153 Insurance Loss 2020Form of Notice of Casualty Loss to Building
Under Massachusetts General Laws Chapter 139 Section 36
May 19, 2020
Northhampton Health Department
212 Main Street, #101
Northhampton, MA 01060
RE: INSURED
LOSS LOCATION
CO. CLAIM NO.
POLICY NO.
TYPE OF LOSS
DATE OF LOSS
OUR FILE #
To whom it may concern:
C HALL, LLC dba THELO
153 Main Street
Northhampton, MA 01060
HBD-0004215
HBD10028946
Water Damage
5/2/2020
BOS20163370
100 Corporate Drive, Suite 210
Windsor, Connecticut. 06095
Phone(860)296-0261
Fax(860)296-0581
Claim has been made involving loss, damage or destruction of the above -captioned property,
which may either exceed $1,000.00 or cause Massachusetts General Laws Chapter 143
Section 6 to be applicable. If any notice under Massachusetts General Laws Chapter 139
Section 313 is appropriate, please direct it to the attention of the writer and include a reference
to the captioned insured, location, policy number, date of loss and claim or file number.
Ban" Ubd&
Signature
Title: Sr. Adiuster
On this date, I caused copies of this notice to be sent to the person named above at the
addresses indicated above by First Class Mail.
Batwe Uh"
Date & Signature
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