68 Weatherly Drive 10-2-18 claim 1100 Crown Colony Drive
P.O.Box 699195
A R B E L L A Quincy,MA 02269-9195
617.328.2800
INSURANCE GROUP arbella.com
' JECEIVED
November 2, 2018
NOV 0 82018
SALEM BUILDING COMMISSIONER
SALEM CITY HALL CITY OF SALEM
93 WASHINGTON STREET BOARD OF HEALTH
SALEM, MA 01970
Claim Number: 033975585
Policy Number: 71446400005
Company Name: Arbella Mutual Insurance Company
Date of Loss: 10/02/2018
Insured: ANDREW WARK
Property Location: 68 WI-:ATHERLY DRIVE, 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,
Douglas McGuirk
Claim Service Specialist
Property Claim Office
800-272-3552 ext. 2454
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