10 CHANDLER STREET 11-4-18 CLAIM 1100 Crown Colony Drive
P.O.Box 699195
Quincy,MA 02269-9195
ARBELLA RECEIVED 617.328.2800
INSURANCE GROUP arbella.com
January 2, 2019 CITY OF SALEM
BOARD OF HEALTH
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
93 WASHINGTON STREET
SALEM.-MA 01970
Claim Number: 033989895
Policy Number: 55772400004
Company Name: Arbella Mutual Insurance Company
Date of Loss: 11/04/2018
Insured: RICHARD CHAMPIGNY
Property Location: 10 CHANDLER 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.
Sincerely,
Debra Gellerman
Claim Technical Specialist
Property Claim Office
800-272-3552 ext. 7358
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