60 Insurance Loss 2019 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(6171 723-3800 Ma Only(8 001 392-6108,FAX(8001 851-8424
21212019
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139,Sec.3B
HEALTH DEPT.
PUCHALSKI MUNICIPAL BUILDING
212 MAIN STREET
NORTHAMPTON MA 01060
Re: Insured: MARI-JON ADAMS
Property Address: 60 NORWOOD AVE,FLORENCE,MA 01062
Policy Number: 1435142
Type Loss: Furnace/Boiler
Date of Loss: 01/31/2019
Claim Number: 435733
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
CMAC0021