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10.5 Langdon Street 9-1-18 claim Samuel F. McCormack Co. Inc. Insurance Adjusters and Appraisers Samuel F.McCormack Co.,Inc. ADJUSTERS AND APPRAISERS RECEIVE® June 11, 2021 JUN 17 2021 Salem City Hall CITY OF SALEM Building Inspector BOARD OF HEALTH 93 Washington Street Salem. MA 01970 RE ASSURED: David Blatt LOSS LOCATION: 10 1/2 Langdon St, Salem, MA 01970 POLICY NO: DF13083636 TYPE OF LOSS: Sewage DATE OF LOSS: 09/01/2018 OUR FILE NO: 21-01448 To Whom It May Concern: Claim has been made involving loss, damage or destruction of the above-captioned property,which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 313 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 or file number. Thank you for your anticipated cooperation. Very truly yours, Edward Bennett Adjuster efb@mccormackadjuster.com cc: Board of Health 98 Washington St, Salem, MA 01970 cc: Salem Fire Dept 48 Lafayette Street Salem, MA 01970 42 Holbrook Avenue,Braintree,MA 021841-800-972-5399(781)843-1222 Fax(781)849-8191 125 Waterhouse Road,Bourne,MA 02532(508)403-2600 Fax(508)403-2602 www.mcconnackadjuster.com