10 Insurance Loss Phone: 978-632-2660 Fax: 978-632-2661
JAMES A. TRUDEAU
Adjustment Service Inc.
P.O. Box 7
Gardner,MA 01440
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Notice of Casualty Loss of Building
Under Massachusetts General Laws, Chapter 139, Section 3B
May 22,2019
Building Inspector
210 Main Street
Northampton, MA 01060
/Board of Health
210 Main Street
Northampton, MA 01060
Fire Department
Dept. of Records
26 Carlon Drive
Northampton, MA 01060
Insured: Lisa Leary
Loss Location: 10 Hayward Road,Florence,MA 01062
Insurance Company: Preferred Mutual Insurance Co.
Policy No.: PH00100775965
Date of Loss: May 22,2019
File Number: 19-17584
Claim Number: 19111450
Type of Loss: Water Damage
Claim has been made involving loss, damage, or destruction of the above captioned property, which may either
exceed 57,000.00 or cause"Mass. Gen. Laws, Chapter 143, Section 6"to be applicable. If any notice under"Mass.
Gen. Laws, Chapter 139, Section 3B" is appropriate, please direct it to the writer and include a reference to the
captioned insured, location,policy number, date of loss,and file or claim number.
Claim has been made involving loss, damage or destruction of the above-captioned property, which may
exceed 55000. If any notice under Massachusetts General Laws, Chapter 175, Section 97A is appropriate,
please direct it to the attention of this writer and include a reference to the above-captioned insured,
location,policy number,date of loss and claim number.
On this date, I cause copies of this notice to be sent to the person(s) named above at the address indicated by first
class mail.
Sincerely,
Joshua M.Trudeau
Claims Adjuster