126 FEDERAL ST- CLAIM NOTICE W. Springfield, MA Pittsfield, MA
(413) 781-2897 (888)881-4598
Quincy, MA Worcester, MA
(617)479-2619 (888)881-4598
Mattapoisett, MA Cape Cod&Islands
(508) 758-6633 (888)881-4598
Rhode Island Hartford, CT
(888)881-4598 BUTLER (888)881-4598
Building Commissioner or Board of Health o
Inspector of Buildings Board of Sele en
City of Salem City of S m
120 Washington Street 120 shington Street
Salem, MA 01970 S m, MA 01970
Attention: Records ttention: Records
COMPANY: Certain Underwriters at Lloyds, London_ c/o Vanguard Claims _
Administration, Inc.
POLICY NUMBER: XSZ203281
CLAIM NUMBER: XS 10617
INSURED: 126 Federal Street Condo
LOSS LOCATION: 126 Federal Street, Salem, MA
DATE OF LOSS: 08/15/2023
DESCRIPTION: Wind
OUR FILE NUMBER: P23-13420
To Whom It May Concern:
Claim has been made involving loss, damage, or destruction of the above captioned property which
may either exceed $1,000, or cause Massachusetts General Law, Chapter 143, Section 6, to be
applicable. If any notice under Massachusetts General Law, Chapter 139, Section 3B, is appropriate,
please direct it to the attention of this writer and include a reference to the captioned insured,
location, policy number, company claim number, date of loss, and claim or file number.
Sincerely,
John Schillizzi -
Claims Adjuster
P—(978) 818-5453
F—617-470-1740
JohnS@georgebutleradj usters.com
On this date, I caused copies of this notice to be sent to the persons named above at the address
indicated above, by first class mail.
r
Secretary = .�
August 22, 2023 - -
P.O. Box 710120,Quincy, MA 02171