18 WASHINGTON SQUARE WEST-HAWTHORNE HOTEL 1-9-24 CLAIM REcEsvE® (40)
FEB 2 6 2024 CITY OF SALEM sedgwi ck c.
BOARD OF HEALTH David M.Zito,AIC,HCI-C
david.zito(ftedgwick.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 Massachusetts Board of Health
98 Washington Street, 31 Floor
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.
ecuu" emu* d
Signature
Title: Executive General Adiuster
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.
eomw4 eAg&V&d 2/14/2U24
Date & Signature