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Building Commissioner or Board of Hea or
Inspector of Buildings Board of S ectmen
Town of Yarmouth Town o armouth
1146 Route 28 1146 oute 28
South Yarmouth, MA 02664 S th Yarmouth, MA 02664
Attention: Records Attention: Records
COMPANY: Certain Underwriters at Lloyd's, London do Quaker Special Risk
POLICY NUMBER: QSRMA19843
CLAIM NUMBER:
INSURED: Even Tide Condominium Trust
LOSS LOCATION: 109 Seaview Avenue, South Yarmouth, MA
DATE OF LOSS: 05/10/2019 ' A'( 21
7
1
DESCRIPTION: Water
OUR FILE NUMBER: CCI19-7183
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
May 22, 2019
209 Park Avenue,West Springfield,MA 01089