160 LAFAYETTE STREET - CLAIM NOTICE flJf
UNION MUTUAL
Live life well protected
January 7,2022
Building Inspector
Board of Health
93 Washington Street
Salem,MA 01970
MASSACHUSETTS GENERAL LAWS,
CHAPTER 139 LETTER
RE: Insured: 160 Lafayette St.Condo
Loss Location: 160 Lafayette St.
Salem,MA
Policy Number: BOP0005685
Date of Loss: 12/11/2021 report as
Type of Loss: Water damage
Claim #: CLM56508
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 JAN 11 ,m I:
1-800-671-8550 ext. 616 `IAIN
jstaples@unionniutual.com
Union Mutual Fire Insurance Company 139 State Street,P.O.Box 158 �RQh
Community Mutual Insurance Company Montpelier,VT 056oi
New England Guaranty Insurance Company,Inc. 8o0-300-526i
www.unionmutual.com
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