INS LOSS LTR 04/26/2021 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(6171723-3800 Ma Only(8001392-6108, FAX(8001851-8424
4/29/2021
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: 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
MAY
2 29