75 MASON STREET 12-6-21 CLAIM Phone: 978-632-2660 R E C E' 092-2662
JAMES A. TRUDEAU DEC 2 8 2021
Adjustment Service Inc.
P. O. Box 7 CITY OF SALEM
Gardner, MA 01440 BOARD OF HEALTH
claimAmtrudeauadi.com
Notice of Casualty Loss of Building
Under Massachusetts General Laws, Chapter 139, Section 3B
December 20,2021
Building Tnspector
93 Washington Street
Salem,MA 01970
Xard
of Health
Washington Street
Salem, MA 01970
Fire Department
Dept. of Records
48 Lafayette Street
Salem,MA 01970
Insured: Mack Park Condo Association% L.Scanlon
Loss Location: 75 Mason St., Salem,MA 01970
Insurance Company: The Concord Group Ins.Companies
Policy No.: 20031590
Date of Loss: December 6, 2021
File Number: 21-19619
Claim Number: 30031525
Type of Loss: Property Damage
Claim has been made involving loss, damage, or destruction of the above captioned property, which may either
exceed 1,000.00 or cause "Mass. Gen. Laws, Chapter 143, Section 6"to be applicable. If any notice under"Mass.
Gen. Laws, Chapter 139, Section 3B" is appropriate, please direct it to the writer and include a reference to the
captioned insured,location,policy number, date of loss, and file or claim number.
Claim has been made involving loss, damage or destruction of the above-captioned property, which may
exceed $5000. If any notice under Massachusetts General Laws, Chapter 175, Section 97A 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 number.
On this date, I cause copies of this notice to be sent to the person(s) named above at the address indicated by first
class mail.
Sincerely, DEC
Justen Hires
Claims Adjuster