155 DERBY STREET - CLAIM NOTICE . t�- -
UNION MUTUAL
Live life well protected
November 4,2021
Building Inspector
Board of Health
93 Washington Street
Salem,MA 01970
MASSACHUSETTS GENERAL LAWS,
CHAPTER 139 LETTER
RE: Insured: Wharfside Condo Trust
Loss Location: 155 Derby St.
Salem,MA
Policy Number: BOP0142029
Date of Loss: 9/22/2021
Type of Loss: Glass Breakage
Claim#: CLM55809
Dear Sir or Madam:
A claim has been made involving loss, damage or destruction of the property captioned above,
which may either exceed$1,000.00 or cause Massachusetts General Laws, Chapter 143, Section
6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 313 is
appropriate,please direct it to the attention of the writer and include a reference to the captioned
insured, location,policy number date of loss, cause of loss and claim number.
On this date, I caused copies of this notice to be sent to the persons named above at the addresses
indicated above by first class mail.
Sincerely,
t<3 1 r..2-54
Jeff Staples
Regional General Adjuster
1-800-671-8550 ext. 616
jstaples@unionmutual.com
Union Mutual Fire Insurance Company i39 State Street,P.O.Box 158
= Community Mutual Insurance Company Montpelier,VT 056oi
New England Guaranty Insurance Company,Inc. 8o0-300-526i �J
www.unionmutual.com