48 BRIDGE STREET 1-27-18 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only 18001392.6108. FAX(8001851.8424
1/30/2018
Form of Notice of Casualty Lass to Building
Under Mass. Gen. Laws Ch.139 Sec.3B RLCEIVED
SALEM HEALTH DEPT. FEB 0 2 2018
SALEM CITY HALL CITY OF SALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: CHRISTOPHER,MCGOWAN
Property Address: 48 BRIDGE ST,SALEM, MA 01970
Policy Number: 1347887
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 01/27/2018
Claim Number: 422163
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