50 #1 Insurance Loss 2020Aldftl
PSafety Insurance
AUTO • HOME • BUS/NESS I
P.O. Box 55098
--.
Boston MA 02205
817-951-0600
Building Commissioner or Inspector of Buildings
Fire Department or Arson Squad
Board of Health or Board of Selectman
City Hall
NORTHAMPTON, MA 01060
Insured: KAREN L PEDERSEN
Property Address:.__ 50_UN_ION ST#1, NORTHAMPTON MA
Policy Number: HMA0132745
Claim Number: BOS00097257
Date of Loss: 4/6/2020
Notice of Loss Under M.G.L. c. 139,§ 3B
July 29, 2020
This communication shall serve as written notice pursuant to M.G.L. c. 139, § 36 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, § 3B, if the city or town intends to initiate proceedings designed
to perfect a lien under Section 3B, M.G.L. c. 143, § 9 or M.G.L. c. 111, § 127B, please notify
Safety of the same by certified mail. Kindly forward such notice to my attention, at the address
indicated above, and include with such notice a reference 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 5196.
Sincerely,
Evangelos Orfanos
Claim Examiner