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P.O. Box 55098
Boston MA 02205
617-951-0600
September 12, 2019
Building Commissioner or Inspector of Buildings
Fire Department or Arson Squad
Board of Health or Board of Selectman
City Hall
YARMOUTHPORT, MA 02675
Insured: VINCENT C GUARDIA
Property Address: 35 AVON RD,YARMOUTHPORT MA
Policy Number: HMA0304059
Claim Number: BOS00093164
Date of Loss: 9/10/2019
Notice of Loss Under M.G.L. c. 139,§3B
This communication shall serve as written notice pursuant to M.G.L. c. 139, § 3B 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, §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
- — -- - ----- -- ---
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 3235.
Sincerely, 1 ��J� �
SEA 6 ,!)
Paul LaGrandeur
Claim Examiner