283 DERBY STREET - REINSTATEMENT NOTICE QUINCY MUTUAL GROUP
57 Washington Street
ke,J16 Quincy,MA 02169
STATEMENT DATE: 09/30/2021
INSURED:
BUSINESSOWNERS HAZEL DELI LLC DBA BROTHERS
TAVERNA
283 DERBY STREET
SALEM MA 01970
BO 205484 08/26/2021 01399
CITY OF SALEM DESCRIPTION OF PROPERTY:
93 WASHINGTON ST 283 DERBY ST
SALEM MA 01970 SALEM MA 01970-3600
POLICY NUMBER POLICY PERIOD AGENT (01399) AGENT TEL.
BO 205484 08/26/2021 TO 08/26/2022 ROSE INSURANCE AGENCY 978-745-6464
QUINCY MUTUAL FIRE INSURANCE COMPANY
REINSTATEMENT NOTICE
You are hereby notified that the above policy has been reinstated. The policy remains
in force without a lapse in coverage. If you have any questions concerning this notice
please contact your agent.
Important Notice:
If the payment accepted by the Company for this reinstatement is in the form of a check,
draft or electronic funding and the bank on which the payment is drawn does not honor it
on presentation, this reinstatement is void as of its inception.
Authorized Representative:
Angela Mitchell
OCT 4 P htrfl-:54
OCT
ADDITIONAL INSURED COPY
REIN0107