4 HOLLY STREET 12-5-25 CLAIM y 1100 Crown Colony Drive
` r- P.O.Box 699195
Quincy,MA 02269-9952
617.328.2800
NSs jAANCe GROJ N arbella.com
December 10, 2025 RECEIVED
DEC 16 2025
SALEM HEALTH DEPARTMENT
SALEM CITY HALL CITY OF SALEM
93 WASHINGTON STREET BOARD OF HEALTH
SALEM, MA 01970
Claim Number: 034579518
Company Name: Arbella Indemnity Insurance Company
Date of Loss: 12/05/2025
Insured: JOHANNA RODRIGUEZ
Property Location: 4 HOLLY ST, SALEM, MA
To Whom It May Concern:
A claim has been made involving loss, damage, or destruction of the above captioned property, which
may either exceed $1,000 or cause Massachusetts General Laws, 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 the writer. Please include a reference to the captioned insured, location, date of loss
and claim number.
Thank you for your assistance.
Best regards,
Douglas McGuirk
Claim Service Specialist
Property Claim Office
617-328-2454
Fax 617-773-4760