395 LAFAYETTE STREET - CLAIM NOTICE Safety onsurancen
irif AUTO.HOME•BUSINESS
May 2, 2021
Building Commissioner or Inspector of Buildings
Fire Department or Arson Squad
Board of Health or Board of Selectmen
City Hall
SALEM, MA 01970
RE: Claim Number: LHMA001361
Insured(s): ANTHONY ZIETMAN and ALISON BROOKES
Property Address: 395 LAFAYETTE STREET, SALEM, MA 01970
Policy Number: HMA0201535
Date of Loss: April 14, 2021
Notice of Loss Under M.G.L. c. 139, § 313
This communication shall serve as written notice pursuant to M.G.L. c. 139, § 313 that [Safety
Insurance Company] ("Safety") has received a claim involving loss, damage or destruction to a
building or other structure at the above-reference address which may either: (1) meet or exceed
$1,000; or (2) cause the condition or the building or other structure to render M.G.L. c. 143 § 6
applicable.
In accordance with M.G.L. c. 139, § 313, if the city or town intends to initiate proceedings designed to
perfect a lien under Section 3B, M.G.L. c. 143, §9 or M.G.L. c. 111, § 127B, please notify Safety of
the same by certified mail. Kindly forward such notice to my attention, at the address indicated
above, and include with such notice a reference to the above-described insured, property address,
policy number and claim number.
If you have any questions regarding this notice, please feel free to contact me directly by email at
petenajarian@safetyinsurance.com or by phone at 617-951-0600 x3168.
Sincerely,
Pete Najarian
Property Adjuster
MAY 7 Avg8:2
14AY
Safety Insurance P.O. Box 55098 Boston, MA 02205-5098 800-951-2100
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