9 ABBOTT STREET 4-26-21 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392.6108,FAX(800)851-8424
4/29/2021
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139. Sec.36 R Er E-IN V EE n
MAY 0 4 2021
SALEM HEALTH DEPT. CITY OF SALEM
SALEM CITY HALL SALEM MA 01970 BOARD OF HEALTH
Re: Insured: JOSEPH NJUGUNA NGOTHO AND
Property Address: 9 ABBOTT ST, SALEM, MA 01970-1101
Policy Number: 0754099
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 04/26/2021
Claim Number: 455419
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