57 1/2 OCEAN AVENUE - 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
1/8/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws. Ch.139 Sec.313
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970
Re: Insured: MICHAEL BRIGGS AND ANDREW SCHWEIHS
Property Address: 57-571/2 OCEAN AVE. SALEM, MA 01970
Policy Number: 1476124
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 01/04/2022
Claim Number: 462594
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
TAN