392 damage loss W. Springfield, MA@gyp Pittsfield, MA
(413)781-2897 (888)881-4598
Quincy. MA Butler Worcester, MA
(617)479-2619 (888)881-4598
Mattapoisett, MA Adjusters Cape Cod&Islands
(508)758-6633 (888)881-4598
Rhode Island Inc. Hartford, CT
(888)881-4598 BUTLER (888)881-4598
Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
City of Northampton City of Northampton
210 Main Street 210 Main Street
Northampton,MA 01060 Northampton,MA 01060
Attention: Records Attention: Records
COMPANY: Commerce Insurance Company MA
POLICY NUMBER: H BDJXYC
CLAIM NUMBER: HXKC20-CI\'KYV5
INSURED: Timothy G. Reynolds&Rachel A. Maiore
LOSS LOCATION: 392 Chesterfield Road,Leeds,MA
DATE OF LOSS: 03/23/2014
DESCRIPTION: Puff-Back
OUR FILE NUMBER: S14-51344
Gentlemen:
Claim has been made involving loss, damage, or destruction of the above captioned property which
may either exceed $1,000, or cause Massachusetts General Law, Chapter 143, Section 6, to be
applicable. If any notice under Massachusetts General Law, Chapter 139, Section 3B, is appropriate,
please direct it to the attention of the writer and include a reference to the captioned insured, location,
policy number, company claim number, date of loss,and claim or file number.
Sincerely,
Peter Shea
Adjuster
P—413-781-2897
F—413-731-5553
peter.shea@georgebutleradjusters.com
On this date, I caused copies of this notice to be sent to the persons named above at the address indicated
above, by first class mail.
K. aa0,6-0
Secretary
February 15, 2017
209 Park Avenue,West Springfield,MA 01089