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48 Summit Avenue 7-6-21 claim 1100 Crown Colony Drive P.O.Box 699195 �R B E L L A Quincy,MA 02269-9952 617.328.2800 INSURANCE GROUP arbella.com July 9, 2021 RECEIVED SALEM HEALTH DEPARTMENT JUL 14 2021 SALEM CITY HALL CITY OF SALEM 93 WASHINGTON STREET BOARD OF HEALTH SALEM,MA 01970 Claim Number: 034194628 Policy Number: 65454400004 Company Name: Arbella Mutual Insurance Company Date of Loss: 07/06/2021 Insured: MICHAEL GRIFFIN Property Location: 48 SUMMIT 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. Best regards, Douglas McGuirk Claim Service Specialist Property Claim Office 800-272-3552 ext. 2454 Fax 617-773-4760