41 APPLETON STREET - CLAIM NOTICE ,!E
WSafety lnsurance�
AUTO. HOME•BUSINESS
July 11, 2021
Building Commissioner or Inspector of Buildings
Fire Department or Arson Squad
Board of Health or Board of Selectmen
City Hall
SALEM, MA 01970
RE: Claim Number: LHMA0017AE
Insured(s): DENNIS DALY and JOANNE M DALY
Property Address: 41 APPLETON ST, SALEM, MA 01970
Policy Number: HMA2400415
Date of Loss: July 9, 2021
Notice of Loss Under M.G.L. c. 139 313
This communication shall serve as written notice pursuant to M.G.L. c. 139, § 3B that [Safety
Insurance Company] ("Safety") has received a claim involving loss, damage or destruction to a
building or other structure at the above-reference 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, § 3B, if the city or town intends to initiate proceedings designed to
perfect a lien under Section 3B, 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 by email at
DavidJaworski @ Safetylnsurance.com or by phone at 800-951-2100 x2048.
Sincerely,
David Jaworski
Field Claims Examiner
JUL
Safety Insurance P.O. Box 55098 Boston, MA 02205-5098 800-951-2100
Well help you manage life`s stormsO a n ® Q 010 C139