5-7 DERBY SQUARE - CLAIM NOTICE August 24, 2021
Sent Via First Class Mail
Building Commissioner or
Inspector of Buildings
City/Town Hall
Salem, MA 01970
Board of Heath or
Board of Selectmen
City/Town Hall
Salem, MA 01970
RE: PROPERTY DAMAGE TO 5 DERBY SQUARE UNIT#1 SALEM
Named Insured: 5-7 Derby Square
Claim Number: 80080321000266-
Date of Loss: 8/23/2021
Policy Number: 8008030014071
Policy Period: 5/31/2021 —5/31/2022
Building Damages Possibly Exceeding $1,000.00
Notice Pursuant to MGL Chapter 139, Section 3B
Dear Sir or Madam:
5-7 Derby Square has presented a claim involving loss, damage or destruction of the above
captioned property which may exceed $1,000.00 in total damages or cause Massachusetts
General Laws, Chapter 143, Section 6 to be applicable.
If any notice under Massachusetts General Laws Chapter 139 Section 313 is appropriate, please
direct said notice to my attention, referencing the above captioned insured, location, policy
number, date of loss and file number on any correspondence.
Please contact the undersigned with any questions at 1-866-351-2548, ext. 15905
Sincerely,
MAPFRE INSURANCE COMPANY
Darline Shong
Claim Specialist, Property
MAIL: 11 Gore Rd, Webster, MA 01570
SEP
MA Homeowner Property Damage Notice(Rev.09/20)