HomeMy WebLinkAboutInsurance Letter - Correspondence - 268 RALEIGH TAVERN LANE 3/10/2023 MAN
mod' Inlovieu
O Box 5
Worcester MA 01615-10145
March, 2023
TOWN CLERK
IN S
NORTH ANDOVER MA 0,1845
R,e
y pure �s m
Policy, Number: H;PN
Claim Number: -. ,
Date
Property Address: 268, Raleigh Tavern L North, Ando,velr- MA
o , it ni,ay,c '
Claill,n has, been r-nade involving loss, darnage or destruction of the above captioned pt-loperty,,
which il-nay eithier exceed $,,,1.,,01010,.0;0 or caUse Mass. General L Ch. 143 Sec. 6 tio be
under Mass. Genera] La Slec., 313, is appriopriate,, please
direct i tio attention of the L,indersigned and include a riefet ce to thie capdoIned insured,
location, Policy number,, date of loss and claimi number.
addresses, indicated above by firs class, mail.
Sincerely,
Christopher Lennon
Field Property Adjuster
The C tiZe is Insurance C nip ny l" Ameirica,
F:r,aud Warning Statement��fori-� all, States(excelk w; individually listed below):
Wily perscofrll, lvlvir-.�,,o arid vv��fl �,.�d ar-'�y o,d,-��,,er persm fid,,es aT-�
f-jr, r
containing any matcytially false infounation or conceak" f0f� 0-14D f')Ljrr)05E? A MISIES(TrIly, hforrnatior-�, ning any cmi, material
thicareto cornmits; a act, which in; a chme and Subjects d"I""',vt Ix), ar-1,-d c'JO ,,is (h-r t�-lve
aic)rernen6orw(:,1 may, 1!`,';tJ1A,0E? a fraUddent WISUrarx(E act maybe a crime ancl, si,,�b,JEM the tt-,)l
'Ork, MCI ChAl F)EIM11t) t and dollars($5,000)and the �:-:,J the dairn for,ew'J''r
Y iS�')(Dt tO MWENCI fW(,,
iri ALI,A,R,,/\Z, (�-A, (,',,C), DC,,, F1-, I<S, I-A, M1,1_11]"I" Pvl()i M111111", NIA R1, T1,40 VAO VT, W,A,alrd'V%/'V),.
APPLICABLE 114 AL, AR, DO LA, ivic), tow Fm "nic (Worlikers' Com Fp:ensliation Onlyl, and WV: Atr-,,�y
ItAff-m (or �[') VD) for I,-.,)a)fl`T-),Evnt of a loss or co- vvhc.-),
k r-i�aw ri g r WA/i I I fh I I It �n PA D) �p r e s e t s f W SE? hfcmviatio,r�, iri ar�,�, apphca�l,-J(:�)r-� for ASUrat-110EI !S JAPty a &r-'s,(:.,J r-nay s��-Ib-
j lei ct t c u i- le e-vt r
APPLICABLE IN ARIZONA: 1"""""""or protection, Arkizona law reqLV�,J`Ea,.,c,.:) 6110C,,"� .011COM!Ig st-atcnrrrer"'�t to
[,I -esienits a fEWSE? or WILICASEe n't clak-i'-,,� focr 1�)ayl,)"ner-'�,�A of
a p F)E?a r ()n t h is f c)rm. Atly P( rson whco kiriolvAr, j�y pi
c)w; i E; 1;u bm E?C t t 0 c r�,i i�"n i�l�i a I a n d (c i v, p e t-i a���-t i es
I the frAwAhrig to appear or-, td,-I�s I......y
APPLICABLE IN CALIFORNIA: For your pr'........ C�ahforrda laviv, requires;
Wylly presents or i'�;,��,",,,'��,,�r,,�3,,,,,,,��(�,�!,,�t information to o[,.-.,)tain or arnend hsurar,,v�� tyle or to n rakE��,,a f ot"ttl,-�( t y
of ii crime and imay [0 fir-ies and stat:e [,:)r�scm,
APPLICABLE IN COLORADO: It W unlawkill U) provircie fabse, facts or NOTMOKOrl "M EM WSUITICE'
COMpany for, flhf (".)f diefrinjcfir',�g or t:c) thkc",� may, �,Fllf fines, dmial cx�,�"
