103 Ins Loss 1-13-20 � Safety Insurance
AUTO•HOME•BUSINESS
P.O. Box 55098
Boston MA 02205
617-951-0600
January 13, 2020
Building Commissioner or Inspector of Buildings
Fire Department or Arson Squad
Board of Health or Board of Selectman
City Hall
FLORENCE, MA 01062
Insured: BRIAN-A-WIL-BY-and:LINDSEY K WILBY ---
Property Address: 103 BLISS STREET, FLORENCE MA
Policy Number: HMA0428400
Claim Number: BOS00095150
Date of Loss: 1/4/2020
Notice of Loss Under M.G.L. c. 139,§3B
This communication shall serve as written notice pursuant to M.G.L. c. 139, § 313 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 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-&WVe-and-include with--such`notice a reference to the-above=descrbed-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 3422.
Sincerely,
Tracy Lopes
Claim Examiner