HomeMy WebLinkAboutClaim of Loss - 1/4/2019 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392.6108,FAX(800)851-8424
1/9/2019
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139,Sec.3B
RECE1� -
YARMOUTH BUILDING DEPT JO 14 2019 ]
1146 ROUTE 28 TrnENT
SOUTH YARMOUTH MA 02664 ��� pjj�G DEPAr�
Re: Insured: DENNY&ALTA HIGH
Property Address: 16 BENJAMIN WAY.WEST YARMOUTH,MA 02673
Policy Number: 0774555
Type Loss: Other Causes of consequential Mold
Date of Loss: 01/04/2019
Claim Number. 434910
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 38 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