14 Puritan Road 3-3-18 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
318/2018
Form of Notice of Casualty Loss to Building �>��
Under Mass Gen Laws Ch.139 Sec.36 RECEIVED'
C L
MAR 12 2018
SALEM HEALTH DEPT. CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
SALEM MA 01970
Re: Insured: ORQUIDEA UMANA
Property Address: 14 PURITAN ROAD, SALEM, MA 01970
Policy Number: 1441242
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 03/03/2018
Claim Number: 425455
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
GMA00021