4 Insurance Loss 2020Building Commissioner or Inspector of Buildings
Fire Department or Arson Squad
Board of Health or Board of Selectmen
City Hall
NORTHAMPTON, MA 01060
RE: Claim Number:
Insured(s):
Property Address:
Policy Number:
Date of Loss:
August 9, 2020
LHMA00017C
JOHN R KELLY and DOROTHY KELLY
4 CROSBY STREET, NORTHAMPTON, MA 01060
HMA0324319
August 4, 2020
Notice of Loss Under M.G.L. c. 139, 4 313
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 -reference 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 by email at
JacquelineYawnick@Safetylnsurance.com or by phone at 800-951-2100 x3104.
Sincerely,
Jacqueline Yawnick
MultiLines PD Claims Adjuster
Safety Insurance P.O. Box 55098 Boston, MA 02205-5098 800-951-2100
Well help you manage life's stormsO
010_C139