375 LAFAYETTE STREET - CLAIM NOTICE VVI
UNION MUTUAL
Live life well protected
November 17, 2021
Building Inspector
Board of Health
93 Washington Street
Salem,MA 01970
MASSACHUSETTS GENERAL LAWS,
CHAPTER 139 LETTER
RE: Insured: 375 Lafayette St. Condo
Loss Location: 375 Lafayette St.
Salem,MA
Policy Number: BOP0178974
Date of Loss: 10/25/2021
Type of Loss: Wind
Claim#: CLM55994
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 3B 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,
Jeff Staples
Regional General Adjuster
1-800-671-8550 ext. 616 NOV 22 PN12:22-
jstaples@unionmutual.com NOV
Union Mutual Fire Insurance Company 139 State Street,P.O.Box 158
Community Mutual Insurance Company Montpelier,VT 056oi
New England Guaranty Insurance Company,Inc. 8o0-300-526i
t www.unionmutual.com
2016