7 WILLIAMS STREET 2-6-25 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723.3800 Ma Onlv(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
RECEIVED
SALEM HEALTH DEPT. FEB 2 4 2025
SALEM CITY HALL
SALEM MA 01970 CITY OF SALEM
BOARD OF HEALTH
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