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10 AMES STREET 6-4-23 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108-1904 (6171723.3800 Ma Only(800)392-6108, FAX(800)851.8424 6/10/2023 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch.139, Sec.313 RECEIVED SALEM HEALTH DEPT. JUN 16 2023 SALEM CITY HALL SALEM MA 01970 CITY OF SALEM BOARD OF HEALTH Re: Insured: CRAIG BILODEAU Property Address: 10 AMES STREET, SALEM, MA 01970 Policy Number: 0713707 Type Loss: Water Damage:All Other Water Damage Date of Loss: 06/04/2023 Claim Number: 473015 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 3B 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