9.5 Intervale Road 1-25-21 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
5/13/2021
Form of Notice of Casualty Loss to Building RECEIVED
Under Mass. Gen. Laws. Ch.139. Sec.313
MAY 17 2021
SALEM HEALTH DEPT. CITY OF SALEM
SALEM CITY HALL
BOARD OF HEALTH
SALEM MA 01970
Re: Insured: JAIRO VANEGAS
Property Address: 9 1/2 INTERVALE RD, SALEM, MA 01970
Policy Number: 1420091
Type Loss: All Other Section I Losses
Date of Loss: 01/25/2021
Claim Number: 455699
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