96 BROADWAY_ DAMAGE LOSS CLAIM 1-28-2025 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723.3800 Ma Only(800)392.6108. FAX(8001851-8424
2/15/2025
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: MARIA G PEREZ
Property Address: 96 BROADWAY.SALEM, MA 01970
Policy Number: 1362949
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 01/28/2025
Claim Number: 483867
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