107-109 Loring Avenue 8-4-20 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108.FAX(800)851-8424
8/6/2020
Form of Notice of Casualty Loss to Building
Under Mass,Gen. Laws Ch.139, Sec.313
SALEM HEALTH DEPT. AUG 10 2020
CITY OF SALEM
SALEM CITY HALL BOARD HEALTH
SALEM MA 01970
Re: Insured: NELSON TRINIDAD
Property Address: 107-109 LORING AVE.SALEM. MA 01970
Policy Number- 0637285
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 08/04/2020
Claim Number: 449796
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 ChaFiter 143. section 6 to be applicable. If any
notice under Massachusetts General Laws, Chaoter 139. Section 36 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