incomplete or misleading information -to an 'insurance company for the purpose of defrauding the company. Penalties may include
imprisonment, fines or a denial of insurance benefits.
APPLICABLE IN INDIA A:A person who knowingly and with intent to defraud a insurer filess-a statement of claim containing any false,.
incomplete,or misleading information commits:a felony.
APPUCABLF 1 'f ENTUCKY.- Any person who knowingly and with intent to defraud any insurance company or other person files-a
statement of claim containing arty materially-false'information or concea,Is,for the purpose of-Misleading, information concerning any
fact material thereto commits a fraudulent insurance act,which is a crime.
APPLICABLE IN NEW HAMP HIF E: Any person who with a purpose to injure, defraud or deceive any insurance company, flies a
statement of claim containing false, incomplete or misleading information is subject to prosecution and punishment for insurance fraud,
as provided in RSA 6 : 0.
APPLICABLE IN MII NESOTA: A person who files a claim with intent t6 defraud or helps commit a fraud against an insurer is guilty of
a crime. INN Workers'ers' o nsatl r' Only: Any person who with..intent to-defrau , receives workers com pensation benefits to which
the person is not untitled by 1 nowingIy misrepresenting,-misstating,or1aiIing to disclose any material fact is.guilty of theft and shall be
sentenced pursuant to s 609.52., subdivision 3.
P E N N SYLVAN IA ,Motor Vehicle Only: Any person who,knowingIy and with.i tent:to.injure or defraud any insurer files an application
or claim contaiihing any false; incomplete.or misleading information shall, upon conviction, be subject to i�npri onrnent for up to seven
years and pa ment.of a fine of up-to 15,000