6 Hawthorne Boulevard 2-17-21 claim W. Springfield, MA RECEIVED
(413)781-2897 ;*i G � k V. Pittsfield,(888)881-459898
Quincy, MA Butler FEB 2 2 2021 Worcester,MA
(617)479-2619 (888)881-4598
Mattapoisett, MA Adjust CITY OF SALEM
(508) 758-6633 BOARD OF HEALTI ape Cod& Islands
(888)881-4598
Rhode Island f em Hartford, CT
(888)881-4598 BUTLER (888)881-4598
Building Comnjis�:sioner or Board of Health or
Inspector of Bilildings Board of Selectmen
City of Salem City of Salem
120 Washington Street 120 Washington Street
3rd Fl Or
4th Floor
Sale : MA 01970 Salem, MA 01970
Yention: Records Attention: Records
COMPANY: Certain Underwriters at Lloyds, London c/o Vanguard Claims
Administration, Inc.
POLICY NUMBER: XSZ163569
CLAIM NUMBER: XS08641
INSURED: Fatima Mitchell
LOSS LOCATION: 6 Hawthorne Blvd, Salem, MA
DATE OF LOSS: 02/17/2021
DESCRIPTION: Property - Other
OUR FILE NUMBER: P21-11218
To Whom It May Concern:
Claim has been made involving loss, damage, or destruction of the above captioned property which
may either exceed $1,000, or cause Massachusetts General Law, Chapter 143, Section 6, to be
applicable. If any notice under Massachusetts General Law, Chapter 139, Section 3B, is appropriate,
please direct it to the attention of this writer and include a reference to the captioned insured,
location,policy number, company claim number, date of loss, and claim or file number.
Sincerely,
John Schillizzi
Claims Adjuster
P—(978) 818-5453
F—617-470-1740
JohnS@georgebutleradjusters.com
On this date, I caused copies of this notice to be sent to the persons named above at the address
indicated above, by first class mail.
Secretary
February 17, 2021
209 Park Avenue,West Springfield,MA 01089