HomeMy WebLinkAboutClaim of Loss (2) W.Springfield,MA Geos a Pittsfield,MA
(413)781-2897 (888)881-4598
Quincy,MA OVJ 1Or Worcester,MA
(617)479-2619 r (888)881-4598
Mattapoisett,MA r. d j ostlers Cape Cod&Islands
(508)758-6633 (888)881-4598
Rhode Island
1110. Hartford, CT
(888)881-4598 BUTLER (888)8814598
Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
Town of Yarmouth Town of Yarmouth
1146 Route 28 1146 Route 28
South Yarmouth, MA 02664 South Yarmouth,MA 02664
Attention: Records Attention: Records
COMPANY: Certain Underwriters at Lloyd's, London do Quaker Special Risk
POLICY NUMBER: QSRMA17205
CLAIM NUMBER: NA
INSURED: Zi Qian Zhang
LOSS LOCATION: 228 Rte 28, Yarmouth, MA
DATE OF LOSS: 10/13/2018
DESCRIPTION: Theft
OUR FILE NUMBER: CCI18-7071
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,
Ed Dibona
Claims Adjuster
P—508-758-6633
F—508-758-6199
ed@georgebutleradjusters.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
October 23, 2018
P.O.Box 1557,Mattapoisett,MA 02739