44 CEDAR STREET 9-4-20 CLAIM VERMONT MUTUAL INSURANCE COMPANY
VERMONT MUTUAL
NORTHERN SECURITY INSURANCE COMPANY, INC.
® INSURANCE GROUP GRANITE MUTUAL INSURANCE COMPANY
SINCE 1828
May 24, 2021 RECEIVE®
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Board of Health CITY OF SALEM
Town of Salem BOARD OF HEALTH
98 Washington St
Salem, MA 01970-5094
NOTICE OF CASUALTY LOSS UNDER MASSACHUSETTS
GENERAL LAWS, CHAPTER 139, SECTION 313
Insured: Pedro Dasilva
Claim Number: H0029227
Policy Number: H012303122
Date of Loss: 09/04/20
Property Location: Christina Dasilva, 44 Cedar St, Salem, MA 01970-5094
Type of Loss: Tree Fell In The Backyard And On The Fence - Fence Has Not Been
Repaired
Ladies and Gentlemen:
A claim has been made involving loss, damage or destruction of the above-captioned property
which may either exceed $1,000.00 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 the attention of the writer and include a reference to the captioned
insured, locations, policy number, date of loss and claim or file number.
Thank you for your cooperation.
Si y,
Colin eag Wer &q
Associate Claim Representative II
Extension:7150
Claims@vermontmutual.com
Vermont Mutual Insurance Group®
STABLE PREDICTABLE COMPETENT PARTNER
89 State Street, PO Box 188,Montpelier, VT 05601-0188 800.451.5000 1 vermontmutual.com