5-7 DERBY SQUARE 4-29-22 CLAIM INDEPENDENT RECEiVEDMAYY 0
CLAIMS SERVICE, INC. 2022
CITY OF SALEM
Service Integrity • Experience BOARD OFHEALTH
Notice of Casualty Loss to Building
Under Massachusetts General Laws, Chapter 139, Section 3B
May 4, 2022
Salem, MA Building Inspector
1 Salem Green
Salem, MA 01970
Salem,MA Board of Health
9 North Street
Salem, MA 01970
Salem, MA Fire Department
48 Lafayette Street
Salem,MA 01970
INSURED: 5-7 Derby Square
ADDRESS: 5-7 Derby Square Salem, Salem,MA 01970
LOCATION OF LOSS: 5-7 Derby Square Salem,Salem, MA 01970, US
COMPANY: MAPFRE Insurance
POLICY#: 8008030014071
CLAIM#: 22-91431
DATE OF LOSS: 04/29/2022
TYPE OF LOSS: Water
Dear Sir or Madam.
Independent Claims Service is the insurance adjusting firm hired by the above referenced client to handle the
captioned loss on behalf of their insured.
A 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
notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please bring it to our
attention, and include a reference of the captioned insured: Location,policy number, and/or date of loss.
Sincerely,
INDEPENDENT CLAIMS SERVICE,INC.
22 Water Street • Westborough.MA 01 581 • 508.366.8535 • FAX 508.366.0917 • www.icsclaims.com