278 Lafayette Street 1-6-18 claim W. Springfield, MA v a F, . Pittsfield, MA
(413)781-2897 (888) 881-4598
Quincy, MA Sc?
?'IyA. s' Worcester, MA
(617)479-2619 :„ (888) 881-4598
Mattapoisett, MA4.zyd1*v Cape Cod&Islands
(508)758-6633 (888)881-4598
Rhode Island -- ----ii ., Hartford, CT
(888)881-4598 BUTLER (888)881-4598
Building Commissioner or �r Board of Health or RECEIVED
of Buildings Board of Selectmen
City of Salem City of Salem
120 Washington Street 120 Washington Street JAN 2 92018
3rd Floor 4th Floor CITY OF SALEM
Salem, MA 01970 Salem, MA 01970 BOARD OF HEALTH
Attention: Records Attention: Records
COMPANY: Certain Underwriters at Lloyds, London c/o Vanguard Claims
Administration, Inc.
POLICY NUMBER: XSZ97026
CLAIM NUMBER: XSO4608
INSURED: 278 Lafayette Street Trust
LOSS LOCATION: 278 Lafayette Street, Salem, MA
DATE OF LOSS: 01/06/2018
DESCRIPTION: Freeze Up
OUR FILE NUMBER: B18-41433
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 3B, 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.
T
garpan
Claims Adjuster
P—603-742-9747 -office
F—617-479-1740
jeffm@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
January 23, 2018
P.O. Box 1557, Mattapoisett,MA 02739