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73 Claim Involving Loss 2016 0$ ARBELLA 02/04/2016 NORTHAMPTON BUILDING COMMISSIONER QTY GOVERNMENT OFFICE 212 MAIN STREET# 100 NORTHHAMPTON,MA 01060 Claim Number. Policy Number. Company Name: Date of Loss: Insured: Property Location: Elaine Dupuis-Lane,Claim Manager 033679388 64322400003 Arbella Mutual Insurance Company 02/03/2016 DAVID KATZ 73 MASSASOIT ST,NORTHAMPTON,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 CO NORTHAMPTON I ICALTH DEPARTMENT CITY GOVERNMENT OFFICE 212 MAIN STREET#101 NORTHHAMPTON,MA 01060 CO NORTHHAMPTON FIRE DEPARTMENT QTY HALL 210 MAIN STREET NORTHHAMPTON,MA 01060 oo Crown Colony Drive PQ Box 699195 Quincy, MA oz269-9195 telephone(Soo)ARBELLA wvw.arbella.com