143 CANAL ST_ CLAIM 2.4.23 Samuel F. McCormack Co., Inc.
Insurance Adjusters and Appraisers
SRmuY F.McCormack Co.,Ire.
AMSTERR IRR RIVMIRER9
February 7, 2023
Salem City Hall
Building Inspector
93 Washington Street
Salem. MA 01970
RE ASSURED: Daniel Jacobson
LOSS LOCATION: 143 Canal St, Salem, MA 01970
POLICY NO: BP21062971
TYPE OF LOSS: Freeze Up
DATE OF LOSS: 02/04/2023
OUR FILE NO: 23-00599
To Whom It May Concern:
Claim has been made involving loss, damage or destruction of the above-captioned property, which
may either exceed $1,000.00 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 this writer and include a reference to the above-
captioned insured, location, policy number, date of loss and claim or file number.
Thank you for your anticipated cooperation.
Very truly yours,
Donald McKnight
Adjuster
DMcknight@mccormackadjuster.com
cc: Board of Health
Fire Department
42 Holbrook Avenue,Braintree,MA 02184 1-800-972-5399(781)843-1222 Fax(781)849-8191
125 Waterhouse Road,Bourne,MA 02532(508)403-2600 Fax(508)403-2602
w .mccormackadjuster.com