HomeMy WebLinkAboutInsurance Claim - Miscellaneous - 4 HARVEST DRIVE 102 2/15/2023 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108, FAX(800)851-8424
2/11/2023
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.313
NORTH ANDOVER HEALTH DEPT.
NORTH ANDOVER TOWN HALL
NORTH ANDOVER MA 01845
Re: Insured: MARK AND LUDMILA GERVITS
Property Address: 4 HARVEST DRIVE. UNIT#102, NORTH ANDOVER, MA 01845
Policy Number: 1089293
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 02/01/2023
Claim Number: 470593
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
CMA00021 �4�3
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