155 DERBY STREET - CLAIM NOTICE 11.18.21 ra►7
UNION MUTUAL
Live life well protected
November 18, 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 Street
Salem,MA
Policy Number: BOP0142029
Date of Loss: 11/12/2021
Type of Loss: Wind/water
Claim#: CLM56032
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,
ki.ov pol 2:22
Jeff Staples NOV
Regional General Adjuster
1-800-671-8550 ext. 616
jstaples@uniorimutual.com
Union Mutual Fire Insurance Company 139 State Street,P.O.Box 158
Community Mutual Insurance Company Montpelier,VT 056oi
SUM New England Guaranty Insurance Company,Inc. 800-300-5261
s www.unionmutual.com V.
YDtD