354-356 ESSEX STREET - BUILDING JACKET i
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Adjusters' Collaborative, Inc.
27 Water Sr- eet Flear•Wakefield, MA 09 6aO
C6 1 71 245-5662/6296•FAX C6171 245-SOSS
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/To.. BUILDING COMMISSIONER OR BOARD OftSLLECTMOE
R FIRE D 7MENT OR /
INSPECTOR OF BUILDINGS BOARD N AR QUAD
CITY OF SALEM
CITY HALL, SALEM; MA 01970
RE: INSURED: LEONARD C. OWENS, JR. & LANA OWENS
PROPERTY ADDRESS: 356 ESSEX ST. , SALEM; MA
POLICY NO: 10335073-01 - Chubb Group of Ins. Cos.
LOSS OF: JANUARY 14, 1994 TYPE OF LOSS: Water Damage
FILE OR CLAIM NO. :
Claim has been made involving loss, damage or destruction of the above-captioned property,
which may either exceed $1 ,000.00 or cause Mass. Gen. Laws , Chapter 143, Section 6 to be
applicable; If any notice under Mass. Gen. Laws , Ch. 139, Sec. 3B 1s 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.
On this date, I caused copies of this notice to be sent to the persons named above at the
addresses indicated above via first class mail .
Mass. House Bill 3923, effective October 23, 1986, requires adjusters or insurers to
notify the Fire Dept. or Arson Squad of the city or town in which a loss of $1 ,000.00
or more is sustained to a building.
Robert C. Gonnam
Adjuster
CHUBB GROUP OF INS. COS.
Company
FEB. 23, 1994
Date