420 Lafayette Street 10-17-19 claim RECEIVED
1100 Crown Colony Drive
OCT 2 4 2019 P.O.Box 699195
A R � E L L A® Quincy,MA 02269-9195
CITY OF SALEM 617.328.2800
INSURANCE GROUP arbella.com
BOARD OF HEALTH
October 22, 2019
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
93 WASHINGTON STREET
SALEM, MA 01970
Claim Number: 034065230
Policy Number: 81389400003
Company Name: Arbella Mutual Insurance Company
Date of Loss: 10/17/2019
Insured: KEMITH LUSTER
Property Location: 420 LAFAYETTE, 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 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
CC: SALEM HEALTH DEPARTMENT
SALEM CITY HALL
93 WASHINGTON STREET
SALEM, MA 01970
CC: SALEM FIRE DEPARTMENT
48 LAFAYETTE STREET
SALEM,MA 01970