19 Buena Vista Avenue 10-14-19 claim 1100 Crown Colony Drive
may_ P.O.Box 699195
�,,,� � �Ag Quincy,MA 02269-9195
ARB617.328.2800
INSURANCE GROUP arbella.com
October 29, 2019 RECEIVED
SALEM BUILDING COMMISSIONER NOV 0 5 2019
SALEM CITY HALL
93 WASHINGTON STREET CITY OF SALEM
SALEM, MA 01970 BOARD OF HEALTH
Claim Number: 034065240
Policy Number: 94043400002
Company Name: Arbella Mutual Insurance Company
Date of Loss: 10/14/2019
Insured: ROLAND BERUBE
Property Location: 19 BUENA VISTA AVENUE, 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,
Melissa Ross
Claim Service Specialist
Property Claim Office
800-272-3552 ext. 2489
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