107 Federal Street, Unit 3 5-27-21 claim Phone: 978-632-2660 Fax: 978-632-2662
RECEIVED
JAMES A. TRUDEAU
Adjustment Service Inc. .JUN 0 3 2021
P. O. Box 7
F SALEM
Gardner, MA 01440 CITY OF HEALTH
BOARD O
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Notice of Casualty Loss of Buildin
Under Massachusetts General Laws, Chapter 139, Section 3B
June 1,2021
Building inspector
93 Washington Street
Salem,MA 01970
oard ofXgtoealth93 Washn Street
Salem,MA 01970
Fire Department
Dept. of Records
48 Lafayette Street
Salem,MA 01970
Insured: 107 Federal Street Condo Trust
Loss Location: 107 Federal Street, Unit 3,Salem,MA 01970
Insurance Company: The Concord Group Ins.Companies
Policy No.: 20018243
Date of Loss: May 27, 2021
File Number: 21-19131
Claim Number: 0030018675
Type of Loss: Water Damage
Claim has been made involving loss, damage, or destruction of the above captioned property, which may either
exceed$1,000.00 or cause "Mass. Gen. Laws, Chapter 143, Section 6" to be applicable. If any notice under"Mass.
Gen. Laws Cha ter 139 Section 3B" is appropriate, please direct it to the writer and include a reference to the
captioned insured,location,policy number, date of loss, and file or claim number.
Claim has been made involving loss, damage or destruction of the above-captioned property, which may
exceed $5000. If any notice under Massachusetts General Laws, Chapter 175 Section 97A is appropriate,
please direct it to the attention of this writer and include a reference to the above-captioned insured,
location,policy number,date of loss and claim number.
On this date, I cause copies of this notice to be sent to the person(s) named above at the address indicated by first
class mail.
Sincerely,
Joshua M. Trudeau
Claims Adjuster