HomeMy WebLinkAboutInsurance Letter - Correspondence - 440 WAVERLY ROAD 3/10/2023 1j,nsuraR(I1Ie ("Art"),up",
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PO Box 1514,5
Worcester, MA 0,1615-01,45
Telephone.: 8,00-628-02,50 Ext: 85554001
Fax N',LJmib,e,r.m 508-926-51660,
March 10, 2023
TOWN CLERK
120, MAIN ST
NORTHANDOVER MA 01845
R,e, Otir Insured: Chad Pick
Policy Number:, HPN D057191
Claim Number: 85-00,308282 001
Date of Loss: 04/151/20,23,
Property Address.- 440, WAVERLEY RD, NORTH ANDOVER MA
To whore it,may, concern IN,
Claim ha�s, been made involving loss, da,mage or destrUCtiOrl ofthe above captioned proplerty.,
wh
I ' 4 ich may either, exceed $1,000.00 or cause Mass. General 6 to be,.
applicable. If any notice under Mass. General, Lqw _ Sec. 3B is appropriate,, please,
direct it to the attention of thie undersigned, and include, a reference 'to, 'the captioned insuredf
location,, policy nor mber, date of loss, and, clawn nUmber.
On this date, I caused copies this notice to be sent to the, persons, rlal'11,ed above at the
addresses indicateld above by first, class it
Sincerely,,
C
Victoria Thybault
Inside Propefty A,dj I ustier
The Citizens Insurance Company of America
P age l 1 o If 111
271-5657(2/22)
f
Fraud Warning Statement for all States(except as individually listed below): '
Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance
containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material
thereto cornrnits a fraudulent insurance act, which is a crime and-subjects,that person to criminal and civil 'enalties 0n Oregoh, the
aforementioned actions may constitute:a frauduIent:insu.rance act which m ay be a crime and may subject the person to penaltles , In
N ew York,the civii penaity is not to exceed i five th ousan d dollars($ ,000)and-the stated vaIure of the claim for-each such violation).(N of
applicable in AL,AR,AZ, CA,CO, ID, , FL, KS, LA, ME, MID, Mfg, NM, OK, PR., f 1,TN,VA,VT,WA and WV).
APPLICABLE IN AL, AR, DC, LA, MD, NM, Ill, T Workers' Compensation Only), and WV: Any person
who kn wingl' (or willfully in MD) presents a forks or- fraudulent tlalm for payment of a loss or benefit or who
F
knowingly or willfully in MD) presents false information in an application for insurance is guilty of a crime and-may be sub-
ject to fires or confinement in prison.
APPLICABLE IN AF I O A: For your protection Arizona law requires the following statement t
appear on this fora. Any person who n wingl'y presents a false or fraudulent elaim for payment of
Ions is subject to criminal and civil penalties.
AI PLICA LE IN CALI1=ORN[A: For your protection CaIifornia Iaw requires the following to appear on this form.Any person who know-
ingly presents false or fraudulent information to obtain or amend insurance coverage or to male a claim for the payment of a loss is guilty
f a crime-and may be subject to fi nes and confinement.in state prison.
APPLI ABLE I C LOI ADO: It.is unlawful to knowingly provide false., incomplete, or rnisieading facts or information tb an insurance
F company for the purpose of.defra'uding.or attempting to defraud the corn pany. Penalties may include imprisonment, fines, denial of
insurance and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or
misleading facts or information to a poIicyh Older or claimant for the purpose of defrauding or atte rn pti ng to defraud the poiicyhold er or
claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance
within the.department of regulatory:agencies.
APPLICABLE iI I DELAwAI E,PLO F IDA and`O LAH MA:Any person.who knowingly and with intent to injurer defraud,or deceive any
in surer files a statement of claim or an application containing any false,-in c.omplete,or misleading information is-guilty of-a felony In FL,
a person is guilty of a felony of the third degree).
APPLICABLE IN I A A : Any person who, knowingly and with intent'to defraud, prqseints, causes to be presented or prepares with
knowledge or belief that it will be presented to or by an insurer, purported insurers braker ar any agent tin "re of, any written.statement
as part of,of in support of, an application for the issuarnce of,or the rating of-an insurance policy for personal or commercial insurance,
or a claim for payment or other benefit pursuant to an insurance policy for cornme.(Cial or personal insurance which 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 thereto commits a fraudulent insurance act.
APPLICABLE IN III'fAII E, TENNESSEE, VIRGINIA,WASH,INGTON AND NORTH CAROLINA: It is a crime to knowingly provide false,
incomplete or misleading ianformation to an insurance company for the purpose of defrauding the company. Penalties may include
imprisonment,fines or-a denial of insurance benefits,
APPLICABLE IN I DIAi A:A person who knowingly and with intent to defraud an insurer files a statement of claim containi+ngr any false,
incomplete.,or rn is]eading information commits.a felony.
R '
APPLICABLE IN KENT i Y: Any parson who knowingly and with intent to defraud any insurance company or other person files a
statement of claim containing any materially false information or conceals, for the purpose of rni leading, information concerning any
fact material thereto commits a fraudulent insurance act, which is a crime.
APPLICABLE IN NEW HAMP HI E: Any person who with a purpose to injure,.defraud or deceive any insurance company, files a
statement of claim containing false, incomplete or misleading information is subject to prosecution and punishme nt for insurance fraud,
as provided in RSA 6 : 0.
APPLICABLE IN MI NI E OTA: A person who files a claim with intent to defraud or helps commit a fraud against an insurer i.s guilty of
a crime. M111Workers' Compensation only:Any person\�.ho with intent to defraud, receives workers compensati.o.n benefits to which
the person is riot entitled by Knowingly misrepresenting, misstating,or failing t.o disclose any material fact is guilty of theft..and shaII be
sentenced pursuant to s 609-52, subdivision 3.
PEN N SYLVAN1A Motor Vehicle only: Any person who knowingly and with intent to injure or i Iefraud any insurer files an application
or clairn containing any' false, incomplete or imisIeading information shall, upon conviction, be su,bject.to-ir prison ment for up to seven
years and payment of a fine of-up to 15,000.