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MCAC I <br />• Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />• Print your name and address on the reverse <br />so that we can return the card to you. <br />• Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />Berkley Surety Group <br />Attn: Richard Harman <br />11201 Douglas Avenue <br />Urbandale, IA 50322 <br />A. Signature <br />11 Agent <br />X C�j1J►v ❑ Addressee <br />B. \Received by (Printed Name) C. Date of Delivery <br />Yi. C (,.i —\ C / <br />� !-Z /_ <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />3. Service Type <br />❑ Certified Mail ❑ Express Mail <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number- 7012 34'60 0000 6384 7706 <br />(Transfer from service label) <br />PS Form 3811, February 2004 Domestic Return Receipt 102595 -02 -M -1540 <br />C O Postage: $0.46 <br />M Certified Fee: $3.10 <br />Return Receipt Fee: ;AN $2.55 <br />C3 2 U14 <br />C3 (En Total Postage & Fees: $6.11 <br />I= R, <br />C3 <br />J] <br />= Total Postage 8 Fees <br />rn - <br />nu Sent To Berkley Surety Group <br />CI Sireer,Ajit:" Attn: Richard Harman <br />or PO Box No. <br />C�ty,S[ate,ZlP +� 11201 Douglas Avenue <br />:,, , Urbandale, IA 50322 <br />l Service Tan <br />ED MAILTM RECEIF <br />7d,11very <br />l Only; No Insurance Coverai <br />r <br />rmation visit our website at wwm <br />C O Postage: $0.46 <br />M Certified Fee: $3.10 <br />Return Receipt Fee: ;AN $2.55 <br />C3 2 U14 <br />C3 (En Total Postage & Fees: $6.11 <br />I= R, <br />C3 <br />J] <br />= Total Postage 8 Fees <br />rn - <br />nu Sent To Berkley Surety Group <br />CI Sireer,Ajit:" Attn: Richard Harman <br />or PO Box No. <br />C�ty,S[ate,ZlP +� 11201 Douglas Avenue <br />:,, , Urbandale, IA 50322 <br />