INS LOSS LTR, WATER DAMAGE 03/13/2020 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108, FAX(800)851-8424
3/17/2020
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: JOSE SANTOS
Property Address: 36 PALMER STREET,SALEM, MA 01970
Policy Number: 1200932
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 03/13/2020
Claim Number: 446531
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