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Home My WebLink AboutNotice of Loss 71323 mem GEICO Insurance Agency, LLC Horfies'te Undef Newn ork Homesite Insurance Company Of New York HOME INSURANCE 6000 American Parkway Tel: 1 800 566 1518 Fax: 1-866-935-2858 Madison,WI 53783-0001 66259002 NN RP 14 20230714 NNNNNNNN 0005008 0018 Claim Number: 01-006-394213 YARMOUTH TOWNHALL Date Of Loss: 11/08/2022 1146 ROUTE 28 Policy Number: 39082251 SOUTH YARMOUTH, MA 02664-4463 Policyholder: James Kubat And Karleen Kubat IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII July 13, 2023 ATTENTION: Building Commissioner or Inspector of Buildings Fire Department or Arson Squad, Board of Health or Board of Selectmen C/O City or Town Hall NOTICE PURSUANT TO MASS. GEN. LAWS, CHAPTER 139, SECTION 3B Our Insured: JAMES KUBAT Property Address: 65 Avon Rd Yarmouth Port, MA, 02675-1404 Policy Number: 39082251 Claim Number: 01-006-394213 Date of Loss 11/08/2022 This correspondence shall serve as notice that, pursuant to Massachusetts General Laws Chapter 139, Section 3B, a claim has been made involving loss, damage or destruction to a building or other structure which may either exceed$1,000 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice pursuant to Massachusetts General Laws Chapter 139, Section 3B is appropriate, ease diect such notice to my attention and kindly, pursuant to the information provided above, includth nsuredls name,address, policy number, claim number and date of loss. If you contact us via email, please use claimdocuments@afics.corn and be sure to reference the claim number in the subject line of your email. Please contact me with any questions. Sincerely, kia,frCA-Roaree4 Kiara Rougeau Claims TPA Property Independent Adjuster AFICS on behalf of Homesite Insurance Company of New York Kiara.Rougeau @ afics.com Phone: 1-866-382-7522 Ext. 1921 I Fax: 1-866-935-2858 Mail: 6000 American Parkway, Madison, WI 53783-0001 r:r2 4 2023 mt_Nr Page 1 of 1 66258002 NN RP 14 20230714 NNNNNNNN 0005008 0018 2577582-82094667-5564654.4m6.,.7