HomeMy WebLinkAboutNotice of DamageMASSACHUSETTS PROPERTY INSURANCE UNOERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 021 08.1 904
(617) 723-3800 Ma Onlv (800) 392-6108, FAX (800) 851-8424
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.3B
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- "/,€arr o JAtt tot6YARMOUTH HEALTH DEPT
1146 ROUTE 28
SOUTHYARMOUTH MA 02664
Re: lnsured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
JAMES M DUNBAR
3 SWORDFISH DR, S YARI,IOUTH, MA
1645036
Water Damage: Plumbing Systems
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489461
02664
Claim has been made involving loss, damage or destruction of the above captioned property, which may either
exceed $1000.00orcause Massachusetts General Laws. Chapter 143. section 6to be applicable. lfany
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