2A CLEVELAND ROAD EXTENSION 10-27-21 CLAIM REECEIVED
1100 Crown Colony Drive
NOV 0 5 2021 P.O.Box 699195
02269-9952
R B E L L.[7►. CITY OF SALEM Quincy,M
.tom 6117 328 2800
INSURANCE GROUP BOARD OF HEALTH arbella.com
October 28, 2021
SALEM HEALTH DEPARTMENT
SALEM CITY HALL
93 WASHINGTON STREET
SALEM,MA 01970
Claim Number: 034219951
Policy Number: 36425400004
Company Name: Arbella Mutual Insurance Company
Date of Loss: 10/27/2021
Insured: SEAN O'KEEFE
Property Location: 2A CLEVELAND RD EXT, 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