11 Flying Cloud Lane 7-13-20 claim RECEIVED
Safety Insurance JUL 2 2 2020
AUTO•HOME •BUSINESS
P.O. Box 55098 CITY OF SALEM
Boston MA 02205 BOARD OF HEALTH
617-951-0600
July 14, 2020
Building Commissioner or Inspector of Buildings
Fire Department or Arson Squad
Board of Health or Board of Selectman
City Hall
SALEM,MA 01970
Insured: JENNIFER ZIELINSKI
Property Address: 11 FLYING CLOUD LANE, SALEM MA
Policy Number: HMA0207235
Claim Number: BOS00098152
Date of Loss: 7/13/2020
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 313, 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 3420.
Sincerely,
Lisa Monette
Claim Examiner