13 Ins Loss 12-3-19 Safety Insurance
AUTO•HOME •BUSINESS
P.O. Box 55098
Boston MA 02205
617-951-0600
December 03, 2019
Building Commissioner dr Inspector of Buildings
Fire Department or Arson Squad
Board of Health or Board of Selectman
City Hall
FLORENCE, MA 01062
Insured: KAREN_S ROWE_and,JONATHAN B HEYMA.N
Property Address: 13 OAK STREET, FLORENCE MA
Policy Number: HMA0299562
Claim Number: BOS00094631
Date of Loss: 11/28/2019
Notice of Loss Under M.G.L. c. 139,§3B
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: (1) 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, § 313, if the city or town intends to initiate proceedings designed
to perfect a lien under Suction 36, M.G.L. 143, 9 or M.G.L. c. 111, 127B, please notify
P I I�.. �- § §
Safety of the same by certified mail. Kindly forward such notice to my attention, at the address
-.indicated above, and-in lude-with-such-notice--a-referei-ice-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 5132.
Sincerely,
Kirill Shubin
Claim Examiner