18 WASHINGTON STREET_ LOSS CLAIM 1.9.24 sedgwick
David M.Zito,AIC, HCI-C
david.zitoasedavnck.com
Regional General Adjuster
Fax Number:860-296-0581
Office:(860)304-4045
Form of Notice of Casualty Loss to Building
Under Massachusetts General Laws Chapter 139, Section 3B
February 14, 2024
Salem City Building Inspector
1 Salem Green
Salem, MA 01970
INSURED RHA-HAWTHORNE HOTELS
LOSS LOCATION 18 Washington Street
West Salem, MA 01970
CO. CLAIM NO. Aggregate/Multiple
TYPE OF LOSS Water Damage
DATE OF LOSS 1/9/2024
SEDGWICK FILE # PH124192690
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 the writer and include a reference
to the captioned insured, location, policy number, date of loss and claim or file number.
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Signature
Title: Executive General Adjuster
On this date, I caused copies of this notice to be sent to the person named above at the
addresses indicated above by First Class Mail.
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Date 8s Signature