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12 Admirals Lane - Claim Notice 21422 TRAVELERS J 336 THE STANDARD FIRE INSURANCE COMPANY P.O. Box 430 Buffalo, NY 14240-0430 02/14/2022 City of Salem Building Inspector 120 Washington Street Salem MA 01970 Insured: Kenneth-Fine-Ella Kenneth-Fine-Ella-Fine Claim Number: IAW9015 Policy Number: OHF636-600840553-636-1 Date of Loss: 01/28/2022 Loss Location: 12 Admirals Ln Salem MA To: Board of Selectmen Building Commissioner Inspector of Buildings Board of Health A claim has been made involving loss, damage or destruction of the above captioned property which may either 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 313 is appropriate, please direct it to my attention and include a reference to our insured, the policy number, the claim/file number, the date of loss, and the location. If you have any questions, please feel free to contact me at (978)763-5874 or email me at MSERAF]2@travelers.com. Sincerely, Murphy Serafino Claim Professional (978)763-5874 Ext. 9787635874 Fax: (877)786-5584 -E-mail: MSERAFI2@travelers.com On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Signature Date � -marts, .- r�iy:_,� FEB P0062 F3162C1 S22046000336 00001 N