76 Leach Street 10-25-19 claim W. Springfield,MA { GeOl RECEIVED i E D Pittsfield, MA
(413)781-2897 R E (888)881-4598
Quincy, MA Butler Worcester, MA
(617)479-2619 0 N O V U 5 2019 (888)881-4598
Mattapoisett, MA A #Justelf Cape Cod&Islands
(508) 758-6633 CITY OF SALEM (888)881-4598
Rhode Island Inc. BOARD OF HEALTH Hartford, CT
(888)881-4598 BUTLER (888)881-4598
Building Commis ' ner or Board of Health or
Inspector of Bu' ings Board of Selectmen
City of Sale City of Salem
120 Wash' gton Street 120 Washington Street
3rd Flo 4th Floor
Salen , MA 01970 Salem, MA 01970
A tion: Records Attention: Records
COMPANY: Certain Underwriters at Lloyds, London c/o Vanguard Claims
Administration, Inc.
POLICY NUMBER: XSZ140477
CLAIM NUMBER: XS07100
INSURED: 76 Leach Condominium Trust
LOSS LOCATION: 76 Leach Street, Salem, MA
DATE OF LOSS: 10/25/2019
DESCRIPTION: Water
OUR FILE NUMBER: P 19-10144
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, or cause Massachusetts General Law, Chapter 143, Section 6, to be
applicable. If any notice under Massachusetts General Law, Chapter 139, Section 313, is appropriate,
please direct it to the attention of this writer and include a reference to the captioned insured,
location,policy number, company claim number, date of loss, and claim or file number.
Sincerely,
John Schillizzi
Claims Adjuster
P—978-818-5453
F—617-470-1740
JohnS@georgebutleradjusters.com
On this date, I caused copies of this notice to be sent to the persons named above at the address
indicated above, by first class mail.
Secretary
October 30, 2019
209 Park Avenue,West Springfield,MA 01089