1 ABORN STREET_ NOITICE OF LOSS 9-2-25 HomesiteGEICO Insurance Agency, LLC
Underwritten By.
NO ME 1 Homesite Insuran a company
NSURgNCE
6000 American Parkway Tel:1-866-372-8903
Madison,WI 53783-0001 Fax: 1-866-935-2858
000090FC6500M01052541931 Q03A 001 Claim Number:
r,. SALEM CITY HALL Date Of Loss: 01-009-254011
Policy Number: 09/02/2025
93 WASHINGTON ST Policyholder: 36509731
Chantal C Coughlin And David G
SALEM, MA 01970-3527
Hollinger
September 11, 2025
ATTENTION.
Board of Selectmen /O Clay o Town Halle
Bu"Pgs Fire Department or Arson Squad, Board of Health or
Our Insured: NOTICE PURSUANT TO MASS. GEN. LAWS, CHAPTER 139, SECTION 3B
Property Address: CHANTAL C COUGHLIN
3 Policy Number: 1 Aborn St Salem, MA, 01970-1103
Claim Number: 36509731
n Date of Loss 01-009-254011
09/02/2025
This correspondence shall serve as notice that, pursuant to Massachusetts General Laws Chapter 139, Section
3B, a claim has been made involving loss, damage or destruction to a building or other structure which may either
exceed$1,000 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable.
' n
If any notice pursuant to Massachusetts General Laws Chapter 139, Section 36 is appropriate, please direct such
notice to my attention and kindly, providedon
Policy number, claim number and date of loss•If YOU conthe act us va email, Pleaseluse cllaimdocume is@af cs.com
and be sure to reference the claim number in the subject line of your email.
Please contact me with any questions.
i
Sincerely,
(" C&Aft
Taaylor Cheatham
Desk Adjuster
AFICS on behalf of Homesite Insurance Company
Tayior.Cheatham@afics.com
Phone: 1-608-621-9656 1 Fax: 1-866-935-2858
Mail: 6000 American Parkway, Madison, WI 53783-0001
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