5 KING STREET CLAIM NOTICE USA, Inc.
United Service Adjustment Independent Claims Adjuster—Property and Casualty
March 14, 2022
Building Commissioner/ Inspector of Buildings
Board of Health/Board of Selectmen
93 Washington Street
Salem, MA 01970
Please distribute to each of these departments, to comply with the reporting requirements of
MGL Chapter 139, Section 3B and MGL Chapter 143 Section 6.
TO: [X] Building Commissioner or Inspector of Buildings
[X] Board of Health or Board of Selectmen
[X] Fire Department
Insured: Duhaime, Eric
Property Address: 5 King Street, Salem, MA 01970
Claim Number: CLM57593
Policy Number: DWP0I87638-02
Date of Loss: 01/16/2022
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause Mass. General Laws, Chapter 143, Section 6 to be
applicable. If any notice under MGL, Chapter 139, Section 3B is appropriate, please direct it to
the attention of this writer and include a reference to the captioned insured, location, policy
number, date of loss and file number. 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.
Sincerely,
Chris Loeb
General Adjuster
MR R + "r :3S
MPIR
P.O. Box 269 - Framingham, MA 01704 - Telephone 1-888-633-4855 - Fax 1 508-879-7385