108 Water Damage Claim 2011 ed - d ustment Service, Inc.
StP _ B2011 61Co
OEPORTHA PION IMA 0/06IO
NOiRryAMRON,Mq OfC6p
and Liability Ad usters
tage Street, Easthampton, 911A 01027
413-282-0150 Pat 413-527-5144
TolrTree: 800-791-5432
BOARD OF HEALTH
CITY HALL/MUNICIPAL OFFICES
Northampton, MA 01060
Insured:
Policy#:
Date of Loss:
Type of Loss:
Our File:
Loss Loc.:
Busi, Frederick A. & Esta S.
HP0628868
08/28/2011
Water damage
11-08183-00P21
111 South St.,Northampton, MA 01060
n has been made involving loss, damage or destruction of the above-captioned property,
h may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be
cable.
y notice under Mass. Gen. Laws, Chapter 139, Sec. 3B is appropriate, please direct it to the
tion of the writer and include a reference to the captioned insured, location, policy number,
of loss and claim or file number.
Edward J. Popoli Ext 204
tis date, I caused copies of this notice to be sent to the persons named above at the addresses
atefl above by first class mail.
ature
8/31/11
Date