20 CLEVELAND ROAD 10-17-19 CLAIM ►� f InsuranceRECEIVE®
0 Safety
AUTO•HOME •BUSINESS 0 C T 312019
P.O. Box 55098
Boston MA 02205 CITY OF SALEM
617-951-0600 BOARD OF HEALTH
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: THOMAS CONWAY and LOUISE CONWAY
Property Address: 20 CLEVELAND RD, SALEM MA
Policy Number: HMA2400315
Claim Number? BOS00093848
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, § 313 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 2070.
Sincerely,
Bryan Savosik
Claim Examiner