43 BRIDGE STREET, UNIT 2 1-19-23 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723.3800 Ma Only(800)392-6108. FAX(800)851-8424
1/28/2023
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139 Sec.313 RECEIVE®
SALEM HEALTH DEPT. FEB O 6 2023
SALEM CITY HALL CITY OF SALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: SAMUEL MANDRACCHIA&OLIVIA MANDRACCHIA
Property Address: 43 BRIDGE ST UNIT 2. SALEM, MA 01970
Policy Number: 1417154
Type Loss: Water Damage:Appliance failure
Date of Loss: 01/19/2023
Claim Number: 469842
Claim has been made involving loss,damage or destruction of the above captioned property,which may either
exceed$1000.00 or cause Massachusetts General Laws. Chapter 143. section 6 to be applicable. If any
notice under Massachusetts General Laws. Chapter 139. Section 313 is appropriate,please direct it to the
attention of the writer and include a reference to the captioned insured, location, policy number,date of loss
and claim or file number.
MPIUA Claims Division
CMA00021