irmUrarICE) WId C&H darnagEMY �,r�surml(W CORIP011y' or agent of ix-� nq,)any 1,,,:)rov�( false, Wwriplete, or
fn)i si g f a ur to a pokyholder or for the F)W-1,,,,,,'WC)SE� of defrauchigg oi to PDh(,'),rhO C' 0
to i payable from :Is bl�,,, 'to colmadic) hnst-jr'.�il c
0 C
within of regtda�,D�ry
APPLICABLE IN DELAVVARE tf� ��nter"'t to injUrc o"r ".":,i�ny
,, FLORIDA and 01<1AHOMA:),'Naly persor I �v"vtm ,.,v� t -, c,""j,
&SUrcyr Mes,is of chad T1 or lan contaking any,false, Acumpkne, tor �',;qforrw t 10 11 it;guily of a fdony(In R.,
'#6 JARIP ch a Of the Wird Ch(JEW),
APPLICABLE IN KANSAS: )i whic), knuvsviri,�,....)1y arid wit[-,� rit to be �r vil
i("Jic"', or L)(::di(��,-,vf t �t:1/vill pr,(:,/-,",���l, I 4c",�,":] tio lo�� b�y, ciiri purpmed irmirc!G broker or any
or in supporl of, an application for,the issuance of, ()r-the rating of an insurance pukry for Funmonal nr
11�,x or wher beveh t�c,,,,) i !i�'15 ILI�,i'll"')rl for WISURMCM 014d) SORT [HIP""c"n
ta umitaK materindly falsi� ;,"Mi"Y' LE.IC-A rn,&t1e6al fl-renetc); or conceals, for the purpme fri-ji'lleading, information
concerr&",��:�,j ,ny materlY f",I,�"')t�",',,',",'�'!,,"4,,,�-"""-""'',��,',( �r-�stjranc'e acl,,.-
APPLICAEBI lE IN MAINE, "ITINANESSEE, VIRGINIA, WASHINGTON AND NORI H CAROLINA: It W a crime, to knowhyly p(mck hise,
ling OR COMFDarly PCIMINFOS Mily i"ACludif
or g i Cor, r iation to till '['c'),` V"IE� vqve cdl:
imphumirmcmit, 1`h� 1 0101 Of U`lsllj�l�I i") r"I S,
a statefv�/-et-�t(0clahm cantaining any WAse,
APPLICABLE IN VNEMANA., i",,�":�)Evrson oll 11 knowingly to defraud
incornplete, or mislew iir-ti� i�,-,�J,c:xmathan cunnr"nil's,z,:1,
APPLICABLE IFNI PlUcrUCKY: AT PEnsaw who, C311d witi-11 to Irlpylt or other persun Ticis Eli
any v (""')f
statoment of dalm y ri"ater-My false inforrywhon or conceak;l, for ung any
thereto corn"rr-,)O-s a, lr,,:iuduWn[ Anuance actlp vvl-kh a
APPLICABLE IN rl,4,EV%f HAMPSHIRE Any persor'� VVI')( With 21 tC) WjUw, dElfraud or deceive any insurance ccompa-f-my hHus "",I
-l., ant-,.-i pi�
statement of dairn r r-'n[',,","d r r'r-���is 1�ela cl f c)r a t i c)i !S SLA)jE!(C1t ll'.o S e("",IL'I fc,�r wl�,
a s F)r c)'v�( RSA 61`3�",'?O,
APPLICABLE! IN IMINNESOTA: r�'S 0 01111 C) f!I El 1; 21 c hi 1 rn w i i t r,�,t t(c d r,i:i�-i cl ()r hi e I p s c c)nnITIlt a fraud againvit an
.I / -�,, ip-o,,,e) to workers
�MN Workers' Compervsation Ordy: A�iiy lw[-�c�, w�t[ r -vt
t I 16' r',� �s rll� ii'�,-",,[ "',"i Ir:,�Y,k 0 vv 1 n y I y 11111;t- Ir e r�ii t i n Sy rn i s s t a t A c, w f,-i, r-�g d i s c 1 cm e
any �i is g,,iiity of theft and shall bc,"!
S El V1 t 11 rl C E?("I p tJ l�5 L")i t t C) s 1509.52, subchhswr� 3,
PENNSYLVANIA Motior, Vehicle Only: Any person who knowingly anc/1 �rttero: to irljkrc,','� or Cl Eefi-&,,-vll:J ar)
Of Claim ar,�y faise, �ncompht(? or �rJoi,r-r��ial,'Jon S1101, LAIDOn conviction, M WTIFWSOMYIEmo,� I(` to
y co a m a n d p a YM c;n't o f a f i n El 0 f lu p t C) $ 15 J)0()�,