152 BAY VIEW AVENUE 3-3-18 CLAIM 1-I►oCiCIV�U
1100 Crown Colony Drive
MAR 2 6 2013 P.O.Box 699103
CITY OF SALEM Quincy,M 1 2269-9103
A NS RA E L L 67.328.2800
A BOARD OF HEALTH
INSURANCE GROUP azbella.com
March 16, 2018
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
93 WASHINGTON STREET
SALEM, MA 01970
Claim Number: 033911439
Policy Number: 32785400004
Company Name: Arbella Mutual Insurance Company
Date of Loss: 03/03/2018
Insured: SCOTT CLARK
Property Location: 152 BAY VIEW AVE, 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,
I
Diane Lewis
Claim Service Specialist
Property Claim Office
800-272-3552 ext. 2437
Fax 617-773-4760
CC: SALEM HEALTH DEPARTMENT
SALEM CITY HALL
93 WASHINGTON STREET
SALEM, MA 01970
i
CC: SALEM FIRE DEPARTMENT
48 LAFAYETTE STREET
SALEM,MA 01970 R