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20 BRADFORD STREET - CLAIM NOTICE Admbk 'V0 Safety Insurance, AUTO• HOME.BUSINESS December 24, 2021 Building Commissioner or Inspector of Buildings Fire Department or Arson Squad Board of Health or Board of Selectmen City Hall SALEM, MA 01970 RE: Claim Number: LHMA0053CA Insured(s): EDWARD MCCARTHY Property Address: 20 BRADFORD STREET, SALEM, MA 01970 Policy Number: HMA0140105 Date of Loss: 12/19/2021 Notice of Loss Under M.G.L. c. 139 3B This communication shall serve as written notice pursuant to M.G.L. c. 139, § 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. In accordance with M.G.L. c. 139, § 3B, if the city or town intends to initiate proceedings designed to perfect a lien under Section 3B, M.G.L. c. 143, §9 or M.G.L. c. 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 a reference to the above-described insured, property address, policy number and claim number. if you havo any questions regarding this notice, please feel free to contact me directly by email at petenajarian@safetyinsurance.com or by phone at 6179510600. Sincerely, Pete Najarian Property Adjuster •'�'S F {� f"'�'ggiyy��;mx npe 6 j J AN, Visit us at www.safetyinsurance.com/claims for Frequently Asked Claims Questions Safety Insurance P.O. Box 55098 Boston, MA 02205-5098 800-951-2100 We'll help you manage life's storms® In n 010_..C139 e 93