Insurance Claim W. Springfield, MA Pittsfield, MA
(413)781-2897 g. � (888)881-4598
Quincy, MA Worcester, MA
(617)479-2619 _ (888)881-4598
e Cod&Islands
Mattapoisett, MA �; Cape
(508)758-6633 (888)881-4598
Rhode Island _ --- - - "�� Hartford, CT
(888)881-4598 BUTLER (888)881-4598
Building Co sioner or Board of Health or
Inspector of :uildings Board of Selectmen
Town of armouth Town of Yarmouth
1146 'oute 28 1146 Route 28
So,th Yarmouth, MA 02664 South Yarmouth, MA 02664
- ttention: Records Attention: Records
COMPANY: Certain Underwriters at Lloyds, London c/o Vanguard Claims
Administration, Inc.
POLICY NUMBER: XSZ121082
CLAIM NUMBER: XS06938
INSURED: Andrew & Efthymia Kouris Trustees of the 33 Anthony Road
Realty Trust
LOSS LOCATION: 31-33 Anthony Road, West Yarmouth, MA
DATE OF LOSS: 08/31/2019
DESCRIPTION: Water
OUR FILE NUMBER: CCI19-7289
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,
Chris Troy
Claims Adjuster
P—401-241-5373
F—617-479-1740
chris.troy@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
September 11, 2019
209 Park Avenue, West Springfield,MA 01089