HomeMy WebLinkAbout28 Gardiner Loss NoticeMASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617) 723-3800 Ma Onlv (800) 392-6108, FAX (800) 851-8424
Form of Notice of Casualty Loss to Building
Under lVlass. Gen. Laws, Ch.139, Sec.3B
5t2t2026
YARIUOUTH HEALTH DEPT
1146 RoUTE 28
SOUTHYARMOUTH MA 02664
Re: lnsured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
XIAXI LI AND YACHEN SHU
28 GARDINER LN, SOUTH YARMOUTH. IVA
1581374
Water Damage: Plumbing Systems
04119t2026
492941
42664
CIaim has been made involving loss, damage or destruction of the above captioned property, which may either
exceed $1000.00 or cause Massachusetts General Laws. Chaoter 143, section 6to be applicable, lfany
notice under Massachusefts 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
ctvA00021