11 CHURCH STREET, #204 3-14-10 CLAIM Phone: 978-342-1660 Far: 978-342-2699
JAMES A. TRUDEAU
Adjustment Service Inc.
P. O. Box 942
Fitchburg,MA 01420
claims a trudeauade.com
Notice of Casualty Loss of BuildinLy
Under Massachusetts General Laws, Chapter 139, Section 3B
April 5, 2010
Building Inspector
93 Washington Street
Salem, MA 01970
Board of Health
93 Washington Street
Salem,MA 01970
Fire Department
Dept. of Records
48 Lafayette Street
Salem, MA 01970
Insured: Paula Ayotte
Loss Location: 11 Church St. #204,Salem,MA 01970
Insurance Company: One Beacon Insurance Co.
Policy No.: HBIP97534
Date of Loss: March 14,2010
File Number: 10-08706
Claim Number: OAA701931
Type of Loss: Water Damage
Claim has been made involving loss, damage, or destruction of the above captioned property, which may either
exceed 11..000.00 or cause"Mass. Gen. Laws Chapter 143 Section G" to be applicable. If any notice under"Mass.
Gen. Laws, Chapter 139, Section 3B" is appropriate, please direct it to the writer and include a reference to the
captioned insured, location,policy number,date of loss, and file or claim number.
On this date, I cause copies of this notice to be sent to the person(s) named above at the address indicated by first
class mail.
Sincerely,
Thomas Murphy '
Claims Adjuster