109 Lafayette St_ Claim Notice 10.13.22 W. Springfield, MA Pittsfield, MA
(413) 781-2897 (888)881-4598
Quincy, MA ENNWorcester, MA
(617)479-2619 (888) 881-4598
Mattapoisett,MA Cape Cod& Islands
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Rhode Island Hartford, CT
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(888)881-4598 BUTLER
Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
City of Salem City of Salem
120 Washington Street 120 Washington Street
3rd Floor 4th Floor
Salem, MA 01970 Salem, MA 01970
Attention: Records Attention: Records
COMPANY: Certain Underwriters at Lloyds, London c/o Vanguard Claims
Administration, Inc.
POLICY NUMBER: XSZ192264
CLAIM NUMBER: XS 10145
INSURED: Concord Enterprises LLC dba Witch Dr
LOSS LOCATION: 109 Lafayette Street, Salem, MA
DATE OF LOSS: 10/13/2022
DESCRIPTION: Water
OUR FILE NUMBER: P22-12764
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@georgebutleradjusters.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.
Secretary
December 7, 2022 _A `
P.O. Box 1557, Mattapoisett, MA 02739