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INS LOSS CLAIM 04/09/2020 TRAVELERS J 233 The Phoenix Insurance Company P.O. Box 430 Buffalo, NY 14240-0430 04/13/2020 Town of Salem Building Inspector 120 Washington street Salem MA 01970 Insured: Marc M Darisse Claim Number: STF8280 Policy Number: 0HF636-019683544-633 -9 Date of Loss: 04/09/2020 Loss Location: 20 Grant Rd Salem MA To: Board of Selectmen Building Commissioner Inspector of Buildings Board of Health A claim has been made involving loss, damage or destruction of the above captioned property which may either exceed $1,000 or cause Massachusetts General Laws Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws Chapter 139, Section 3B is appropriate, please direct it to my attention and include a reference to our insured, the policy number, the claim/file number, the date of loss, and the location. If you have any questions, please feel free to contact me at (508)209-7901 or email me at IHERZIG@travelers.com. Sincerely, Ian Herzig Claim Professional (508)209-7901 Ext. 209-7901 Fax: (877)786-5584 Email: IHERZIG@travelers.com 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. Signature Date P0062 F3162C1S20105000233 00001 N