8 Hubon Street 10-17-19 claim G RECEIVED
Safety Insurance AUTO•HOME •BUSINESS OCT 31 2019
P.O. Box 55098 CITY OF SALEM
Boston MA 02205 BOARD OF HEALTH
617-951-0600
October 21, 2019
Building Commissioner or Inspector of Buildings
Fire Department or Arson Squad
Board of Health or Board of Selectman
City Hall
SALEM, MA 01970
Insured: GRISTAL LLORENS and JACKSON OLIVEIRA.
Property Address: 8 HUBON ST, SALEM MA
Policy Number: HMA0495062
Claim Number: BOS00093847
Date of Loss: 10/17/2019
Notice of Loss Under M.G.L. c. 139,§ 3B
This communication shall serve as written notice pursuant to M.G.L. c. 139, § 3B that [Safety
Insurance Company] ("Safety") has received a claim involving loss, damage or destruction to a
building or other structure at the above-referenced address which may either: (1) meet or exceed
$1,000; or(2)cause the condition or the building or other structure to render M.G.L. c. 143, § 6
applicable.
In accordance with M.G.L. c. 139, §313, if the city or town intends to initiate proceedings designed
to perfect a lien under Section 3B. M.G.L. c. 143, §9 or M.G.L. c. 111, § 127B, please notify
Safety of the same by certified mail. Kindly forward such notice to my attention, at the address
indicated above, and include with such notice a reference to the above-described insured, property
address, policy number and claim number.
If you have any questions regarding this notice, please feel free to contact me directly at
617-951-0600 EXT 6486.
Sincerely,
Daniel Magee
Claim Examiner