29 FIRST ST UNIT C- CLAIM Underwritten By:
ark :*' MAW Main Street America Assurance Company
STREET Tel: 1-800-258-5310
AMERKA Fax: 1-866-935-2858
ir+We E
6000 AMERICAN PARKWAY
MADISON,WI 53783-0001
Claim Number: 01-006-575273
Date Of Loss: 08/16/2023
005375FC6500MO1032290314 Q03A 001 Policy Number: 51 J5761 P
CITY OF SALEM - BUILDING DEPARTMENT Policyholder: Nikolai Kovs
93 WASHINGTON ST
SALEM, MA 01970-3527
August 16, 2023
ATTENTION: Building Commissioner or Inspector of Buildings Fire Department or Arson Squad, Board of Health or
Board of Selectmen C/O City or Town Hall
NOTICE PURSUANT TO MASS. GEN. LAWS, CHAPTER 139, SECTION 3B
Our Insured: Nikolai Kovs
Property Address: 29 1st St Unit C Salem, MA, 01970-1874
Policy Number: 51J5761P
Claim Number: 01-006-575273
Date of Loss 08/16/2023
This correspondence shall serve as notice that, pursuant to Massachusetts General Laws Chapter 139, Section
g 3B, a claim has been made involving loss, damage or destruction to a building or other structure which may either
8 exceed$1,000 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable.
0
If any notice pursuant to Massachusetts General Laws Chapter 139, Section 3B is appropriate, please direct such
notice to my attention and kindly, pursuant to the information provided above, include the insured's name, address,
policy number, claim number and date of loss. If you contact us via email, please use claimdocuments@afics.com
and be sure to reference the claim number in the subject line of your email.
Please contact me with any questions.
Sincerely,
r W64 a
Thomas Wuelper
Claim Adjuster II
AFICS on behalf of Main Street America Assurance Company
Thomas.Wuelper@afics.com
Phone: 1-857-248-8047 j Fax: 1-866-935-2858
Mail: 6000 American Parkway, Madison, WI 53783-0001
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