13 Orleans Road 3-2-18 claim 1100 Crown Colony Drive
P.O.Box 699195
Quincy,MA 02269-9195
A R B E L L A 617.328.2800
fNSURANCE GROUP
RECEIVED
May 7, 2018
MAY 0 9 2018
SALEM BUILDING COMMISSIONER CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
93 WASHINGTON STREET
SALEM,MA 01970
Claim Number: 033909350
Policy Number: 82473400005
Company Name: Arbella Indemnity Insurance Company
Date of Loss: 03/02/2018
Insured: JOHN PERO
Property Location: 13 ORLEANS ROAD, SALEM, MA
To Whom It May Concern:
I
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,
David Goldman
Claim Service Specialist
Special Investigative Unit
800-272-3552 ext. 2937
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