3 BERTUCCIO AVENUE 6-29-18 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston; Massachusetts 02108-1904
(617)723.3800 Me Onlv(800)392-6108, FAX(800)851.8424
7/5/2018
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139 Sec 3B ®E C E I VE D
t SALEM HEALTH DEPT. JUL 12 2018
SALEM CITY HALL CITY OF SALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: DARIUS GREGORY
Property Address: 3 BERTUCCIO AVENUE,SALEM,MA 01970
Policy Number: 1414854
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 06/29/2018
Claim Number: 430322
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
0
CMA00021