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99 Washington Street 8-10-20 claim 1100 Crown Colony Drive RECEIVED P.O.Box 699195 Quincy,MA 02269-9195 A R B E L L A& 617.328.2800 INSURANCE GROUP AUG 19 2020 arbella.com CITYOF SALEM BOARD OF HEALTH August 12,2020 SALEM HEALTH DEPARTMENT SALEM CITY HALL 93 WASHINGTON STREET SALEM, MA 01970 Claim Number: 034126121 Policy Number: 36989400005 Company Name: Arbella Mutual Insurance Company Date of Loss: 08/10/2020 Insured: KRISTEN JIANG Property Location: 99 WASHINGTON ST#41, 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 313 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