INS LOSS LTR, WATER, 01/25/2019 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392.6108, FAX(800)851-8424
8/22/2019
Form of Notice of Casualty Loss to Building
Under Mass.Gen. Laws, Ch.139,Sec.315
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970 _
Re: Insured: GEORGE&CONSTANCE CLAVEAU
Property Address: 115-117 LEACH ST, SALEM, MA 01970
Policy Number: 0669248
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 01/25/2019
Claim Number: 441894
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.
MFiUA Claims Division
CMA00021