25C-004 (5) Phone: 978-632-2660 Fax: 978-632-2662
JAMES A. TRUDEAU
Adjustment Service Inc.
P. O.Box 7
Gardner,MA 01440
claims(a�trudeauadi.com
Notice of Casualty Loss of Building
Under Massachusetts General Laws, Chapter 139, Section 3B
March 30,2021
Building Inspector
4orthampton,
12 Main Street
MA 01060
Board of Health
212 Main Street
Northampton,MA 01060
Fire Department
Dept.of Records
26 Carlon Dr.
Northampton,MA 01060
Insured: Svetlana S Speyer
Loss Location: 124 North Street,Northampton,MA 01060 a5 C. - 0 0 W>
Insurance Company: The Concord Group Ins.Companies
Policy No.: 1419536
Date of Loss: March 1,2021
File Number: 21-19041
Claim Number: 30015252
Type of Loss: Mold
Claim has been made involving loss, damage, or destruction of the above captioned property, which may either
exceed$1,000.00 or cause"Mass. Gen. Laws, Chapter 143, Section 6"to be applicable. If any notice under"Mass.
Gen. Laws, Chapter 139, Section 3B" is appropriate, please direct it to the writer and include a reference to the
captioned insured, location,policy number,date of loss, and file or claim number.
Claim has been made involving loss, damage or destruction of the above-captioned property, which may
exceed $5000. If any notice under Massachusetts General Laws, Chapter 175, Section 97A is appropriate,
please direct it to the attention of this writer and include a reference to the above-captioned insured,
location,policy number,date of loss and claim number.
On this date, I cause copies of this notice to be sent to the person(s) named above at the address indicated by first
class mail.
Sincerely,
Joshua M.Trudeau
Claims Adjuster