Insurance Claim W. Springfield, MA Pittsfield, MA
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(413)781-2897 (888)881-4598
Quincy, MA 0ev Worcester, MA
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Mattapoisett, MA ,� Cape Cod&Islands
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Rhode Island — Hartford, CT
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Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
Town of Yarmouth Town of Yarmouth
1146 Route 28 1146 Route 28
South Yarmouth, MA 02664 South Yarmouth, MA 02664
Attention: Records Attention: Records
COMPANY: Certain Underwriters at Lloyd's, London c/o Quaker Special Risk
POLICY NUMBER: QSRMA25482
CLAIM NUMBER: QSRMA25482
INSURED: Yarmouth Village Condominium Association
LOSS LOCATION: 135 South Shore Drive, Bldg F, Yarmouth, MA
DATE OF LOSS: 03/06/2020
DESCRIPTION: Water
OUR FILE NUMBER: P20-10432
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—508-241-1923
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
March 13, 2020
P.O.Box 1557,Mattapoisett,MA 02739