7 WILLIAMS STREET_ DAMAGE LOSS CLAIM 2-6-2025 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(617)723.3800 Ma Onlv(800)392.6108.FAX(800)851.8424
2/15/2025
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws Ch 139 Sec 38
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970
Re: Insured: ROBERT OSGOOD III
Property Address: 7 WILLIAMS ST, SALEM, MA 01970
Policy Number: 1626858
Type Loss: Freezing
Date of Loss: 02/06/2025
Claim Number: 483850
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