76 Notice of Loss 2016 pSafely Insurance
P.O. Box 55098
Boston, MA 02205-5098
1-617-951-0600
Building Commissioner or Inspector of Buildings
Fire Department or Arson Squad
Board of Health or Board of Selectmen
City Hall
NORTHAMPTON, MA 01060
Insured:
Property Address:
Policy Number:
Claim Number:
Date of Loss:
GORDON E MURPHY and NANCY E MURPHY
76 NORTH ELM STREET NORTHAMPTON, MA
HMA 0003179
BOS00070187
6/19/2016
Notice of Loss Under M G L. c. 139, § 3B
June 21, 2016
This communication shall serve as written notice pursuant to M.G.L. c. 139, § 3B that [Safety
Insurance Company] ("Safety") has received a claim involving loss, damage or destruction to a
building or other structure at the above-referenced address which may either: (I) 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, § 3B, 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. 11 I, § 127B, please
notify Safety of the same by certified mail. Kindly forward such notice to my attention, at the
address indicated below, 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 at (617)
951-0600 EXT 3315.
Sincerely,
Dan Rex
Claim Examiner