14 DEARBORN STREET 12-18-23 CLAIM
95 OLD RIVER ROAD, ANDOVER, MA 01810 | P: 800.225.0770 | ANDOVERCOMPANIES.COM
MERRIMACK MUTUAL FIRE INSURANCE COMPANY | BAY STATE INSURANCE COMPANY | CAMBRIDGE MUTUAL FIRE INSURANCE COMPANY
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or
Inspector of Buildings
Salem, MA 01970
RE: Insured: 14 Dearborn St Condo Trust
Property Address: 14 Dearborn Street
Company: Merrimack Mutual Fire Insurance Company
Policy Number: SBP37049008
Claim Number: CLM37217
Date/Cause of Loss: 12/18/2023, Wind/Fence
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.
Ryan Werner
On this date, I caused copies of this Notice to be sent to the persons named above at the
addresses indicated above by First Class Mail.
Signature and Date
Cc: Health Department
Fire Department