83 damage loss W.Springfield, MA Geer Pittsfield, MA
(413) 781-2897 , (888)881-4598
Quincy, MA Butler Worcester, MA
(617)479-2619 1 (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: MAPFRE Insurance
POLICY NUMBER: H BCKJNB
CLAIM NUMBER: NHKC71-KXPHC9
INSURED: Peter&Marilyn Kolodziej
LOSS LOCATION: 83 Florence St., Leeds, MA
DATE OF LOSS: 03/06/2017
DESCRIPTION: Sewer Back up
OUR FILE NUMBER: SI7-54119
To Whom It May Concern:
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 this writer and include a reference to the captioned insured,
location,policy number,company claim number, date of loss, and claim or file number.
Sincerely,
Tom Murphy
Claims Adjuster
P—413-8244201
F—413-731-5553
butler.adj@the-spa.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.
Secretary
March 7, 2017
209 Park Avenue,West Springfield,MA 01089