1 Maple Avenue 3-2-18 claim 110o Crown Colony Drive
RECc`�tEr � P.O.Box 69195
RECEIVED V l� Quincy,MA 02269-9195
617.328.2800la.co
A R B E L L A
APR 2 3 2013 azbella.com
INSURANCE GROUP
G11 ,101 1 1 SA
BOARD OF HEALTH
April 18, 2018
I
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
93 WASHINGTON STREET
SALEM, MA 01970
Claim Number: 033910904
Policy Number: 09714400006
Company Name: Arbella Indemnity Insurance Company
Date of Loss: 03/02/2018
Insured: REBECCA EVERETT
Property Location: 1 MAPLE AVE, 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.
Sincerely,
Colin Cantrell
Enter Employee Type of the Current Adjus
HO Claim Administration
800-272-3552 Ext. 3808
Fax 617-773-4760
CC: SALEM HEALTH DEPARTMENT
SALEM CITY HALL
93 WASHINGTON STREET
SALEM, MA 01970
CC: SALEM FIRE DEPARTMENT
48 LAFAYETTE STREET
SALEM, MA 01970