17 BUTLER STREET 3-1-23 CLAIM RECEIVED
K]S INDEPENDENT
CLAIMS SERVICE, INC. AUG Q` 2023
CITY OF SALEM
Service Integrity • Experience BOARD OF HEALTH
Notice of Casualty Loss to Building
Under Massachusetts General Laws, Chapter 139, Section 3B
July 26, 2023
Salem, MA Building Inspector
1 Salem Green
Salem, MA 01970
Salem,MA Board of Health
9 North Street
Salem, MA 01970
Salem, MA Fire Department
48 Lafayette Street
Salem, MA 01970
INSURED: Gaby Adisho
ADDRESS: 17 Butler St, Salem,MA 01970
LOCATION OF LOSS: 17 Butler St, Salem,MA 01970
COMPANY: Narragansett Bay Insurance
POLICY#: MAH0024462
CLAIM#: 23-94288
DATE OF LOSS: 03/01/2023
TYPE OF LOSS: Water
Dear Sir or Madam:
Independent Claims Service is the insurance adjusting firm hired by the above referenced client to handle the
captioned loss on behalf of their insured.
A claim has been made involving loss, damage, or destruction of the above-captioned property which may
either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If
notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please bring it to our
attention, and include a reference of the captioned insured: Location,policy number, and/or date of loss.
Sincerely,
INDEPENDENT CLAIMS SERVICE, INC.
22 Water Street • Westborough.MA 01 581 • 508.366.8535 • FAX 508.366.091 7 • www.icsclaims.com