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77 WEBB STREET 11-4-22 CLAIMLaMarche Associates 5 North Road, P.O. Box 250 Chelmsford, MA 01824 800-349-1525 Fax: 978-256-8590 November 8, 2022 Building Commissioner/Inspector of Buildings Salem, MA 01970-4379 Fire Department/Arson Squad Salem, MA 01970-4379 Board of Health/Board of Selectmen Salem, MA 01970-4379 NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B Claim has been made involving loss, damage or destruction of the property captioned below, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss, cause of loss and LA file number. Insured:Charles O'Callaghan Loss Location:77 Webb Street, Apt. C Salem, MA 01970-4379 Policy Number:HP00172154 Date of Loss:11/04/2022 Cause of Loss:Water LA File Number:MA-2-41664 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. Connor Dooley Adjuster LaMarche Associates, Inc. - 800-349-1525Page 1 of 1