12 Weatherly Drive 11-13-18 claim IRECEIVED 1100 Crown Colony Drive
P.O.Box 699195
N 0 V 0 0 2.n 13 Quincy,MA 02269-9195
AR B E L Lam= 617.328.2so0
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INSURANCE GROUP '' P,D Ct_1 EA'Tr-'
November 21, 2018
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
93 WASHINGTON STREET
SALEM,MA 01970
Claim Number: 033979701
Policy Number: 08910400006
Company Name: Arbella Indemnity Insurance Company
Date of Loss: 11/13/2018
Insured: PETER BLAKE
Property Location: 12 WEATIIERLY DR UNIT 12, 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,
Emily Migre
Claim Service Specialist
Property Claim Office
800-272-3552 ext. 7369
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