5 TANGLEWOOD LANE - CLAIM NOTICE AMERICAN CLAIMS SERVICE
MULTI-LINE ADJUSTERS
ACS Notice of Claim
Letter 143
October 10, 2021
City of Salem
Building Department
https:/Iwww.salem.com/user/856/contact
Salem, MA 01970
Attention: Building Inspector
Board of Health and/or
Board of Selectman
Insured: Silverman
Location: 5 Tanglewood Lane Salem, MA 01970
Policy: 41252400002
Loss Date: April 21, 2021
Loss Type: Dining room ceiling possible mold
ACS File: 21139
Dear Sir/Madam,
Claim has been made involving loss, damage or destruction of the above captioned property, 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,
loss date and file.
On this date, October 10, 2021, 1 caused copies of this notice to be sent to the persons named above
at the addresses indicated above by first class mail.
Unless a response is received within the next ten days we will not be obligated to pay any portion of
this claim to you.
Respectfully submitted,
Gerard Gillespie
Claims Representative OCT 12�;�S: S
OCT
PO Box 688 Lynnfield, MA 01940 claims.acs verizon.net 781-246-9516