HomeMy WebLinkAboutwater damage 2017MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617) 723-3800 Ma Onlv (800) 392-6108, FAX (8001851-8424
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws. Ch.139. Sec.3B
1t6t2017
YARMOUTH FIRE DEPT
96 OLD MAIN ST
SOUTH YARMOUTH MA 02664
lnsured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
CHARLES K. BERGIN III
121 CAMP STREET UNIT .116. WEST YARMOUTH. MA
1170914
Water Damage: All Other Water Damage
01t02t2017
411167
02673
Re
cMA00021
Claim has been made involving loss, damage or destruction ofthe above captioned property, which may either
exceed$1000,00orcaUse@tobeapplicable.lfanynotice 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 daim or file number.
MPIUA Claims Division