11 CHURCH STREET, #202 2-20-00 CLAIM PATRICK J. DONOVAN ASSOCIATES, INC.
elmm and Foss .` dustments n
P. U. BUR 110
WAKE?c IELD. MA 01880
TEL, (781) 245-5540 --- FAX (781) 245-7016 AUG, 1 4 20D
CITY OF SALEM
HEALTH DEPT.
August 11, 2000
Building Commissioner
City or Town Hall
Salem, MAg197n
Insured : Claire H Beauvais
Property Address : 11 Church St, #202, Salem, MA
Insurer : Merimack Mutual Ins Co
Policy Number : HP2035970
Type of Loss : Water Damage
Date of Loss : 2120/00
Our File # : WAP#31201
Claim has heen made involving IosS, damage or destruction of the above-captioned
property, which may either exceed $1,000 or cause Mass. Gen. Laws, Chapter 143,
Section 6, to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section
313 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 file number.
On this date, I caused copies of this notice to be sent to the persons named above at
the addresses indicated above by first class mail.
Vern Laws, Adjuster
VL/so
ISSOCIATION OF INDEPENDENT INSURANCE ADJUSTERS
ASSMATION
of MassachusettsWAMM
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