11D FILLMORE ROAD - CLAIM NOTICE 75 Sam Fonzo Drive I Beverly,Massachusetts 01915
•; Claims Department
$00.227.2757 ( Electricinsurance.com
October 12, 2021
Building Commissioner or
Inspector of Buildings
98 Washington St
Salem, MA 01970
RE: Insured: DOUGLAS ERICKSON
Claim Number: 20211012A56
Policy Number: H6215416H1
Date of Loss: October 09, 2021
Property Address: 11D FILLMORE RD SALEM, MA 01970-2700
Form of Notice of Casualty Loss to Building
Under Massachusetts General Laws Chapter 139, Sec. 3B
Claim has been made involving loss, damage or destruction to the above-captioned property, which may
equal or exceed $1,000 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 to
the attention of the undersigned and include a reference to the captioned insured, location, policy
number, date of loss and claim or file number.
On October 12, 2021 copies of this notice were sent by first class mail to the entities and addresses noted
herein.
Sincerely,
P44enallm
Javiera Verdugo
Claims Specialist
OCT 25 AHS:12-
OCT
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