126 Federal Street 4-16-21 claim W. Springfield,MA �s�0�, Pittsfield, MA
(413)781-2897 RECEIVED (888)881-4598
Quincy, MA BYfl er Worcester, MA
(617)479-2619 (888)881-4598
`
Mattapoisett,MA Adjust „ APR 2 7 2021 Cape Cod&Islands
(508)758-6633 (888)881-4598
Rhode Island -Inc. CITY OF SALEM
(888)8 Island
8 BOARD OF HEALTH Hartford, CT
BUTLER (888)881-4598
Building Commi oner or Board of Health or
Inspector of B ' dings Board of Selectmen
City of Sal City of Salem
120 W ington Street 120 Washington Street
3rd FI or 4th Floor
Salem, MA 01970 Salem, MA 01970
Mention: Records Attention: Records
COMPANY: Certain Underwriters at Lloyds, London c/o Vanguard Claims
Administration, Inc.
POLICY NUMBER: XSZ170324
CLAIM NUMBER: XS08791
INSURED: 126 Federal Street Condo
LOSS LOCATION: 126 Federal Street, Salem, MA
DATE OF LOSS: 04/16/2021
DESCRIPTION: Wind
OUR FILE NUMBER: P21-11350
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
April 21, 2021
209 Park Avenue,West Springfield,MA 01089