149 DERBY STREET - CLAIM NOTICE Samuel F. McCormack Co., Inc.
Insurance Adjusters and Appraisers
Samuel F.McCormack Co.,Inc.
ADJUSTERS AND APPRAISERS
September 22, 2021
Salem City Hall
Building Inspector
93 Washington Street
Salem. MA 01970
RE ASSURED: 149 Derby St Condo Tr c/o Jim Sullivan
LOSS LOCATION: 149 Derby St, Salem, MA 01970
POLICY NO: BP18002921
TYPE OF LOSS: Foundation
DATE OF LOSS: 09/21/2021
OUR FILE NO: 21-02886
To Whom It May Concern:
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 313 is
appropriate, please direct it to the attention of this writer and include a reference to the above-
captioned insured, location, policy number, date of loss and claim or file number.
Thank you for your anticipated cooperation.
Very truly yours,
Edward Bennett
Adjuster
efb@mccormackadjuster.com
cc: Board of Health
Fire Department
SEA`2 pm.1:4
SEP
42 Holbrook Avenue,Braintree,MA 021841-800-972-5399(781)843-1222 Fax(781)849-8191
125 Waterhouse Road,Bourne,MA 02532(508)403-2600 Fax(508)403-2602
www.mccormackadjuster.com