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77 Claim Involving Loss 2016 12/02/2016 ARBELLA NORTHAMPTON BUILDING COMMISSIONER CITY GOVERNMENT OFFICE 212 MAIN STREET#100 NORTHAMPTON, MA 01060 Elaine Dupuis-Lane,Claim Manager Claim Number: 033779290 Policy Number: 90687400003 Company Name: Arbella Mutual Insurance Company Date of Loss: 11/30/2016 Insured: ANDREW KESIN Property Location: 77 HILLCREST DRIVE, FLORENCE,MA To Whom It May Concern: 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. Kindly include a reference to the captioned insured, location, date of loss and claim number. Very truly yours, Marc Lindell Claim Service Specialist Property Claim Office 800-272-3552 ext. 6867 Fax 617-773-4760 CC: NORTHAMPTON HEALTH DEPARTMENT CITY GOVERNMENT OFFICE 212 MAIN STREET #101 NORTHAMPTON, MA 01060 CC: NORTHAMPTON FIRE DEPARTMENT CITY HALI. 2W MAIN STREET NORTHAMPTON, MA 01060 u00 Crown Colony Drive P.O.Box 699195 Quincy,MA 02269-9195 telephone(80o)ARBELLA wuw.arbella.com