7 ASH STREET 12-22-17 CLAIM y 1100 Crown Colony Drive
p� P.O. Box 699101
A R B E L L A Quincy, MA 010
617.328.2328.2800
INSURANCE GROUP arbella.com
January 2, 2018 RECEIVED
JAN 0 8 2018
SALEM BUILDING COMMISSIONER CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH j
93 WASHINGTON STREET
SALEM, MA 01970
Claim Number: 033889137
Policy Number: 27763400004
Company Name: Arbella Mutual Insurance Company
Date of Loss: 12/22/2017
Insured: RICHARD POISSON
Property Location: 7 ASH ST, SALEM, MA
Dear: Madam/Sir
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,
Douglas McGuirk
Claim Service Specialist
Property Claim Office
800-272-3552 ext. 2454
Fax 617-773-4760
CC: SALEM HEALTH DEPARTMENT"
SALEM CITY HALL
93 WASHINGTON STREET
SALEM, NL1 01970
CC: SALEM FIRE DEPARTMENT
48 J AFAYETTE STREET
SALEM, MA 01970