HomeMy WebLinkAboutNotice of Loss 122122 W. Springfield, MA Pittsfield, MA
(413) 781-2897 (888) 881-4598
Quincy, MA Worcester, MA
(617)479-2619 n (888)881-4598
Mattapoisett, MA Cape Cod & Islands
(508) 758-6633 (888)881-4598
Rhode Island Hartford, CT
(888) 881-4598 (888)881-4598
Building Commissioner or Board of Health or
Inspector of Buildings Board of Sele en
Town of Yarmouth Town of .rmouth
1146 Route 28 114. oute 28
South Yarmouth, MA 02664 •uth Yarmouth, MA 02664
Attention: Records Attention: Records
COMPANY: Certain Underwriters at Lloyds, London do Vanguard Claims
Administration, Inc.
POLICY NUMBER: XSZ192898
CLAIM NUMBER: XS 10189
INSURED: Swaminarayan LLC dba Bass River Motel
LOSS LOCATION: 891 Route 28, South Yarmouth, MA R E C E I V D
DATE OF LOSS: 12/21/2022
DESCRIPTION: Property Damage JAN 03 2023
OUR FILE NUMBER: P22-12809
DEPARTMENT
BUILDING
By.____--
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,
EdDiBona __ --
Claims Adjuster
P—(508) 241-1923
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
December 29, 2022
209 Park Avenue,West Springfield,MA 01089