169 OCEAN AVENUE WEST 2-11-25 CLAIM IC ' INDEPENDENT RECEIVED
CLAIMS SERVICE, INC. FEB 19 2025
CITY OF SALEM
Service Integrity Experience BOARD OF HEALTH
Notice of Casualty Loss to Building
Under Massachusetts General Laws, Chapter 139, Section 311
February 11, 2025
Salem,MA Building Inspector
1 Salem Green
Salem,MA 01970
Salem, MA Board of Health
9 North Street
Salem, MA 01970
Salem,MA Fire Department
48 Lafayette Street
Salem,MA 01970
INSURED: Fatima Islam
ADDRESS: 169 Ocean Ave W, Salem,MA 01970
LOCATION OF LOSS: 169 Ocean Ave W, Salem,MA 01970
COMPANY: Vermont Mutual Insurance
POLICY#: HP00188668
CLAIM#: 25-98355
DATE OF LOSS: 02/11/2025
TYPE OF LOSS: Sewerage
Dear Sir or Madam:
Independent Claims Service is the insurance adjusting firm hired by the above referenced client to handle the
captioned loss on behalf of their insured.
A 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
notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please bring it to our
attention, and include a reference of the captioned insured: Location,policy number, and/or date of loss.
Sincerely,
INDEPENDENT CLAIMS SERVICE,INC.
22 Water Street • Westborough. MA 01 581 • 508.366.8535 • FAX 508.366.091 7 • www.icsclaims.com