36 Summit Street 10-17-19 claim RECEIVED 1100 Crown Colony Drive
i� P.O.Box 699195
jw OCT 2 4 2019 Quincy,MA 02269-9195
AA 617.328.2800
A R S E 1.1' A CITY OF SALEM arbella.com
INSURANCE GROUP BOARD OF HEALTH
October 22, 2019
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
93 WASHINGTON STREET
SALEM,MA 01970
Claim Number: 034065267
Policy Number: 87494400001
Company Name: Arbella Mutual Insurance Company
Date of Loss: 10/17/2019
Insured: MICHAEL LORD
Property Location: 36 SUMMIT S`C'. SAI,EM. MA
To Whom It May Concern:
A claim has been made involving loss, damage, or destruction o Chapter 143f the above ptionSectid 6,property,which
may either exceed $1,000 or cause Massachusetts General
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,
Sarah Monaco
Claim Service Specialist
Property Claim Office
800-272-3552 ext. 7323
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