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13 FIRST STREET - BUILDING INSPECTION 13 Fi �sT ST Liberty Mutual® Liberty Mutual Insurance New England Region Central Property Unit INSURANCE 75 Sylvan Street Danvers,MA 01923 Tel:(800)566-0323 May 12,2015 City of Salem Attn:Building Inspector 93 Washington St Salem,MA 01970 Re: Property Address: 131st St 131, Salem,Ma 01970 Policy Number: H6521823679440 Underwriting Company: LM Insurance Corporation Claim Number:031632586-0001 Date of Loss: 2/26/2015 Attn: Town/City Official Pursuant to M.G.L. c. 139, 5 313, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, 5 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, 599, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, 5 3A & B, or Mass. General Laws, Ch. 143, 5 9, or Mass. General Laws,Ch. 111, 5 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address,policy number,claim number,and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 POBOX55098 Boston,MA022055098 817-951-0000 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall SALEM, MA 01970 SALEM, MA 01970 RE: Insured: LAURA J LANES and SCOTT F LANES Property Address: 13 1 ST ST UNIT B-2, SALEM, MA Policy Number: HMA 0395113 Claim Number: BOS00059148 Date of Loss: 2/26/2015 Company: Safety Insurance Company 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, Chanter 143, Section 6 to be applicable. If any notice under Mass. Gen. 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 number. Daniel Olsen Claim Examiner 4/14/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3323 Fax: (617) 531-2762 Email: Danie101sen@Safetylnsurance.com