20 CHASE STREET 2-8-19 CLAIM 1100 Crown Colony Drive
P.O.Box 699195
T la TL�� Quincy,MA 02269-9195
617.328.2800
INSURANCE GROUP arbella.com
RECEIVED
February 8, 2019 rrn 'A . 7f1iA
SALEM BUILDING COMMISSIONER CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
93 WASHINGTON STREET
SALEM, MA 01970
Claim Number: 034000051
Policy Number: 00310400001
Company Name: Arbella Mutual Insurance Company
Date of Loss: 02/08/2019
Insured: BERTRAM POUSSARD
Property Location: 20 CHASE 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,
Cynthia Holden-Amor
Claim Service Specialist
Property Claim Office
800-272-3552 ext.7549
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