302 Insurance Loss 9-6-20MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(6171723.3800 Ma Only (800)392.6108. FAX (800) 851-8424
HEALTH DEPT.
PUCHALSKI MUNICIPAL BUILDING
212 MAIN STREET
NORTHAMPTON MA 01060
Re: Insured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
CMA00021
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch, 139, Sec.313
JOAN LISSAUER
302 FAIRWAY VILLAGE, LEEDS, MA 01053
1270505
Water Damage: Plumbing Systems
09/06/2020
450549
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
9/10/2020