62 BRIDGE STREET 3-13-18 CLAIM RECEIVED MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
MAR 2 6 2pig Two Center Plaza
Boston,Massachusetts 02108-1904
CITY OF SALEM (617)7233800 Ma Only(800)392.6108.FAX(800)851-8424
BOARD OF HEALTH 3/20/2018
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.3B
SALEM HEALTH DEPT,
SALEM CITY HALL
SALEM MA 01970
Re: Insured: PATRICIA RODRIGUEZ AND WANDER PIMENTAL
Property Address: 62 BRIDGE ST.SALEM, MA 01970
Policy Number: 1391108
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 03,113/2018
Claim Number: 426800
Clairn 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