55 APPLETON STREET - CLAIM NOTICE Safety lnsurance;,
AUTO^ HOME^BUSINESS
November 14. 2O21
Building Commissioner or Inspector of Buildings
Fire Department 0r Arson Squad
Board of Health Or Board 0fSelectmen
City Hall
SALEyN. K8A01S7O
RE: Claim Number: LHK4A003082
lnsmred(s): PN|CH/\ELBOLDUC
Property Address: 55APPLET0N STREET, @ALEM' /NAO1S7O
Policy Number: HMA0410383
Date of Loss: 11/10/2021
_............______ ........... _______------------___...............--------- .........._____
This communication Sh8|| aen/8 as written notice pursuant 10 M.G.L. c. 139' G 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.
|n accordance with yN.G.Lc. 189' § 3B' if the city or town intends to initiate proceedings designed
tD perfect a lien under Section 3B, K8.G.Lo. 148' §9oryW.G.Lc. 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 8 reference tothe above-described insured, property address,
policy number and claim number.
If you have any questions regarding this noticS, please feel Ynae to contact me directly UV email 81
RichZak@Ssdetv|neunsnce.commurby phone 8t8OO95121OO.
Sin0ere|y,
Rick Zak
Property Claims Examiner
NOT V 22PM12:22
NOV Visit uaa1vmmw.aahetyinoummoo.00m/c|aims for Frequently Asked Claims Questions
Safety Insurance P.O. Box 55088 Boston, MAV2205'5O98 800-051-2100
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