50 ROSLYN STREET 7-7-23 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
7/15/2023
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws,Ch.139,Sec.36 RECEIVED
SALEM HEALTH DEPT JUL 24 2023
SALEM CITY HALL CITY OF SALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: ENDICOTT ST REALTY, LLC
Property Address: 50 ROSLYN ST, SALEM, MA 01970
Policy Number: 1625973
Type Loss: Fire(including Fire caused by Lightning
Date of Loss: 07/07/2023
Claim Number: 473553
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. Cha ter 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