19 WEST AVENUE - CLAIM NOTICE CONCORD GROUP Massachusetts Branch
INSURANCE 1 Research Drive Suite 301B I Westborough MA 01581
A MEMBER OFTHEAUTO-OWNERS INSURANCE GROUP'" (p)800.422.5246
ConcordGroupinsurance.com
December 20,2021
Salem City Hall
93 Washington Street
Salem,MA 01970
Insured: David Dicesare
Loss Location: 19 West Ave Salem,MA 01970
Insurance Company: The Concord Group Ins.Companies
Policy No.: 1334444
Date of Loss: 12/11/2021
Claim Number: 0030031468
Type of Loss: Property Damage
Dear Sir or Madam:
A 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$1,000.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.
If you have any questions,please let me know
Sincerely,
Marc Marquis,AIC
Property Adjuster
DEC2'2_1iH1 :51
E.C.