50 ROSLYN ST 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 3B
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970
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 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